Scott L Zuckerman1,2, R J Elbin3, Allen K Sills1,2,4, Jeff R Crandall5, David J Lessley5, Caitlin M Moran4, Caroline D Moran4, Gary S Solomon1,2,4,6,7. 1. Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center , Nashville, TN, USA. 2. Department of Neurological Surgery, Vanderbilt University Medical Center , Nashville, TN, USA. 3. Department of Health Human Performance and Recreation/Office for Sport Concussion Research, University of Arkansas , Fayetteville, AK, USA. 4. Player Health and Safety Department, National Football League , New York, NY, USA. 5. Biomechanics Consulting and Research, LLC , Charlottesville, VA, USA. 6. Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center , Nashville, TN, USA. 7. Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center , Nashville, TN, USA.
Abstract
Background: The use of video review to document visible signs (VS) of sport-related concussion in the National Football League (NFL) is a novel method to recognize head injuries. Hypothesis/Purpose: The current pilot studies used varying methodologies to (1) examine the frequency of VS in concussed NFL players using the Australian Football League's (AFL) checklist, and (2) assess the reliability of VS between non-expert and expert raters. Study design: Cohort study Methods: In the first pilot study, two non-expert raters rated VS of SRC occurring in the 2015 NFL season (n = 96) using a single VS from the AFL checklist. Based on this pilot study, two expert raters then rated VS of SRC during the 2017 NFL season (n = 211) using all VS from the AFL checklist. The frequency, total percent agreement (TPA), and reliability (kappa coefficients) were calculated for all VS of concussion for the two seasons. Kappa agreement was classified as fair (.41-.60), moderate (.61-.80), or substantial (.81-1.00). Significance was set at p < .05. Results: The most frequent VS of concussion identified by both non-expert and expert raters were no behavior observed, slow to get up, and motor incoordination. The least frequent VS were impact seizure, blank/vacant look, and facial injury. For non-expert raters, the average TPA for VS ranged from 84% to 100% and kappa coefficients ranged from .52 to .68. For expert raters, the average TPA ranged from 83% to 100%, and kappa coefficients ranged from .56 to .86. Conclusion: In these preliminary analyses, use of multiple VS was a superior methodology, and the reliability of VS rating was stronger for experts. Due to the inherent differences in gameplay and protective equipment used in the NFL compared to other professional sports, it is our hope these data can generate new ways to improve existing practices and identify potentially novel VS of SRC.
Background: The use of video review to document visible signs (VS) of sport-related concussion in the National Football League (NFL) is a novel method to recognize head injuries. Hypothesis/Purpose: The current pilot studies used varying methodologies to (1) examine the frequency of VS in concussed NFL players using the Australian Football League's (AFL) checklist, and (2) assess the reliability of VS between non-expert and expert raters. Study design: Cohort study Methods: In the first pilot study, two non-expert raters rated VS of SRC occurring in the 2015 NFL season (n = 96) using a single VS from the AFL checklist. Based on this pilot study, two expert raters then rated VS of SRC during the 2017 NFL season (n = 211) using all VS from the AFL checklist. The frequency, total percent agreement (TPA), and reliability (kappa coefficients) were calculated for all VS of concussion for the two seasons. Kappa agreement was classified as fair (.41-.60), moderate (.61-.80), or substantial (.81-1.00). Significance was set at p < .05. Results: The most frequent VS of concussion identified by both non-expert and expert raters were no behavior observed, slow to get up, and motor incoordination. The least frequent VS were impact seizure, blank/vacant look, and facial injury. For non-expert raters, the average TPA for VS ranged from 84% to 100% and kappa coefficients ranged from .52 to .68. For expert raters, the average TPA ranged from 83% to 100%, and kappa coefficients ranged from .56 to .86. Conclusion: In these preliminary analyses, use of multiple VS was a superior methodology, and the reliability of VS rating was stronger for experts. Due to the inherent differences in gameplay and protective equipment used in the NFL compared to other professional sports, it is our hope these data can generate new ways to improve existing practices and identify potentially novel VS of SRC.
Entities:
Keywords:
National Football League; Sport-related concussion; football; head injury; traumatic brain injury; video review; visible signs
Authors: Adam J Bartsch; Daniel Hedin; Jay Alberts; Edward C Benzel; Jason Cruickshank; Robert S Gray; Kenneth Cameron; Megan N Houston; Tyler Rooks; Gerald McGinty; Erick Kozlowski; Steven Rowson; Joseph C Maroon; Vincent J Miele; J Chris Ashton; Gunter P Siegmund; Alok Shah; Michael McCrea; Brian Stemper Journal: Ann Biomed Eng Date: 2020-10-27 Impact factor: 3.934
Authors: Lee F Gabler; Samuel H Huddleston; Nathan Z Dau; David J Lessley; Kristy B Arbogast; Xavier Thompson; Jacob E Resch; Jeff R Crandall Journal: Ann Biomed Eng Date: 2020-10-19 Impact factor: 3.934