@article{f3cf58cf581144818bceb1cdd5ef9778,
title = "The Effects of On-Field Heat Index and Altitude on Concussion Assessments and Recovery Among NCAA Athletes",
abstract = "Background: Recent literature has indicated altitude may be a protective factor for concussion but it is unknown whether altitude or heat index affects recovery. Objective: To examine whether on-field heat index and altitude at the time of injury alter acute (< 48 h) concussion assessments, days-to-asymptomatic, and days-to-return-to-play in collegiate athletes following concussion. Methods: Collegiate athletes (n = 187; age = 19.7 ± 1.4 years; male = 70.6%) underwent baseline assessments across 30 universities and experienced a concussion in this retrospective cohort study. Altitude (m) and heat index (°C) at the time and location of injury were determined using valid online database tools. Acute concussion assessments included the Sport Concussion Assessment Tool (SCAT) symptom inventory, Balance Error Scoring System (BESS), and the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). We used multiple linear regression models to determine whether heat index and altitude predicted each acute assessment outcome, days-to-asymptomatic, and days-to-return-to-play. Results: Collegiate athletes were concussed at a 181.1 m (range − 0.6 to 2201.9 m) median altitude and 17.8 °C (range − 6.1 to 35.6 °C) median heat index. Altitude did not predict (p ≥ 0.265) any outcomes. Every one-degree increase in heat index reduced days-to-asymptomatic (p = 0.047; R2 = 0.06) and days-to-return-to-play (p = 0.006; R2 = 0.09) by 0.05 and 0.14 days, respectively. Heat index and altitude did not explain significant variance in SCAT, BESS, and ImPACT composite scores (p{\textquoteright}s = 0.20–0.922). Conclusion: Our findings suggest that on-field altitude and heat index at the time of injury do not contribute to clinically meaningful changes on acute assessments or concussion recovery. On-field altitude and heat index do not appear to significantly alter assessment outcomes or clinical recovery, suggesting that environmental factors at altitudes below < 2500 m are negligible outcomes for researchers and clinicians to consider post-concussion.",
author = "{CARE Consortium Investigators} and Lempke, {Landon B.} and Lynall, {Robert C.} and Le, {Rachel K.} and Michael McCrea and Thomas McAllister and Schmidt, {Julianne D.} and Brooks, {M. Allison} and Houston, {Megan N.} and Svoboda, {Steven J.} and Campbell, {Darren E.} and Jackson, {Johnathan C.} and Clugston, {Jay R.} and Jane McDevitt and Hoy, {April Marie} and Hazzard, {Joseph B.} and Kelly, {Louise A.} and Ortega, {Justus D.} and Nicholas Port and Margot Putukian and Langford, {T. Dianne} and Ryan Tierney and Giza, {Christopher C.} and Goldman, {Joshua T.} and Benjamin, {Holly J.} and Thomas Buckley and Kaminski, {Thomas W.} and Clugston, {James R.} and Schmidt, {Julianne D.} and Feigenbaum, {Luis A.} and Broglio, {Steven P.} and Eckner, {James T.} and Kevin Guskiewicz and Mihalik, {Jason P.} and Miles, {Jessica Dysart} and Anderson, {Scott A.} and Master, {Christina L.} and Micky Collins and Kontos, {Anthony P.} and Bazarian, {Jeffrey J.} and Chrisman, {Sara P.O.} and Alison Brooks and Jonathan Jackson and Gerald McGinty and Patrick O{\textquoteright}Donnell and Cameron, {Kenneth L.} and Houston, {Megan N.} and Susmarski, {Adam J.} and Stefan Duma and Steve Rowson and Bullers, {Christopher Todd}",
note = "Funding Information: This study was made possible, in part, with support from the Grand Alliance Concussion Assessment, Research, and Education Consortium, funded by the National Collegiate Athletic Association and the Department of Defense. The US Army Medical Research Acquisition Activity, 820 Chandler Street, Fort Detrick, MD 21702–5014, USA is the awarding and administering acquisition office. This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs through the Psychological Health and Traumatic Brain Injury Program under Award no. W81XWH-14–2-0151. Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the Department of Defense (Defense Health Program funds). Funding Information: We would like to thank Aashka J. Sheth and Anoop S. Gundala for their efforts in extracting the environmental variables (air temperature, relative humidity, and altitude). We would also like to thank Jody Harland, Janetta Matesan, Larry Riggen (Indiana University); Ashley Rettmann (University of Michigan); Melissa Koschnitzke (Medical College of Wisconsin); Michael Jarrett, Vibeke Brinck and Bianca Byrne (Quesgen); and the research and medical staff at each of the participating sites. This study was made possible, in part, with support from the Grand Alliance Concussion Assessment, Research, and Education Consortium, funded by the National Collegiate Athletic Association and the Department of Defense. The US Army Medical Research Acquisition Activity, 820 Chandler Street, Fort Detrick, MD 21702-5014, USA is the awarding and administering acquisition office. This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs through the Psychological Health and Traumatic Brain Injury Program under Award no. W81XWH-14-2-0151. Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the Department of Defense (Defense Health Program funds). Contributing CARE Consortium Investigators include: Scott A. Anderson, ATC (University of Oklahoma); Holly J. Benjamin, MD (University of Chicago); M. Allison Brooks, MD, MPH (University of Wisconsin-Madison); Thomas Buckley, EdD, ATC and Thomas W. Kaminski, PhD, ATC (University of Delaware); Kenneth L. Cameron, PhD, MPH, ATC, Megan N. Houston, PhD, ATC, and Steven J. Svoboda, MD (United States Military Academy); Darren E. Campbell, MD, Johnathan C. Jackson, MD and Gerald McGinty, PT, DPT (United States Air Force Academy); Sara P. D. Chrisman, MD, MPH (University of Washington); Jay R. Clugston (University of Florida); Micky Collins and Anthony P. Kontos, PhD (University of Pittsburgh); Stefan Duma, PhD and Steve Rowson, PhD (Virginia Tech); Luis A. Feigenbaum, PT, DPT, ATC (University of Miami); Christopher C. Giza, MD and Joshua T. Goldman, MD, MBA (University of California – Los Angeles); Joseph B. Hazzard Jr., EdD, ATC (Bloomsburg University); Louise A. Kelly, PhD (California Lutheran University); Laura Lintner, DO and Chris Miles, MD (Wake Forest University); Christina L. Master, MD (University of Pennsylvania); Jane McDevitt, PhD, ATC (Temple University); Jason P. Mihalik, PhD, CAT(C), ATC (University of North Carolina at Chapel Hill); Jessica D. Miles, PhD, ATC (University of North Georgia); Justus Ortega, PhD (Humboldt State University); Nicholas Port, PhD (Indiana University); Margot Putukian, MD (Princeton University); and Adam J. Susmarski, DO (United States Naval Academy). CARE Consortium Investigators are listed alphabetically by institution: April Marie (Reed) Hoy, MS, ATC (Azusa Pacific University); Joseph B. Hazzard Jr., EdD, ATC (Bloomsburg University); Louise A. Kelly, PhD (California Lutheran University); Justus D. Ortega, PhD (Humboldt State University); Nicholas Port, PhD (Indiana University); Margot Putukian MD (Princeton University); T. Dianne Langford, PhD, and Ryan Tierney, PhD, ATC (Temple University); Christopher C. Giza, MD and Joshua T. Goldman, MD, MBA (University of California, Los Angeles); Holly J. Benjamin MD (University of Chicago); Thomas Buckley, EdD, ATC, and Thomas W. Kaminski, PhD, ATC (University of Delaware); James R. Clugston, MD, MS (University of Florida); Julianne D. Schmidt, PhD, ATC (University of Georgia); Luis A. Feigenbaum, DPT, ATC (University of Miami); Steven P. Broglio, PhD, ATC and James T. Eckner, MD, MS (University of Michigan); Kevin Guskiewicz, PhD, ATC, and Jason P. Mihalik, PhD, CAT(C), ATC (University of North Carolina at Chapel Hill); Jessica Dysart Miles, PhD, ATC (University of North Georgia); Scott Anderson, ATC (University of Oklahoma); Christina L. Master, MD (University of Pennsylvania); Micky Collins, PhD, and Anthony P. Kontos, PhD (University of Pittsburgh Medical Center); Jeffrey J. Bazarian, MD, MPH (University of Rochester); Sara P.O. Chrisman, MD, MPH (University of Washington); Alison Brooks, MD, MPH (University of Wisconsin-Madison); Jonathan Jackson, MD, and Gerald McGinty, DPT (United States Air Force Academy); Patrick O{\textquoteright}Donnell, MHA (United States Coast Guard Academy); Kenneth Cameron, PhD, MPH, ATC; Megan N. Houston, PhD, ATC (United States Military Academy); Adam Susmarski, MD (United States Naval Academy); Stefan Duma, PhD and Steve Rowson, PhD (Virginia Tech); Christopher Todd Bullers, MD, and Christopher M. Miles, MD (Wake Forest University); Brian H. Dykhuizen, MS, ATC (Wilmington College); Laura Lintner DO (Winston-Salem University). Publisher Copyright: {\textcopyright} 2020, Springer Nature Switzerland AG.",
year = "2021",
month = apr,
doi = "10.1007/s40279-020-01395-5",
language = "English",
volume = "51",
pages = "825--835",
journal = "Sports Medicine",
issn = "0112-1642",
number = "4",
}