The Prevalence of Sport Concussion Citations in Blast Concussion Publications Zachary Merz, M.S. – merzz@slu.edu Department of Psychology, Saint Louis University OBJECTIVES RESULTS Biomechanics Despite many physiological and psychological differences between sport and military-specific (blast) concussions, much of blast concussion research is borrowed from existing sport literature. This creates the potential for inappropriate neuropsychological test interpretations and the utilization of inadequate treatment methodologies. The purpose of this analysis is to describe differences between sport and blast concussions and determine the prevalence at which sport-specific citations appear in blast concussion publications. Of 65 military-specific articles that met inclusion criteria, 40% included at least one sport-specific citation. Of this 40%, 38.5% cited only one sport-specific article This left the remaining 61.5% as citing two or more sport-specific articles. Furthermore, an analysis of the Military Acute Concussion Evaluation (MACE), a self-described tool for the identification of military-specific concussions, showed that 50% of references contained sport-specific research focusing on high-school and collegiate athletics. SPORT CONCUSSION BIOMECHANICS Number (N) Percentage (%) Total usable articles N = 65 Articles WITHOUT a sport citation N = 39 60% Articles with AT LEAST ONE sport citation N = 26 40% Number of military-based articles with sport citation(s) Number of articles with MORE THAN ONE sport citation N = 16 61.5% Sport citation breakdown 1 citation N = 10 38.5% 2 citations N = 4 15.4% 3-5 citations 6-10 citations N = 6 23.1% 12 citations N = 1 3.8% 19 citations Total number of sport citations across all documents N = 103 “Sport” specific citations N = 37 35.9% “Football” specific citations N = 28 27.2% “Athlet” specific citations N = 25 24.3% “Colleg” specific citations N = 15 14.6% “Box” specific citations N = 7 6.8% “High school” specific citations “Rugby,” “Hockey,” “Soccer”, “Basketball,” and “Baseball” citations N = 0 0.0% Most common citations throughout documents “Cumulative Effects Associated with Recurrent Concussion in Collegiate Football Players: The NCAA Concussion Study” by Guskiewicz et al. (2003) N = 8 30.8% “Chronic traumatic encephalopathy in athletes: Progressive tauopathy after repetitive head injury” by McKee et al. (2009) “Association between recurrent concussion and late-life cognitive impairment in retired professional football players” by Guskiewicz et al. (2005) N = 3 11.5% “The neuropsychological impact of sports-related concussion: A meta-analysis” by Belanger and Vanderploeg (2005) N = 2 7.7% “Acute Effects and Recovery Time Following Concussion in Collegiate Football Players: The NCAA Concussion Study” by McCrea et al. (2003) http://www.lookfordiagnosis.com/mesh_info.php?term=Contrecoup+Injury&lang=4 Closed head injuries Brain affected directly, other systems affected indirectly Linear and rotational cranial accelerations Coup injuries - forceful blow to a resting, movable head generally results in a brain injury beneath the point of cranial impact Contrecoup injuries - a moving brain impacts an unyielding object, resulting in a brain injury opposite the site of initial impact Injuries result in stretching and/or tearing of neurons and widespread cerebral blood flow disruption METHODS BLAST CONCUSSION BIOMECHANICS This study utilized bibliometrics, a methodology involving the statistical analysis of written publications, such as books or articles. The technique ultimately provides a quantitative analysis of academic literature. These practices are commonly used to analyze citations in the overall evaluation of scientific activity. http://theconcussionblog.com/tag/npr/ Caused by a pressure wave generated at the point of detonation and an instantaneous rise in atmospheric pressure above the threshold level for human life Affects numerous systems directly and indirectly Pressure associated with primary blasts injuries has the potential to rupture both cerebral blood vessels and the blood-brain barrier in the brain itself, leading to hypoxia and potential brain damage Secondary blast injuries can cause penetrating injuries Tertiary blast injuries can also lead to coup and contrecoup injuries Symptom exacerbation common due to occupational hazards High psychiatric prevalence Vastly different injury biomechanics, as well as physiological and psychological consequences exist between sport and blast concussions. Despite observed differences, literature involving return-to-duty guidelines continues to be pulled from sport-specific literature. These differences point to the need for unique return to duty/play guidelines, treatment methodology, and neuropsychological testing for each condition. TAKE HOME POINTS: