Mechanisms of Injury Leading to Concussions in Collegiate Soccer Players: A CARE Consortium Study

Jacob Jo; Adrian J Boltz; Kristen L Williams; Paul F Pasquina; Thomas W McAllister; Michael A McCrea; Steven P Broglio; Scott L Zuckerman; Douglas P Terry; CARE Consortium Investigators; Kristy Arbogast; Holly J Benjamin; Alison Brooks; Kenneth L Cameron; Sara P D Chrisman; James R Clugston; Micky Collins; John DiFiori; James T Eckner; Carlos Estevez; Luis A Feigenbaum; Joshua T Goldman; April Hoy; Thomas W Kaminski; Louise A Kelly; Anthony P Kontos; Dianne Langford; Laura J Lintner; Christina L Master; Jane McDevitt; Gerald McGinty; Chris Miles; Justus Ortega; Nicholas Port; Steve Rowson; Julianne Schmidt; Adam Susmarski; Steven Svoboda

doi:10.1177/03635465241240789

Mechanisms of Injury Leading to Concussions in Collegiate Soccer Players: A CARE Consortium Study

Am J Sports Med. 2024 May;52(6):1585-1595. doi: 10.1177/03635465241240789. Epub 2024 Apr 24.

Authors

Jacob Jo^{1

2}, Adrian J Boltz^{3

2}, Kristen L Williams^{4

2}, Paul F Pasquina^{5

2}, Thomas W McAllister^{6

2}, Michael A McCrea^{7

2}, Steven P Broglio^{3

2}, Scott L Zuckerman^{4

2}, Douglas P Terry^{8

2}; CARE Consortium Investigators²; Kristy Arbogast^{9

2}, Holly J Benjamin^{10

2}, Alison Brooks^{11

2}, Kenneth L Cameron^{12

2}, Sara P D Chrisman^{13

2}, James R Clugston^{14

2}, Micky Collins^{15

2}, John DiFiori^{16

2}, James T Eckner^{17

2}, Carlos Estevez^{18

2}, Luis A Feigenbaum^{19

2}, Joshua T Goldman^{20

2}, April Hoy^{21

2}, Thomas W Kaminski^{22

2}, Louise A Kelly^{23

2}, Anthony P Kontos^{15

2}, Dianne Langford^{24

2}, Laura J Lintner^{25

2}, Christina L Master^{9

2}, Jane McDevitt^{24

2}, Gerald McGinty^{26

2}, Chris Miles^{27

2}, Justus Ortega^{28

2}, Nicholas Port^{29

2}, Steve Rowson^{30

2}, Julianne Schmidt^{31

2}, Adam Susmarski^{32

2}, Steven Svoboda^{33

2}

Affiliations

¹ Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
² Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA.
³ Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA.
⁴ Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁵ Department of Physical Medicine and Rehabilitation at the Uniformed Services University of the Health Sciences in Bethesda, Maryland, USA.
⁶ Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA.
⁷ Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA; Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
⁸ Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁹ University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
¹⁰ University of Chicago, Chicago, Illinois, USA.
¹¹ University of Wisconsin-Madison, Madison, Wisconsin, USA.
¹² United States Military Academy, West Point, New York, USA).
¹³ University of Washington, Seattle, Washington, USA).
¹⁴ University of Florida, Gainesville, Florida, USA.
¹⁵ University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
¹⁶ Hospital for Special Surgery, New York, New York, USA).
¹⁷ University of Michigan, Michigan, USA).
¹⁸ United States Coast Guard Academy, New London, Connecticut, USA.
¹⁹ University of Miami, Coral Gables, Florida, USA.
²⁰ University of California, Los Angeles, Los Angeles, California, USA.
²¹ Azusa Pacific University, Azusa, California, USA.
²² University of Delaware, Newark, Delaware, USA.
²³ California Lutheran University, Thousand Oaks, California, USA.
²⁴ Temple University, Philadelphia, Pennsylvania, USA.
²⁵ Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
²⁶ United States Air Force Academy, El Paso, Colorado, USA.
²⁷ Wake Forest University, Winston-Salem, North Carolina, USA.
²⁸ California State Polytechnic University, Pomona, California, USA.
²⁹ Indiana University, Bloomington, Indiana, USA.
³⁰ Virginia Tech, Blacksburg, Virginia, USA.
³¹ University of Georgia, Athens, Georgia, USA).
³² United States Naval Academy, Annapolis, Maryland, USA).
³³ MedStar Health, Columbia, Maryland, USA.

PMID: 38656160
DOI: 10.1177/03635465241240789

Abstract

Background: Few previous studies have investigated how different injury mechanisms leading to sport-related concussion (SRC) in soccer may affect outcomes.

Purpose: To describe injury mechanisms and evaluate injury mechanisms as predictors of symptom severity, return to play (RTP) initiation, and unrestricted RTP (URTP) in a cohort of collegiate soccer players.

Study design: Cohort study; Level of evidence, 2.

Methods: The Concussion Assessment, Research and Education (CARE) Consortium database was used. The mechanism of injury was categorized into head-to-ball, head-to-head, head-to-body, and head-to-ground/equipment. Baseline/acute injury characteristics-including Sports Concussion Assessment Tool-3 total symptom severity (TSS), loss of consciousness (LOC), and altered mental status (AMS); descriptive data; and recovery (RTP and URTP)-were compared. Multivariable regression and Weibull models were used to assess the predictive value of the mechanism of injury on TSS and RTP/URTP, respectively.

Results: Among 391 soccer SRCs, 32.7% were attributed to a head-to-ball mechanism, 27.9% to a head-to-body mechanism, 21.7% to a head-to-head mechanism, and 17.6% to a head-to-ground/equipment mechanism. Event type was significantly associated with injury mechanism [χ²(3) = 63; P < .001), such that more head-to-ball concussions occurred in practice sessions (n = 92 [51.1%] vs n = 36 [17.1%]) and more head-to-head (n = 65 [30.8%] vs n = 20 [11.1]) and head-to-body (n = 76 [36%] vs n = 33 [18.3%]) concussions occurred in competition. The primary position was significantly associated with injury mechanism [χ²(3) = 24; P < .004], with goalkeepers having no SRCs from the head-to-head mechanism (n = 0 [0%]) and forward players having the least head-to-body mechanism (n = 15 [19.2%]). LOC was also associated with injury mechanism (P = .034), with LOC being most prevalent in head-to-ground/equipment. Finally, AMS was most prevalent in head-to-ball (n = 54 [34.2%]) and head-to-body (n = 48 [30.4%]) mechanisms [χ²(3) = 9; P = .029]. In our multivariable models, the mechanism was not a predictor of TSS or RTP; however, it was associated with URTP (P = .044), with head-to-equipment/ground injuries resulting in the shortest mean number of days (14 ± 9.1 days) to URTP and the head-to-ball mechanism the longest (18.6 ± 21.6 days).

Conclusion: The mechanism of injury differed by event type and primary position, and LOC and AMS were different across mechanisms. Even though the mechanism of injury was not a significant predictor of acute symptom burden or time until RTP initiation, those with head-to-equipment/ground injuries spent the shortest time until URTP, and those with head-to-ball injuries had the longest time until URTP.

Keywords: outcome; return to play; soccer; sport-related concussion.

Publication types

Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

MeSH terms

Adolescent
Athletic Injuries* / epidemiology
Brain Concussion*
Cohort Studies
Female
Humans
Male
Return to Sport*
Soccer* / injuries
Universities
Young Adult