Research Evaluating Sports ConcUssion Events-Rapid Assessment of Concussion and Evidence for Return (RESCUE-RACER): a two-year longitudinal observational study of concussion in motorsport

Naomi D Deakin, John Suckling, Peter J Hutchinson, Naomi D Deakin, John Suckling, Peter J Hutchinson

Abstract

Introduction: Concussion is a clinical diagnosis, based on self-reported patient symptoms supported by clinical assessments across many domains including postural control, ocular/vestibular dysfunction, and neurocognition. Concussion incidence may be rising in motorsport which, combined with unresolved challenges to accurate diagnosis and lack of guidance on the optimal return-to-race timeframe, creates a difficult environment for healthcare practitioners.

Methods and analysis: Research Evaluating Sports ConcUssion Events-Rapid Assessment of Concussion and Evidence for Return (RESCUE-RACER) evaluates motorsports competitors at baseline (Competitor Assessment at Baseline; Ocular, Neuroscientific (CArBON) study) and post-injury (Concussion Assessment and Return to motorSport (CARS) study), including longitudinal data. CArBON collects pre-injury neuroscientific data; CARS repeats the CArBON battery sequentially during recovery for competitors involved in a potentially concussive event. As its primary outcome, RESCUE-RACER will develop the evidence base for an accurate trackside diagnostic tool. Baseline objective clinical scoring (Sport Concussion Assessment Tool-5th edition (SCAT5)) and neurocognitive data (Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT)) will be assessed for specificity to motorsport and relationship to existing examinations. Changes to SCAT5 and ocular, vestibular, and reaction time function (Dx 100) will be estimated by the reliability change index as a practical tool for trackside diagnosis. Neuropsychological (Cambridge Neuropsychological Test Automated Battery (CANTAB)) assessments, brain MRI (7 Tesla) and salivary biomarkers will be compared with the new tool to establish utility in diagnosing and monitoring concussive injuries.

Ethics and dissemination: Ethical approval was received from East of England-Cambridge Central Research Ethics Committee (18/EE/0141). Participants will be notified of study outcomes via publications (to administrators) and summary reports (funder communications). Ideally, all publications will be open access.

Trial registration number: February 2019 nationally (Central Portfolio Management System 38259) and internationally (ClinicalTrials.gov NCT03844282).

Keywords: MRI; accident; brain; concussion; motor sports.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

References

    1. Echemendia RJ, Meeuwisse W, Mccrory P. The sport concussion assessment tool 5th edition (SCAT5): background and rationale. Br J Sport Med 2017;51:848–50.
    1. McCrory P, Meeuwisse W, Johnston K, et al. . Consensus statement on concussion in sport - the Third International Conference on Concussion in Sport held in Zurich, November 2008. Phys Sportsmed 2009;37:141–59. 10.3810/psm.2009.06.1721
    1. Foley C, Gregory A, Solomon G. Young age as a modifying factor in sports concussion management: what is the evidence? Curr Sports Med Rep 2014;13:390–4. 10.1249/JSR.0000000000000104
    1. Noble JM, Hesdorffer DC. Sport-Related concussions: a review of epidemiology, challenges in diagnosis, and potential risk factors. Neuropsychol Rev 2013;23:273–84. 10.1007/s11065-013-9239-0
    1. Harmon KG, Drezner JA, Gammons M, et al. . American medical Society for sports medicine position statement: concussion in sport. Br J Sports Med 2013;47:15–26. 10.1136/bjsports-2012-091941
    1. Koh JO, Cassidy JD, Watkinson EJ. Incidence of concussion in contact sports: a systematic review of the evidence. Brain Inj 2003;17:901–17. 10.1080/0269905031000088869
    1. Prien A, Grafe A, Rössler R, et al. . Epidemiology of head injuries focusing on concussions in team contact sports: a systematic review. Sports Med 2018;48:953–69. 10.1007/s40279-017-0854-4
    1. Hutchinson P, Olvey S. Concussion in motor sport [Internet]. Auto+ Medical. Available: [Accessed 18 Feb 2017].
    1. Deakin ND, Cronin T, Trafford P, et al. . Concussion in motor sport: a medical literature review and engineering perspective. J Concussion 2017;1:205970021773391 10.1177/2059700217733916
    1. Trafford P, Hutchinson P. Survey on Concussion [Internet]. Auto+ Medical, 2015. Available: [Accessed 18 Feb 2017].
    1. ImPACT ImPACT Applications: Concussion Management & Training [Internet]. Available: [Accessed 1 Apr 2020].
    1. Sandel NK, Worts PR, Burkhart S, et al. . Comparison of baseline impact performance in amateur Motocross riders to football and basketball athletes. Brain Inj 2018;32:493–7. 10.1080/02699052.2018.1429020
    1. Feddermann-Demont N, Echemendia RJ, Schneider KJ, et al. . What domains of clinical function should be assessed after sport-related concussion? A systematic review. Br J Sports Med 2017;51:903–18. 10.1136/bjsports-2016-097403
    1. Graham R, Rivara FP, Ford MA. Sports-Related concussions in youth, 2014.
    1. Register-Mihalik JK, Kontos DL, Guskiewicz KM, et al. . Age-Related differences and reliability on computerized and paper-and-pencil neurocognitive assessment batteries. J Athl Train 2012;47:297–305. 10.4085/1062-6050-47.3.13
    1. Allen BJ, Gfeller JD. The immediate Post-Concussion assessment and cognitive testing battery and traditional neuropsychological measures: a construct and concurrent validity study. Brain Inj 2011;25:179–91. 10.3109/02699052.2010.541897
    1. Dziemianowicz MS, Kirschen MP, Pukenas BA, et al. . Sports-Related concussion testing. Curr Neurol Neurosci Rep 2012;12:547–59. 10.1007/s11910-012-0299-y
    1. De Marco AP, Broshek DK. Computerized cognitive testing in the management of youth sports-related concussion. J Child Neurol 2016;31:68–75. 10.1177/0883073814559645
    1. Nelson LD, LaRoche AA, Pfaller AY, et al. . Prospective, head-to-head study of three computerized neurocognitive assessment tools (CNTs): reliability and validity for the assessment of sport-related concussion. J Int Neuropsychol Soc 2016;22:24–37. 10.1017/S1355617715001101
    1. Karr JE, Areshenkoff CN, Garcia-Barrera MA. The neuropsychological outcomes of concussion: a systematic review of meta-analyses on the cognitive sequelae of mild traumatic brain injury. Neuropsychology 2014;28:321–36. 10.1037/neu0000037
    1. Prince C, Bruhns ME. Evaluation and treatment of mild traumatic brain injury: the role of neuropsychology. Brain Sci 2017;7:brainsci7080105. 10.3390/brainsci7080105
    1. Kirkwood MW, Yeates KO, Wilson PE. Pediatric sport-related concussion: a review of the clinical management of an oft-neglected population. Pediatrics 2006;117:1359–71. 10.1542/peds.2005-0994
    1. Williamson IJS, Goodman D. Converging evidence for the under-reporting of concussions in youth ice hockey. Br J Sports Med 2006;40:128–32. 10.1136/bjsm.2005.021832
    1. Garrick JG, McCrea M, Hammeke T. Unreported concussion in high school football players: implications for prevention. Clin J Sport Med 2005;15:385.
    1. Echemendia RJ, Meeuwisse W, McCrory P. Sport concussion assessment tool - 5th edition. Br J Sports Med 2017;51:851–8. 10.1136/bjsports-2017-097506
    1. Davis GA, Purcell L, Schneider KJ, et al. . The child sport concussion assessment tool 5th edition (child SCAT5): background and rationale. Br J Sports Med 2017;51:859–61. 10.1136/bjsports-2017-097492
    1. Neselius S, Brisby H, Marcusson J, et al. . Neurological assessment and its relationship to CSF biomarkers in amateur boxers. PLoS One 2014;9:e99870. 10.1371/journal.pone.0099870
    1. Shahim P, Tegner Y, Marklund N, et al. . Astroglial activation and altered amyloid metabolism in human repetitive concussion. Neurology 2017;88:1400–7. 10.1212/WNL.0000000000003816
    1. Gill J, Merchant-Borna K, Jeromin A, et al. . Acute plasma tau relates to prolonged return to play after concussion. Neurology 2017;88:595–602. 10.1212/WNL.0000000000003587
    1. Shahim P, Zetterberg H, Tegner Y, et al. . Serum neurofilament light as a biomarker for mild traumatic brain injury in contact sports. Neurology 2017;88:1788–94. 10.1212/WNL.0000000000003912
    1. Kilianski J, Peeters S, Debad J, et al. . Plasma creatine kinase B correlates with injury severity and symptoms in professional boxers. J Clin Neurosci 2017;45:100–4. 10.1016/j.jocn.2017.07.021
    1. Geyer C, Ulrich A, Gräfe G, et al. . Diagnostic value of S100B and neuron-specific enolase in mild pediatric traumatic brain injury. J Neurosurg Pediatr 2009;4:339–44. 10.3171/2009.5.PEDS08481
    1. Shahim P, Tegner Y, Wilson DH, et al. . Blood biomarkers for brain injury in concussed professional ice hockey players. JAMA Neurol 2014;71:684. 10.1001/jamaneurol.2014.367
    1. Jessen NA, Munk ASF, Lundgaard I, et al. . The Glymphatic system: a beginner's guide. Neurochem Res 2015;40:2583–99. 10.1007/s11064-015-1581-6
    1. Michetti F, Bruschettini M, Frigiola A, et al. . Saliva S100B in professional sportsmen: high levels at resting conditions and increased after vigorous physical activity. Clin Biochem 2011;44:245–7. 10.1016/j.clinbiochem.2010.10.007
    1. Johnson JJ, Loeffert AC, Stokes J, et al. . Association of salivary microRNA changes with prolonged concussion symptoms. JAMA Pediatr 2018;172:65. 10.1001/jamapediatrics.2017.3884
    1. Meehan WP, Mannix R. Promise of salivary microRNA for assessing concussion. JAMA Pediatr 2018;172:14. 10.1001/jamapediatrics.2017.3924
    1. Hoffer ME, Szczupak M, Kiderman A, et al. . Neurosensory symptom complexes after acute mild traumatic brain injury. PLoS One 2016;11:e0146039. 10.1371/journal.pone.0146039
    1. Balaban C, Hoffer ME, Szczupak M, et al. . Oculomotor, vestibular, and reaction time tests in mild traumatic brain injury. PLoS One 2016;11:e0162168. 10.1371/journal.pone.0162168
    1. TT R, OS E, Alexander K. Oculomotor, vestibular & reaction time outcomes in indy 500 drivers compared to athletes at start of season & after mtbi event, 2018.
    1. Hoffer ME, Balaban C, Szczupak M, et al. . The use of oculomotor, vestibular, and reaction time tests to assess mild traumatic brain injury (mTBI) over time. Laryngoscope Investig Otolaryngol 2017;2:157–65. 10.1002/lio2.74
    1. Giza CC, Hovda DA. The neurometabolic cascade of concussion. J Athl Train 2001;36:228–35.
    1. Hart MG, Price SJ, Suckling J. Connectome analysis for pre-operative brain mapping in neurosurgery. Br J Neurosurg 2016;30:506–17. 10.1080/02688697.2016.1208809
    1. Helmy A, Agarwal M, Hutchinson PJ. Concussion and sport. BMJ 2013;347:f5748. 10.1136/bmj.f5748
    1. Stokx LC, Gaillard AW. Task and driving performance of patients with a severe concussion of the brain. J Clin Exp Neuropsychol 1986;8:421–36. 10.1080/01688638608401332
    1. Preece MHW, Horswill MS, Geffen GM. Driving after concussion: the acute effect of mild traumatic brain injury on drivers' hazard perception. Neuropsychology 2010;24:493–503. 10.1037/a0018903
    1. Baker A, Unsworth CA, Lannin NA. Fitness-To-Drive after mild traumatic brain injury: mapping the time trajectory of recovery in the acute stages post injury. Accid Anal Prev 2015;79:50–5. 10.1016/j.aap.2015.03.014
    1. Agency D & VL Assessing fitness to drive – a guide for medical professionals, 2018.
    1. Motorsport Association MSA concussion guidelines, 2016.
    1. Federation Internationale de Motocyclisme FIM medical code, 2016.
    1. Harris PA, Taylor R, Thielke R, et al. . Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009;42:377–81. 10.1016/j.jbi.2008.08.010
    1. Harris PA, Taylor R, Minor BL, et al. . The REDCap Consortium: building an international community of software platform partners. J Biomed Inform 2019;95:103208. 10.1016/j.jbi.2019.103208
    1. Marques JP, Kober T, Krueger G, et al. . MP2RAGE, a self bias-field corrected sequence for improved segmentation and T1-mapping at high field. Neuroimage 2010;49:1271–81. 10.1016/j.neuroimage.2009.10.002
    1. Asken BM, Houck ZM, Bauer RM. SCAT5 vs. SCAT3 symptom reporting differences and convergent validity in collegiate athletes
    1. Norheim N, Kissinger-Knox A, Cheatham M. Performance of college athletes on the 10-item word list of SCAT5 what are the new findings? BMJ Open Sport Exerc Med 2018;4:412.
    1. Zuckerman SL, Lee YM, Odom MJ. Baseline neurocognitive scores in athletes with attention deficit–spectrum disorders and/or learning disability. J Neurosurg Pediatr 2013.
    1. Bruce J, Echemendia R, Tangeman L, et al. . Two baselines are better than one: improving the reliability of computerized testing in sports neuropsychology. Appl Neuropsychol Adult 2016;23:336–42. 10.1080/23279095.2015.1064002
    1. Silverberg ND, Berkner PD, Atkins JE, et al. . Relationship between short sleep duration and Preseason concussion testing. Clin J Sport Med 2016;26:226–31. 10.1097/JSM.0000000000000241
    1. Covassin T, Elbin RJ, Harris W, et al. . The role of age and sex in symptoms, neurocognitive performance, and postural stability in athletes after concussion. Am J Sports Med 2012;40:1303–12. 10.1177/0363546512444554
    1. Solomon GS, Kuhn A. Relationship between concussion history and neurocognitive test performance in national football League draft picks. Am J Sports Med 2014;42:934–9. 10.1177/0363546513518742
    1. Zahra D, Hedge C. The Reliable Change Index: Why isn’t it more popular in academic psychology? [Internet]. PsyPag Quarterly, 2010. Available: [Accessed 1 Apr 2020].
    1. Jacobson NS, Truax P. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol 1991;59:12–19. 10.1037/0022-006X.59.1.12
    1. Yeo BTT, Krienen FM, Sepulcre J, et al. . The organization of the human cerebral cortex estimated by intrinsic functional connectivity. J Neurophysiol 2011;106:1125–65. 10.1152/jn.00338.2011
    1. Lunter CM, Carroll EL, Housden C, et al. . Neurocognitive testing in the emergency department: a potential assessment tool for mild traumatic brain injury. Emerg Med Australas 2019;31:355–61. 10.1111/1742-6723.13163

Source: PubMed

3
Sottoscrivi