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Prediction of Sport-Related Concussion and Musculoskeletal Injury Occurrences among High School Football Players

PURPOSE: The purposes of this study were to assess retrospective and prospective associations of risk screening metrics with Sport-Related Concussion (SRC) and Core or Lower Extremity Injury (CLEI) for estimating and predicting injury risk for high school football players. METHODS: An observational cohort study included 92 high school football players (15.6 ± 1.1 years of age; range 13 – 18) that completed a pre-participation perceptual-motor test and survey questionnaires concerning recognized symptoms of post-concussion syndrome and persisting effects of prior musculoskeletal injuries (MSI). The perceptual-motor test consisted of a smartphone Flanker Test app which displayed incongruent (<<><< or >><>>) or congruent (<<<<< or >>>>>) arrows and registered a response when manually tilted in a right or left direction. Reaction time and response accuracy were used to determine Flanker Test conflict effect (CE) and efficiency index ratio (EIR). The Overall Wellness Index (OWI) and Sport Fitness Index (SFI) surveys quantified any post-concussion symptoms (Sx) and persisting effects of previous MSI on a 0 – 100 score. RESULTS: Self-reported history of concussion (HxSRC) was reported in 15% of the players. In the surveillance period following the initial screening, 8% of the players suffered SRC, 29% of the players with HxSRC sustained a new SRC, and a total of 64 CLEIs were sustained within the cohort. Factors that discriminated between players with a HxSRC versus no history of concussion included Flanker Test CE ≥52 ms (OR, 3.86), OWI symptoms ≥4 (OR, 8.75), OWI Score ≤88 (OR, 4.78), and SFI score ≤88 (OR, 2.52). Prospective predictors of a new SRC occurrence included Flanker Test EIR ≥1.7 (OR, 3.82), OWI symptoms ≥7 (OR, 36.44), OWI Score ≤76 (OR, 12.83), and SFI score ≤78 (OR, 16.82). Among players with a HxSRC, SFI score ≤92 (OR, 33.80) had a 100% negative predictive value and Flanker Test EIR ≥2.0 (OR, 17.00) had a 100% positive predictive value in prospectively predicting a new CLEI. CONCLUSION: Our findings strongly support utilization of the OWI, SFI, and Flanker Test to identify individual high school football players who are likely to derive greatest benefit from focused efforts to further assess cognitive-motor function and potentially reduce injury risk.