Association between history of multiple
concussion and health outcomes among former college football players: A 15-year
follow-up from the NCAA concussion study (1999-2001)

Kerr Z,
Thomas LC, Simon JE, McCrea M, and Guskiewicz KM. Am J Sports Med 2018. [Epub Ahead of Print].

Take Home Message:
Former collegiate football players reporting
3 concussions were more likely to have
worse physical and mental health than individuals reporting fewer concussions.

While many people raise concerns about
the long-term consequences of concussions, we know little about the long-term
effects of concussions among college football players. Understanding the impact
of concussions on long-term health will help clinicians educate patients and
develop return-to-play protocols, which can better protect athletes’ long-term
health. Therefore, Kerr and colleagues completed a cross-sectional study to
examine the relationship between concussions and adverse health outcomes in 204
former NCAA football athletes, 15 years after playing their final collegiate
game. The authors identified potential participants from the original NCAA
Concussion Study (2905 athletes). They selected former athletes who played at
least 1 season of NCAA football between 1999 to 2001 but never played
professional football. A total of 204 participants responded to the
researcher’s invitation and completed demographic, medical history, injury
history, and health history questionnaires. Concussion exposure was self-reported.
Participants recorded the number of concussions they believed they sustained
before and during their collegiate football career. Participants also completed
The Veterans RAND 36 Item Health Survey, Patient Health Questionnaire, and CAGE to assess physical and mental health, depression, and
alcohol dependence, respectively. Overall, 44 participants (22%) reported worse
physical health than the US average. Former football players who reported 3 or
more concussions may be more than twice as likely to have worse physical or
mental health compared to those who report one or two concussions. Furthermore,
former players reporting ≥ 3 concussions were 4.2 times more likely to report moderate
to severe depression. A history of repeated concussion history was unrelated to
alcohol dependence.

Overall, the authors demonstrated worse
physical and mental health in former football players who reported multiple
concussions. These findings should be important to clinicians as it adds to the
growing body of evidence that multiple concussions can have a long-term impact
on an athlete’s health. This evidence further supports the need for more
long-term follow ups and more research to better understand how these
concussions were treated and when return to play occurred. Although not the
purpose of this study, more detail regarding how these concussions were treated
and when participants returned to play was not recorded for this study. This
makes it difficult to understand how current treatments and return-to-play
protocols impact these long-term outcomes; but, it is a logical next question
to ask. Until the research can bridge this gap, clinicians should continue to
use best practices with regards to determining return to play and seek the most
objective assessment practices possible. Furthermore, clinicians should educate
athletes on the potential long-term implications of multiple concussions.

Questions for Discussion: Do you
educate your athletes on the potential long-term implications regarding their

Written by: Kyle Harris
Reviewed by: Jeffrey Driban

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