Concussion diagnosis and recovery in relation to collegiate athletic department classification: a LIMBIC MATARS consortium investigation

ABSTRACT

Purpose

We investigated time to reach concussion diagnosis and recovery milestones in collegiate athletes relative to their schools’ National Collegiate Athletic Association (NCAA) classification.

Methods

We retrospectively examined 849 (43.1% female) concussion cases from 11 NCAA institutions (Division I Power 5 [n = 4], Division I Non-Power 5 [n = 4], and Division II/III [n = 3]) from the 2015–16 to 2019–20 athletic seasons. Our primary outcome measures were days to reach specific clinical milestones following concussion.

Results

Median (IQR) time from injury to diagnosis was significantly longer at Division II/III institutions (1 [0–4] days) compared to Division I Power 5 (0 [0–1] days) and Division I Non-Power 5 (0 [0–1] days) institutions (p < 0.001). Likewise, Division II/III athletes (15 [11–22] days) took significantly longer to return to sport after concussion than Division I Power 5 (10 [7–16] days) and Division I Non-Power 5 (11 [7–18.5] days) athletes (p < 0.001).

Conclusion

Division II/III athletes had delayed concussion diagnoses and return to sport timelines compared to Division I athletes. Our results suggest that differences in sports medicine resources across NCAA divisions may influence injury recognition and recovery in collegiate athletes with concussion.

KEYWORDS:

• Mild traumatic brain injury (mTBI)
• concussion management
• athletic training
• collegiate athlete
• sports medicine

Acknowledgments

The authorship would like to acknowledge the contributing LIMBIC MATARS site investigators: Michelle Kirk, M.D. and David Gable, ATC (Texas Christian University), Brett Mortensen, Ph.D. and Michael J. Larson, Ph.D. (Brigham Young University), Erica Beidler, Ph.D. (Duquesne University), James Day, Ed.D. (Augustana University), Kristin Wilmoth, Ph.D., Nyaz Didehbani, Ph.D., and C. Munro Cullum, Ph.D. (The University of Texas Southwestern Medical Center), Meredith Decker, Ph.D., (The University of Texas at Arlington), Monique Pappadis, Ph.D. (The University of Texas Medical Branch), Kate Higgins, Psy.D. and Heather Bouchard, M.A. (University of Nebraska), Jessica Wallace, Ph.D. (University of Alabama), Jessica Gill, Ph.D. (Johns Hopkins University), Catherine Donahue, M.Ed., Daniel Rosenblum, M.Ed., Donna Broshek, Ph.D. and Rachel Smetana, Ph.D. (University of Virginia), Tenesha Helm (Lynchburg University), Samuel Walton, Ph.D. and Jessie Oldham, Ph.D. (Virginia Commonwealth University) as well as the NCAA collegiate athletes who contributed to this dataset. We would also like to express our gratitude to Jordan Rodu, Ph.D. from the University of Virginia for providing statistical consultation on this manuscript.

Disclosure statement

JER has received funding from the Medical Technology Enterprise Consortium. All other authors report there are no competing interests to declare.

Additional information

Funding

Partial funding was provided by the University of Virginia School of Education and Human Development Foundation, with support from the U.S. Army Medical Research and Material Command and from the U.S. Department of Veterans Affairs Long-term Impact of Military-relevant Brain Injury Consortium under Award No. W81XWH-18/TBIRP-LIMBIC.