TY - JOUR
T1 - Analysis of longitudinal head impact exposure and white matter integrity in returning youth football players
AU - Kelley, Mireille E.
AU - Urban, Jillian E.
AU - Jones, Derek A.
AU - Davenport, Elizabeth M.
AU - Miller, Logan E.
AU - Snively, Beverly M.
AU - Powers, Alexander K.
AU - Whitlow, Christopher T.
AU - Maldjian, Joseph A.
AU - Stitzel, Joel D.
N1 - Funding Information:
Research reported in this publication was supported by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health under award numbers R01NS094410 and R01NS082453. The National Center for Advancing Translational Sciences, National Institutes of Health, supported Dr. Urban through grant KL2TR001421. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. We give special thanks to the Childress Institute for Pediatric Trauma at Wake Forest Baptist Medical Center for providing support for this study. We thank the youth football organization’s board members, coaches, parents, and athletes whose support makes this research possible. We thank the athletic trainers for their support. We also thank all the research assistants who helped with data collection.
Funding Information:
Research reported in this publication was supported by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health under award numbers R01NS094410 and R01NS082453. The National Center for Advancing Translational Sciences, National Institutes of Health, supported Dr. Urban through grant KL2TR001421. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. We give special thanks to the Childress Institute for Pediatric Trauma at Wake Forest Baptist Medical Center for providing support for this study. We thank the youth football organization's board members, coaches, parents, and athletes whose support makes this research possible. We thank the athletic trainers for their support. We also thank all the research assistants who helped with data collection.
Publisher Copyright:
© AANS 2021, except where prohibited by US copyright law
PY - 2021/8
Y1 - 2021/8
N2 - OBJECTIVE The objective of this study was to characterize changes in head impact exposure (HIE) across multiple football seasons and to determine whether changes in HIE correlate with changes in imaging metrics in youth football players. METHODS On-field head impact data and pre- and postseason imaging data, including those produced by diffusion tensor imaging (DTI), were collected from youth football athletes with at least two consecutive seasons of data. ANCOVA was used to evaluate HIE variations (number of impacts, peak linear and rotational accelerations, and risk-weighted cumulative exposure) by season number. DTI scalar metrics, including fractional anisotropy, mean diffusivity, and linear, planar, and spherical anisotropy coefficients, were evaluated. A control group was used to determine the number of abnormal white matter voxels, which were defined as 2 standard deviations above or below the control group mean. The difference in the number of abnormal voxels between consecutive seasons was computed for each scalar metric and athlete. Linear regression analyses were performed to evaluate relationships between changes in HIE metrics and changes in DTI scalar metrics. RESULTS There were 47 athletes with multiple consecutive seasons of HIE, and corresponding imaging data were available in a subsample (n = 19) of these. Increases and decreases in HIE metrics were observed among individual athletes from one season to the next, and no significant differences (all p > 0.05) in HIE metrics were observed by season number. Changes in the number of practice impacts, 50th percentile impacts per practice session, and 50th percentile impacts per session were significantly positively correlated with changes in abnormal voxels for all DTI metrics. CONCLUSIONS These results demonstrate a significant positive association between changes in HIE metrics and changes in the numbers of abnormal voxels between consecutive seasons of youth football. Reducing the number and frequency of head impacts, especially during practice sessions, may decrease the number of abnormal imaging findings from one season to the next in youth football.
AB - OBJECTIVE The objective of this study was to characterize changes in head impact exposure (HIE) across multiple football seasons and to determine whether changes in HIE correlate with changes in imaging metrics in youth football players. METHODS On-field head impact data and pre- and postseason imaging data, including those produced by diffusion tensor imaging (DTI), were collected from youth football athletes with at least two consecutive seasons of data. ANCOVA was used to evaluate HIE variations (number of impacts, peak linear and rotational accelerations, and risk-weighted cumulative exposure) by season number. DTI scalar metrics, including fractional anisotropy, mean diffusivity, and linear, planar, and spherical anisotropy coefficients, were evaluated. A control group was used to determine the number of abnormal white matter voxels, which were defined as 2 standard deviations above or below the control group mean. The difference in the number of abnormal voxels between consecutive seasons was computed for each scalar metric and athlete. Linear regression analyses were performed to evaluate relationships between changes in HIE metrics and changes in DTI scalar metrics. RESULTS There were 47 athletes with multiple consecutive seasons of HIE, and corresponding imaging data were available in a subsample (n = 19) of these. Increases and decreases in HIE metrics were observed among individual athletes from one season to the next, and no significant differences (all p > 0.05) in HIE metrics were observed by season number. Changes in the number of practice impacts, 50th percentile impacts per practice session, and 50th percentile impacts per session were significantly positively correlated with changes in abnormal voxels for all DTI metrics. CONCLUSIONS These results demonstrate a significant positive association between changes in HIE metrics and changes in the numbers of abnormal voxels between consecutive seasons of youth football. Reducing the number and frequency of head impacts, especially during practice sessions, may decrease the number of abnormal imaging findings from one season to the next in youth football.
KW - Biomechanics
KW - Diffusion tensor imaging
KW - Head acceleration
KW - Head impact frequency
KW - Risk-weighted cumulative exposure
KW - Trauma
UR - http://www.scopus.com/inward/record.url?scp=85111737838&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85111737838&partnerID=8YFLogxK
U2 - 10.3171/2021.1.PEDS20586
DO - 10.3171/2021.1.PEDS20586
M3 - Article
C2 - 34130257
AN - SCOPUS:85111737838
SN - 1933-0707
VL - 28
SP - 196
EP - 205
JO - Journal of Neurosurgery: Pediatrics
JF - Journal of Neurosurgery: Pediatrics
IS - 2
ER -