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Erschienen in: Sports Medicine 4/2021

17.12.2020 | Original Research Article

The Effects of On-Field Heat Index and Altitude on Concussion Assessments and Recovery Among NCAA Athletes

verfasst von: Landon B. Lempke, Robert C. Lynall, Rachel K. Le, Michael McCrea, Thomas McAllister, Julianne D. Schmidt, CARE Consortium Investigators

Erschienen in: Sports Medicine | Ausgabe 4/2021

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Abstract

Background

Recent literature has indicated altitude may be a protective factor for concussion but it is unknown whether altitude or heat index affects recovery.

Objective

To examine whether on-field heat index and altitude at the time of injury alter acute (< 48 h) concussion assessments, days-to-asymptomatic, and days-to-return-to-play in collegiate athletes following concussion.

Methods

Collegiate athletes (n = 187; age = 19.7 ± 1.4 years; male = 70.6%) underwent baseline assessments across 30 universities and experienced a concussion in this retrospective cohort study. Altitude (m) and heat index (°C) at the time and location of injury were determined using valid online database tools. Acute concussion assessments included the Sport Concussion Assessment Tool (SCAT) symptom inventory, Balance Error Scoring System (BESS), and the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). We used multiple linear regression models to determine whether heat index and altitude predicted each acute assessment outcome, days-to-asymptomatic, and days-to-return-to-play.

Results

Collegiate athletes were concussed at a 181.1 m (range − 0.6 to 2201.9 m) median altitude and 17.8 °C (range − 6.1 to 35.6 °C) median heat index. Altitude did not predict (p ≥ 0.265) any outcomes. Every one-degree increase in heat index reduced days-to-asymptomatic (p = 0.047; R2 = 0.06) and days-to-return-to-play (p = 0.006; R2 = 0.09) by 0.05 and 0.14 days, respectively. Heat index and altitude did not explain significant variance in SCAT, BESS, and ImPACT composite scores (p’s = 0.20–0.922).

Conclusion

Our findings suggest that on-field altitude and heat index at the time of injury do not contribute to clinically meaningful changes on acute assessments or concussion recovery. On-field altitude and heat index do not appear to significantly alter assessment outcomes or clinical recovery, suggesting that environmental factors at altitudes below < 2500 m are negligible outcomes for researchers and clinicians to consider post-concussion.
Literatur
1.
Zurück zum Zitat Kerr ZY, Roos KG, Djoko A, Dalton SL, Broglio SP, Marshall SW, et al. Epidemiologic measures for quantifying the incidence of concussion in national collegiate athletic association sports. J Athl Train. 2017;52:167–74.CrossRef Kerr ZY, Roos KG, Djoko A, Dalton SL, Broglio SP, Marshall SW, et al. Epidemiologic measures for quantifying the incidence of concussion in national collegiate athletic association sports. J Athl Train. 2017;52:167–74.CrossRef
2.
Zurück zum Zitat O’Connor KL, Baker MM, Dalton SL, Dompier TP, Broglio SP, Kerr ZY. Epidemiology of sport-related concussions in high school athletes: national athletic treatment, injury and outcomes network (NATION), 2011–2012 through 2013–2014. J Athl Train. 2017;52:175–85.CrossRef O’Connor KL, Baker MM, Dalton SL, Dompier TP, Broglio SP, Kerr ZY. Epidemiology of sport-related concussions in high school athletes: national athletic treatment, injury and outcomes network (NATION), 2011–2012 through 2013–2014. J Athl Train. 2017;52:175–85.CrossRef
3.
Zurück zum Zitat Myer GD, Yuan W, Barber Foss KD, Thomas S, Smith D, Leach J, et al. Analysis of head impact exposure and brain microstructure response in a season-long application of a jugular vein compression collar: a prospective, neuroimaging investigation in American football. Br J Sports Med. 2016; bjsports-2016–096134. Myer GD, Yuan W, Barber Foss KD, Thomas S, Smith D, Leach J, et al. Analysis of head impact exposure and brain microstructure response in a season-long application of a jugular vein compression collar: a prospective, neuroimaging investigation in American football. Br J Sports Med. 2016; bjsports-2016–096134.
5.
Zurück zum Zitat Beaudouin F, aus der Fünten K, Tröß T, Reinsberger C, Meyer T. Head injuries in professional male football (soccer) over 13 years: 29% lower incidence rates after a rule change (red card). Br J Sports Med. 2017;bjsports-2016-097217. Beaudouin F, aus der Fünten K, Tröß T, Reinsberger C, Meyer T. Head injuries in professional male football (soccer) over 13 years: 29% lower incidence rates after a rule change (red card). Br J Sports Med. 2017;bjsports-2016-097217.
6.
Zurück zum Zitat Asken BM, Bauer RM, Guskiewicz KM, McCrea MA, Schmidt JD, Giza CC, et al. Immediate removal from activity after sport-related concussion is associated with shorter clinical recovery and less severe symptoms in collegiate student-athletes. Am J Sports Med. 2018;46:1465–74.CrossRef Asken BM, Bauer RM, Guskiewicz KM, McCrea MA, Schmidt JD, Giza CC, et al. Immediate removal from activity after sport-related concussion is associated with shorter clinical recovery and less severe symptoms in collegiate student-athletes. Am J Sports Med. 2018;46:1465–74.CrossRef
7.
Zurück zum Zitat Lempke L, Jaffri A, Erdman N. The Effects of Early Physical Activity Compared to Early Physical Rest on Concussion Symptoms. J Sport Rehabil. 2017;1–18. Lempke L, Jaffri A, Erdman N. The Effects of Early Physical Activity Compared to Early Physical Rest on Concussion Symptoms. J Sport Rehabil. 2017;1–18.
8.
Zurück zum Zitat Lewis MD, Bailes J. Neuroprotection for the warrior: dietary supplementation with omega-3 fatty acids. Mil Med. 2011;176:1120–7.CrossRef Lewis MD, Bailes J. Neuroprotection for the warrior: dietary supplementation with omega-3 fatty acids. Mil Med. 2011;176:1120–7.CrossRef
9.
Zurück zum Zitat Casa DJ, DeMartini JK, Bergeron MF, Csillan D, Eichner ER, Lopez RM, et al. National athletic trainers’ association position statement: exertional heat illnesses. J Athl Train. 2015;50:986–1000.CrossRef Casa DJ, DeMartini JK, Bergeron MF, Csillan D, Eichner ER, Lopez RM, et al. National athletic trainers’ association position statement: exertional heat illnesses. J Athl Train. 2015;50:986–1000.CrossRef
10.
Zurück zum Zitat Özgünen KT, Kurdak SS, Maughan RJ, Zeren ç., Korkmaz S, Yazιcι Z, et al. Effect of hot environmental conditions on physical activity patterns and temperature response of football players: effect of hot weather in football. Scand J Med Sci Sports. 2010;20:140–7. Özgünen KT, Kurdak SS, Maughan RJ, Zeren ç., Korkmaz S, Yazιcι Z, et al. Effect of hot environmental conditions on physical activity patterns and temperature response of football players: effect of hot weather in football. Scand J Med Sci Sports. 2010;20:140–7.
11.
Zurück zum Zitat Godek SF, Godek JJ, Bartolozzi AR. Thermal responses in football and cross-country athletes during their respective practices in a hot environment. J Athl Train. 2004;39:235.PubMedPubMedCentral Godek SF, Godek JJ, Bartolozzi AR. Thermal responses in football and cross-country athletes during their respective practices in a hot environment. J Athl Train. 2004;39:235.PubMedPubMedCentral
12.
Zurück zum Zitat Cooper ER, Ferrara MS, Broglio SP. Exertional heat illness and environmental conditions during a single football season in the southeast. J Athl Train. 2006;41:332–6.PubMedPubMedCentral Cooper ER, Ferrara MS, Broglio SP. Exertional heat illness and environmental conditions during a single football season in the southeast. J Athl Train. 2006;41:332–6.PubMedPubMedCentral
13.
Zurück zum Zitat Cooper ER, Ferrara MS, Casa DJ, Powell JW, Broglio SP, Resch JE, et al. Exertional heat illness in American football players: when is the risk greatest? J Athl Train. 2016;51:593–600.CrossRef Cooper ER, Ferrara MS, Casa DJ, Powell JW, Broglio SP, Resch JE, et al. Exertional heat illness in American football players: when is the risk greatest? J Athl Train. 2016;51:593–600.CrossRef
15.
Zurück zum Zitat Sakurai A, Atkins CM, Alonso OF, Bramlett HM, Dietrich WD. Mild hyperthermia worsens the neuropathological damage associated with mild traumatic brain injury in rats. J Neurotrauma. 2012;29:313–21.CrossRef Sakurai A, Atkins CM, Alonso OF, Bramlett HM, Dietrich WD. Mild hyperthermia worsens the neuropathological damage associated with mild traumatic brain injury in rats. J Neurotrauma. 2012;29:313–21.CrossRef
17.
Zurück zum Zitat Suzuki T, Bramlett HM, Ruenes G, Dietrich WD. The effects of early post-traumatic hyperthermia in female and ovariectomized rats. J Neurotrauma. 2004;21:842–53.CrossRef Suzuki T, Bramlett HM, Ruenes G, Dietrich WD. The effects of early post-traumatic hyperthermia in female and ovariectomized rats. J Neurotrauma. 2004;21:842–53.CrossRef
18.
Zurück zum Zitat Cedeño Laurent JG, Williams A, Oulhote Y, Zanobetti A, Allen JG, Spengler JD. Reduced cognitive function during a heat wave among residents of non-air-conditioned buildings: An observational study of young adults in the summer of 2016. Patz JA, editor. PLOS Med. 2018;15:e1002605. Cedeño Laurent JG, Williams A, Oulhote Y, Zanobetti A, Allen JG, Spengler JD. Reduced cognitive function during a heat wave among residents of non-air-conditioned buildings: An observational study of young adults in the summer of 2016. Patz JA, editor. PLOS Med. 2018;15:e1002605.
19.
Zurück zum Zitat Qiu W, Zhang Y, Sheng H, Zhang J, Wang W, Liu W, et al. Effects of therapeutic mild hypothermia on patients with severe traumatic brain injury after craniotomy. J Crit Care. 2007;22:229–35.CrossRef Qiu W, Zhang Y, Sheng H, Zhang J, Wang W, Liu W, et al. Effects of therapeutic mild hypothermia on patients with severe traumatic brain injury after craniotomy. J Crit Care. 2007;22:229–35.CrossRef
20.
Zurück zum Zitat Zhi D, Zhang S, Lin X. Study on therapeutic mechanism and clinical effect of mild hypothermia in patients with severe head injury. Surg Neurol. 2003;59:381–5.CrossRef Zhi D, Zhang S, Lin X. Study on therapeutic mechanism and clinical effect of mild hypothermia in patients with severe head injury. Surg Neurol. 2003;59:381–5.CrossRef
21.
Zurück zum Zitat Dietrich WD, Bramlett HM. The evidence for hypothermia as a neuroprotectant in traumatic brain injury. Neurotherapeutics. 2010;7:43–50.CrossRef Dietrich WD, Bramlett HM. The evidence for hypothermia as a neuroprotectant in traumatic brain injury. Neurotherapeutics. 2010;7:43–50.CrossRef
22.
Zurück zum Zitat Li J, Jiang J. Chinese head trauma data bank: effect of hyperthermia on the outcome of acute head trauma patients. j Neurotrauma. 2012;29:96–100.CrossRef Li J, Jiang J. Chinese head trauma data bank: effect of hyperthermia on the outcome of acute head trauma patients. j Neurotrauma. 2012;29:96–100.CrossRef
23.
Zurück zum Zitat Lynall RC, Kerr ZY, Parr MS, Hackney AC, Mihalik JP. Division I college football concussion rates are higher at higher altitudes. J Orthop Sports Phys Ther. 2016;46:96–103.CrossRef Lynall RC, Kerr ZY, Parr MS, Hackney AC, Mihalik JP. Division I college football concussion rates are higher at higher altitudes. J Orthop Sports Phys Ther. 2016;46:96–103.CrossRef
25.
Zurück zum Zitat Myer GD, Smith D, Barber Foss KD, Dicesare CA, Kiefer AW, Kushner AM, et al. Rates of concussion are lower in national football league games played at higher altitudes. J Orthop Sports Phys Ther. 2014;44:164–72.CrossRef Myer GD, Smith D, Barber Foss KD, Dicesare CA, Kiefer AW, Kushner AM, et al. Rates of concussion are lower in national football league games played at higher altitudes. J Orthop Sports Phys Ther. 2014;44:164–72.CrossRef
26.
Zurück zum Zitat Zavorsky GS. Altitude does not reduce concussion incidence in professional football players: a poor understanding of health statistics and altitude physiology. J Orthop Sports Phys Ther. 2014;44:458–9.CrossRef Zavorsky GS. Altitude does not reduce concussion incidence in professional football players: a poor understanding of health statistics and altitude physiology. J Orthop Sports Phys Ther. 2014;44:458–9.CrossRef
27.
Zurück zum Zitat Smoliga JM, Zavorsky GS. Team logo predicts concussion risk: lessons in protecting a vulnerable sports community from misconceived, but highly publicized epidemiologic research. Epidemiology. 2017;28:753–7.CrossRef Smoliga JM, Zavorsky GS. Team logo predicts concussion risk: lessons in protecting a vulnerable sports community from misconceived, but highly publicized epidemiologic research. Epidemiology. 2017;28:753–7.CrossRef
28.
Zurück zum Zitat Zavorsky GS, Smoliga JM. Correct data and meta-analytic approaches show the reduced risk of concussion for athletes playing at higher altitudes—reply. JAMA Neurol. 2017;74:485.CrossRef Zavorsky GS, Smoliga JM. Correct data and meta-analytic approaches show the reduced risk of concussion for athletes playing at higher altitudes—reply. JAMA Neurol. 2017;74:485.CrossRef
29.
Zurück zum Zitat Smoliga JM, Zavorsky GS. Last Word on Viewpoint: All is fair in altitude and concussions. J Appl Physiol. 2017;122:221–221.CrossRef Smoliga JM, Zavorsky GS. Last Word on Viewpoint: All is fair in altitude and concussions. J Appl Physiol. 2017;122:221–221.CrossRef
30.
Zurück zum Zitat Zavorsky GS. Altitude (if you can call it that) has no bearing on the rates of concussions in athletes. J Orthop Sports Phys Ther. 2016;46:226–7.CrossRef Zavorsky GS. Altitude (if you can call it that) has no bearing on the rates of concussions in athletes. J Orthop Sports Phys Ther. 2016;46:226–7.CrossRef
31.
Zurück zum Zitat León-Velarde F, Maggiorini M, Reeves JT, Aldashev A, Asmus I, Bernardi L, et al. Consensus statement on chronic and subacute high altitude diseases. High Alt Med Biol. 2005;6:147–57.CrossRef León-Velarde F, Maggiorini M, Reeves JT, Aldashev A, Asmus I, Bernardi L, et al. Consensus statement on chronic and subacute high altitude diseases. High Alt Med Biol. 2005;6:147–57.CrossRef
32.
Zurück zum Zitat Wilson MH, Edsell MEG, Davagnanam I, Hirani SP, Martin DS, Levett DZH, et al. Cerebral artery dilatation maintains cerebral oxygenation at extreme altitude and in acute hypoxia—an ultrasound and MRI study. J Cereb Blood Flow Metab. 2011;31:2019–29.CrossRef Wilson MH, Edsell MEG, Davagnanam I, Hirani SP, Martin DS, Levett DZH, et al. Cerebral artery dilatation maintains cerebral oxygenation at extreme altitude and in acute hypoxia—an ultrasound and MRI study. J Cereb Blood Flow Metab. 2011;31:2019–29.CrossRef
33.
Zurück zum Zitat Wilson MH, Davagnanam I, Holland G, Dattani RS, Tamm A, Hirani SP, et al. Cerebral venous system and anatomical predisposition to high-altitude headache. Ann Neurol. 2013;73:381–9.CrossRef Wilson MH, Davagnanam I, Holland G, Dattani RS, Tamm A, Hirani SP, et al. Cerebral venous system and anatomical predisposition to high-altitude headache. Ann Neurol. 2013;73:381–9.CrossRef
35.
Zurück zum Zitat Smith DW, Bailes JE, Fisher JA, Robles J, Turner RC, Mills JD. Internal jugular vein compression mitigates traumatic axonal injury in a rat model by reducing the intracranial slosh effect. Neurosurgery. 2012;70:740–6.CrossRef Smith DW, Bailes JE, Fisher JA, Robles J, Turner RC, Mills JD. Internal jugular vein compression mitigates traumatic axonal injury in a rat model by reducing the intracranial slosh effect. Neurosurgery. 2012;70:740–6.CrossRef
36.
Zurück zum Zitat Turner RC, Naser ZJ, Bailes JE, Smith DW, Fisher JA, Rosen CL. Effect of slosh mitigation on histologic markers of traumatic brain injury: laboratory investigation. J Neurosurg. 2012;117:1110–8.CrossRef Turner RC, Naser ZJ, Bailes JE, Smith DW, Fisher JA, Rosen CL. Effect of slosh mitigation on histologic markers of traumatic brain injury: laboratory investigation. J Neurosurg. 2012;117:1110–8.CrossRef
38.
Zurück zum Zitat Yuan W, Barber Foss KD, Thomas S, DiCesare CA, Dudley JA, Kitchen K, et al. White matter alterations over the course of two consecutive high-school football seasons and the effect of a jugular compression collar: a preliminary longitudinal diffusion tensor imaging study. Hum Brain Mapp. 2018;39:491–508.CrossRef Yuan W, Barber Foss KD, Thomas S, DiCesare CA, Dudley JA, Kitchen K, et al. White matter alterations over the course of two consecutive high-school football seasons and the effect of a jugular compression collar: a preliminary longitudinal diffusion tensor imaging study. Hum Brain Mapp. 2018;39:491–508.CrossRef
39.
Zurück zum Zitat Myer GD, Barber Foss K, Thomas S, Galloway R, DiCesare CA, Dudley J, et al. Altered brain microstructure in association with repetitive subconcussive head impacts and the potential protective effect of jugular vein compression: a longitudinal study of female soccer athletes. Br J Sports Med. 2018. Myer GD, Barber Foss K, Thomas S, Galloway R, DiCesare CA, Dudley J, et al. Altered brain microstructure in association with repetitive subconcussive head impacts and the potential protective effect of jugular vein compression: a longitudinal study of female soccer athletes. Br J Sports Med. 2018.
40.
Zurück zum Zitat CARE Consortium Investigators, Broglio SP, McCrea M, McAllister T, Harezlak J, Katz B, et al. A National Study on the Effects of Concussion in Collegiate Athletes and US Military Service Academy Members: The NCAA–DoD Concussion Assessment, Research and Education (CARE) Consortium Structure and Methods. Sports Med [Internet]. 2017 [cited 2017 Mar 24]; Available from: http://link.springer.com/https://doi.org/10.1007/s40279-017-0707-1 CARE Consortium Investigators, Broglio SP, McCrea M, McAllister T, Harezlak J, Katz B, et al. A National Study on the Effects of Concussion in Collegiate Athletes and US Military Service Academy Members: The NCAA–DoD Concussion Assessment, Research and Education (CARE) Consortium Structure and Methods. Sports Med [Internet]. 2017 [cited 2017 Mar 24]; Available from: http://​link.​springer.​com/​https://​doi.​org/​10.​1007/​s40279-017-0707-1
41.
Zurück zum Zitat Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med. 2007;147:573–7.CrossRef Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med. 2007;147:573–7.CrossRef
42.
Zurück zum Zitat McCrory P, Meeuwisse W, Dvorak J, Aubry M, Bailes J, Broglio S, et al. Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. 2017;bjsports-2017–097699. McCrory P, Meeuwisse W, Dvorak J, Aubry M, Bailes J, Broglio S, et al. Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. 2017;bjsports-2017–097699.
43.
Zurück zum Zitat Rose SC, Fischer AN, Heyer GL. How long is too long? The lack of consensus regarding the post-concussion syndrome diagnosis. Brain Inj. 2015;29:798–803.CrossRef Rose SC, Fischer AN, Heyer GL. How long is too long? The lack of consensus regarding the post-concussion syndrome diagnosis. Brain Inj. 2015;29:798–803.CrossRef
44.
Zurück zum Zitat TWC Product and Technology LLC. Weather forecast and reports: long range and local [Internet]. Weather Undergr. [cited 2019 Apr 4]. TWC Product and Technology LLC. Weather forecast and reports: long range and local [Internet]. Weather Undergr. [cited 2019 Apr 4].
46.
Zurück zum Zitat Chandra N, Lal S, Venkataramani S, Patra PK, Sheel V. Temporal variations of atmospheric CO2 and CO at Ahmedabad in western India. Atmos Chem Phys. 2016;16:6153–73.CrossRef Chandra N, Lal S, Venkataramani S, Patra PK, Sheel V. Temporal variations of atmospheric CO2 and CO at Ahmedabad in western India. Atmos Chem Phys. 2016;16:6153–73.CrossRef
48.
Zurück zum Zitat Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychol Bull. 1979;86:420–8.CrossRef Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychol Bull. 1979;86:420–8.CrossRef
49.
Zurück zum Zitat Rothfusz LP, Headquarters NSR. The heat index equation (or, more than you ever wanted to know about heat index). Ft Worth Tex Natl Ocean Atmospheric Adm Natl Weather Serv Off Meteorol. 1990;9023. Rothfusz LP, Headquarters NSR. The heat index equation (or, more than you ever wanted to know about heat index). Ft Worth Tex Natl Ocean Atmospheric Adm Natl Weather Serv Off Meteorol. 1990;9023.
50.
Zurück zum Zitat Schatz P, Pardini J, Lovell M, Collins M, Podell K. Sensitivity and specificity of the ImPACT Test Battery for concussion in athletes. Arch Clin Neuropsychol. 2006;21:91–9.CrossRef Schatz P, Pardini J, Lovell M, Collins M, Podell K. Sensitivity and specificity of the ImPACT Test Battery for concussion in athletes. Arch Clin Neuropsychol. 2006;21:91–9.CrossRef
51.
Zurück zum Zitat Iverson GL, Gardner AJ, Terry DP, Ponsford JL, Sills AK, Broshek DK, et al. Predictors of clinical recovery from concussion: a systematic review. Br J Sports Med. 2017;51:941–8.CrossRef Iverson GL, Gardner AJ, Terry DP, Ponsford JL, Sills AK, Broshek DK, et al. Predictors of clinical recovery from concussion: a systematic review. Br J Sports Med. 2017;51:941–8.CrossRef
53.
Zurück zum Zitat Zavorsky GS, Smoliga JM. Risk of concussion for athletes in contact sports at higher altitude vs at sea level: a meta-analysis. JAMA Neurol. 2016;73:1369–70.CrossRef Zavorsky GS, Smoliga JM. Risk of concussion for athletes in contact sports at higher altitude vs at sea level: a meta-analysis. JAMA Neurol. 2016;73:1369–70.CrossRef
54.
Zurück zum Zitat Giza CC, Hovda DA. The new neurometabolic cascade of concussion. Neurosurgery. 2014;75:S24-33.CrossRef Giza CC, Hovda DA. The new neurometabolic cascade of concussion. Neurosurgery. 2014;75:S24-33.CrossRef
55.
Zurück zum Zitat Barkhoudarian G, Hovda DA, Giza CC. The molecular pathophysiology of concussive brain injury: an update. Phys Med Rehabil Clin N Am. 2016;27:373–93.CrossRef Barkhoudarian G, Hovda DA, Giza CC. The molecular pathophysiology of concussive brain injury: an update. Phys Med Rehabil Clin N Am. 2016;27:373–93.CrossRef
56.
Zurück zum Zitat Stone JG, Goodman RR, Baker KZ, Baker CJ, Solomon RA. Direct intraoperative measurement of human brain temperature. Neurosurgery. 1997;41:20–4.CrossRef Stone JG, Goodman RR, Baker KZ, Baker CJ, Solomon RA. Direct intraoperative measurement of human brain temperature. Neurosurgery. 1997;41:20–4.CrossRef
57.
Zurück zum Zitat Nielsen B, Nybo L. Cerebral changes during exercise in the heat. Sports Med. 2003;33:1–11.CrossRef Nielsen B, Nybo L. Cerebral changes during exercise in the heat. Sports Med. 2003;33:1–11.CrossRef
58.
Zurück zum Zitat Mihalik JP, Sumrall AZ, Yeargin SW, Guskiewicz KM, King KB, Trulock SC, et al. Environmental and physiological factors affect football head impact biomechanics. Med Sci Sports Exerc. 2017;49:2093–101.CrossRef Mihalik JP, Sumrall AZ, Yeargin SW, Guskiewicz KM, King KB, Trulock SC, et al. Environmental and physiological factors affect football head impact biomechanics. Med Sci Sports Exerc. 2017;49:2093–101.CrossRef
59.
Zurück zum Zitat Wilson Van Voorhis CR, Morgan BL. Understanding power and rules of thumb for determining sample sizes. Tutor Quant Methods Psychol. 2007;3:43–50.CrossRef Wilson Van Voorhis CR, Morgan BL. Understanding power and rules of thumb for determining sample sizes. Tutor Quant Methods Psychol. 2007;3:43–50.CrossRef
60.
Zurück zum Zitat Wasserman E, Coberley M, Anderson S, Grant M, Hardin JA. Concussion rates differ by practice type and equipment worn in an autonomy five collegiate football conference. J Sport Med. 2018. Wasserman E, Coberley M, Anderson S, Grant M, Hardin JA. Concussion rates differ by practice type and equipment worn in an autonomy five collegiate football conference. J Sport Med. 2018.
Metadaten
Titel
The Effects of On-Field Heat Index and Altitude on Concussion Assessments and Recovery Among NCAA Athletes
verfasst von
Landon B. Lempke
Robert C. Lynall
Rachel K. Le
Michael McCrea
Thomas McAllister
Julianne D. Schmidt
CARE Consortium Investigators
Publikationsdatum
17.12.2020
Verlag
Springer International Publishing
Erschienen in
Sports Medicine / Ausgabe 4/2021
Print ISSN: 0112-1642
Elektronische ISSN: 1179-2035
DOI
https://doi.org/10.1007/s40279-020-01395-5

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