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Altitude Modulates Concussion Incidence: Implications for Optimizing Brain Compliance to Prevent Brain Injury in Athletes

BACKGROUND: Recent research indicates that the volume and/or pressure of intracranial fluid, a physiology affected by one’s altitude (ie, elevation above sea level), may be associated with the likelihood and/or severity of a concussion. The objective was to employ an epidemiological field investigat...

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Autores principales: Smith, David W., Myer, Gregory D., Currie, Dustin W., Comstock, R. Dawn, Clark, Joseph F., Bailes, Julian E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2013
Materias:
82
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4555510/
https://www.ncbi.nlm.nih.gov/pubmed/26535254
http://dx.doi.org/10.1177/2325967113511588
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author Smith, David W.
Myer, Gregory D.
Currie, Dustin W.
Comstock, R. Dawn
Clark, Joseph F.
Bailes, Julian E.
author_facet Smith, David W.
Myer, Gregory D.
Currie, Dustin W.
Comstock, R. Dawn
Clark, Joseph F.
Bailes, Julian E.
author_sort Smith, David W.
collection PubMed
description BACKGROUND: Recent research indicates that the volume and/or pressure of intracranial fluid, a physiology affected by one’s altitude (ie, elevation above sea level), may be associated with the likelihood and/or severity of a concussion. The objective was to employ an epidemiological field investigation to evaluate the relationship between altitude and concussion rate in high school sports. HYPOTHESIS: Because of the physiologies that occur during acclimatization, including a decline in intracranial compliance (a “tighter fit”), increased altitude may be related to a reduction in concussion rates in high school athletes. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Data on concussions and athlete exposures (AEs) between 2005-2006 and 2011-2012 were obtained from a large national sample of high schools (National High School Sports-Related Injury Surveillance System [High School RIO]) and were used to calculate total, competition, and practice concussion rates for aggregated sports and for football only. RESULTS: Altitude of participating schools ranged from 7 to 6903 ft (median, 600 ft), and a total of 5936 concussions occurred in 20,618,915 exposures (2.88 per 10,000 AEs). When concussion rates were dichotomized by altitude using the median, elevated altitude was associated with a reduction in concussion rates overall (rate ratio [RR], 1.31; P < .001), in competition (RR, 1.31; P < .001), and in practice (RR, 1.29; P < .001). Specifically, high school sports played at higher altitude demonstrated a 31% reduction (95% confidence interval [CI], 25%-38%) in the incidence of total reported concussions. Likewise, concussion rates at increased altitude were reduced 30% for overall exposures, 27% for competition exposures, and 28% for practice exposures in football players (P < .001). CONCLUSION: The results of this epidemiological investigation indicate increased physiological responses to altitude may be associated with a reduction in sports-related concussion rates, especially in collision sports. Future research that focuses on the potential prophylactic effect of optimizing outflow impedance and thus reduction of intracranial compliance (a “tighter fit”) in humans is warranted to determine the most effective approaches to mitigate sport-related concussion, especially in football players.
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spelling pubmed-45555102015-11-03 Altitude Modulates Concussion Incidence: Implications for Optimizing Brain Compliance to Prevent Brain Injury in Athletes Smith, David W. Myer, Gregory D. Currie, Dustin W. Comstock, R. Dawn Clark, Joseph F. Bailes, Julian E. Orthop J Sports Med 82 BACKGROUND: Recent research indicates that the volume and/or pressure of intracranial fluid, a physiology affected by one’s altitude (ie, elevation above sea level), may be associated with the likelihood and/or severity of a concussion. The objective was to employ an epidemiological field investigation to evaluate the relationship between altitude and concussion rate in high school sports. HYPOTHESIS: Because of the physiologies that occur during acclimatization, including a decline in intracranial compliance (a “tighter fit”), increased altitude may be related to a reduction in concussion rates in high school athletes. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Data on concussions and athlete exposures (AEs) between 2005-2006 and 2011-2012 were obtained from a large national sample of high schools (National High School Sports-Related Injury Surveillance System [High School RIO]) and were used to calculate total, competition, and practice concussion rates for aggregated sports and for football only. RESULTS: Altitude of participating schools ranged from 7 to 6903 ft (median, 600 ft), and a total of 5936 concussions occurred in 20,618,915 exposures (2.88 per 10,000 AEs). When concussion rates were dichotomized by altitude using the median, elevated altitude was associated with a reduction in concussion rates overall (rate ratio [RR], 1.31; P < .001), in competition (RR, 1.31; P < .001), and in practice (RR, 1.29; P < .001). Specifically, high school sports played at higher altitude demonstrated a 31% reduction (95% confidence interval [CI], 25%-38%) in the incidence of total reported concussions. Likewise, concussion rates at increased altitude were reduced 30% for overall exposures, 27% for competition exposures, and 28% for practice exposures in football players (P < .001). CONCLUSION: The results of this epidemiological investigation indicate increased physiological responses to altitude may be associated with a reduction in sports-related concussion rates, especially in collision sports. Future research that focuses on the potential prophylactic effect of optimizing outflow impedance and thus reduction of intracranial compliance (a “tighter fit”) in humans is warranted to determine the most effective approaches to mitigate sport-related concussion, especially in football players. SAGE Publications 2013-11-08 /pmc/articles/PMC4555510/ /pubmed/26535254 http://dx.doi.org/10.1177/2325967113511588 Text en © The Author(s) 2013 http://creativecommons.org/licenses/by-nc-nd/3.0/ This open-access article is published and distributed under the Creative Commons Attribution - NonCommercial - No Derivatives License (http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits the noncommercial use, distribution, and reproduction of the article in any medium, provided the original author and source are credited. You may not alter, transform, or build upon this article without the permission of the Author(s). For reprints and permission queries, please visit SAGE’s Web site at http://www.sagepub.com/journalsPermissions.nav.
spellingShingle 82
Smith, David W.
Myer, Gregory D.
Currie, Dustin W.
Comstock, R. Dawn
Clark, Joseph F.
Bailes, Julian E.
Altitude Modulates Concussion Incidence: Implications for Optimizing Brain Compliance to Prevent Brain Injury in Athletes
title Altitude Modulates Concussion Incidence: Implications for Optimizing Brain Compliance to Prevent Brain Injury in Athletes
title_full Altitude Modulates Concussion Incidence: Implications for Optimizing Brain Compliance to Prevent Brain Injury in Athletes
title_fullStr Altitude Modulates Concussion Incidence: Implications for Optimizing Brain Compliance to Prevent Brain Injury in Athletes
title_full_unstemmed Altitude Modulates Concussion Incidence: Implications for Optimizing Brain Compliance to Prevent Brain Injury in Athletes
title_short Altitude Modulates Concussion Incidence: Implications for Optimizing Brain Compliance to Prevent Brain Injury in Athletes
title_sort altitude modulates concussion incidence: implications for optimizing brain compliance to prevent brain injury in athletes
topic 82
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4555510/
https://www.ncbi.nlm.nih.gov/pubmed/26535254
http://dx.doi.org/10.1177/2325967113511588
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