UNEXPECTED SEQUELA OF COVID-19 FOR HIGH SCHOOL ATHLETES: HIGHER RATES OF CONCUSSION FOLLOW COVID-19 INFECTION

G. Bullock¹, C. Emery², V. Nelson³, A. Prats-Uribe⁴, C. Thigpen⁵, E. Shanley⁵

¹Wake Forest University School of Medicine, Orthopaedic Surgery and Rehabilitation, Winston-Salem, United States, ²University of Calgary, Calgary, Canada, ³PRISMA Health, Sports Medicine, Greenville, United States, ⁴University of Oxford, Pharmaco-Device Epidemiology, Oxford, United Kingdom, ⁵ATI Physical Therapy, Greenville, United States

Background: Concussions can have serious consequences, with adolescents being more vulnerable to downstream sequelae due to their developing brains. While COVID-19 infection rates have been established, and long-term physiological and neurological consequences identified, it is currently unclear how suffering a COVID-19 infection may impact subsequent concussion risk following illness recovery. This information will improve clinical examination process, decision making, and athlete and parent education regarding returning to sporting activity.

Purpose: To compare concussion rates in high school athletes after sustaining a COVID-19 infection and in those who did not sustain a COVID-19 infection within the academic year.

Methods: A prospective cohort study was conducted over one high school academic year. STROBE guidelines were used for reporting. Illness and concussion were defined by current international consensus guidelines and reported through the high school athletic trainer. COVID-19 was defined by a positive test. Concussion following a COVID-19 illness was truncated to 60 days following illness recovery. Concussion rates (95% confidence intervals; 95% CI) were estimated per 1,000 athletes per academic year and stratified by those who suffered a COVID-19 infection (COVID) and those who did not (No COVID). COVID-19 athletes did not contribute to No COVID time prior to infection. Missing data were less than 3%, complete case analyses were performed. Poisson regression analyses estimated relative risk of concussion (RR) controlling for state, gender, and an offset of the log athlete participation (COVID and No COVID). Sensitivity analyses included: 1) stratifying by gender; and 2) comparing athlete concussion risk for those that sustained a bacterial or viral infection that was not a COVID-19 illness and those who did not suffer any illness prior to concussion.

Results: 72,521 athletes (female 32,968; male 39,554) in six states participated during the 2020-2021 academic school year. There were430 COVID infections and 1,273 concussions reported during the school year. The concussion rate (CR) was greater in athletes who reported COVID (CR=74.4/1000 athletes/year, 95% CI: 49.6-99.3) compared to No COVID (CR=17.2, 95% CI: 16.3-18.2). COVID athletes had a 3-fold higher rate of concussion (RR=3.1, 95% CI: 2.0-4.7) compared to athletes not experiencing COVID. COVID Females (RR=3.2, 95% CI: 1.8-5.9) and COVID males (RR=2.8, 95% CI: 1.6-4.8) demonstrated a similar 3-fold higher rate of concussion to No COVID athletes. 123 bacterial or viral infections were suffered, with only one concussion sustained followed recovery. Thus, no analysis could be performed.

Conclusions: Athletes returning from COVID-19 have higher concussion rates than those not experiencing COVID-19. Similar results were observed for females and males. General bacterial and viral infections did not demonstrate increased concussion rates following recovery. The higher COVID-19 concussion rates may be related to ongoing COVID-19 sequela or deconditioning related to reduced training and competition load when returning to sport.

Implications: Following recovery from COVID-19 infections, detailed physical examinations (e.g., cognitive, balance, conditioning testing) should be considered for high school athletes. Athletes that play sports with high levels of potential head contacts may benefit from limited player to player contact when returning to sport.

Funding acknowledgements: No funding was used for this syudy.

Keywords:
Coronavirus
Return to Sport
Traumatic Brain Injury

Topics:
COVID-19
Sport & sports injuries
Paediatrics

Did this work require ethics approval? Yes

Institution: PRISMA Health

Committee: PRISMA Health Institutional Review Board

Ethics number: Pro00054926