Contrasting Characteristics and Outcomes of Sports-Related and Non-Sports-Related Traumatic Brain Injury

Abstract

Importance: Exposure to traumatic brain injury (TBI) has raised widespread concern over participation in sports, particularly over possible long-term consequences. However, little is known about the outcomes of individuals presenting to hospitals with sports-related TBI.

Objective: To compare the characteristics and outcomes of individuals presenting to hospitals with sports-related and non-sports-related TBI.

Design, setting, and participants: The CENTER-TBI (Collaborative European NeuroTrauma Effectiveness Research in TBI) observational cohort study was conducted at hospitals in 18 countries. The study enrolled 4509 patients who had TBI and had an indication for computed tomography (CT), of whom 4360 were 16 years or older. Outcomes were assessed at 3 and 6 months, and groups were compared using regression analyses adjusting for clinical and demographic differences. Data were collected between December 9, 2014, and December 17, 2017, and analyzed from August 2022 to March 2023.

Exposure: Sports-related and non-sports-related TBI with subgroups selected by severity of injury.

Main outcomes and measures: The main outcome was the Glasgow Outcome Scale-Extended (GOSE) at 6 months, with secondary outcomes covering postconcussion symptoms, health-related quality of life, and mental health.

Results: A total of 4360 patients were studied, including 256 (6%) with sports-related TBI (mean [SD] age, 38.9 [18.1] years; 161 [63%] male) and 4104 with non-sports-related TBI (mean [SD] age, 51.0 [20.2] years; 2773 [68%] male). Compared with patients with non-sports-related TBI, patients with sports-related TBI were younger, more likely to have tertiary education, more likely to be previously healthy, and less likely to have a major extracranial injury. After adjustment, the groups did not differ in incomplete recovery (GOSE scores <8) at 6 months (odds ratio [OR], 1.27; 95% CI, 0.90-1.78; P = .22 for all patients; OR, 1.20; 95% CI, 0.83-1.73; P = .34 for those with mild TBI; and OR, 1.19; 95% CI, 0.74-1.92; P = .65 for those with mild TBI and negative CT findings). At 6 months, there was incomplete recovery in 103 of 223 patients (46%) with outcomes in the sports-related TBI group, 65 of 168 (39%) in those with mild sports-related TBI, and 30 of 98 (31%) in those with mild sports-related TBI and negative CT findings. In contrast, at 6 months, the sports-related TBI group had lower prevalence of anxiety, depression, posttraumatic stress disorder, and postconcussion symptoms than the non-sports-related group.

Conclusions and relevance: In this cohort study of 4360 patients with TBI, functional limitations 6 months after injury were common after sports-related TBI, even mild sports-related TBI. Persisting impairment was evident in the sports-related TBI group despite better recovery compared with non-sports-related TBI on measures of mental health and postconcussion symptoms. These findings caution against taking an overoptimistic view of outcomes after sports-related TBI, even if the initial injury appears mild.

Figure 1.. Multivariate Association of Background and Clinical Variables With Cause of Injury

Odds ratios are given for membership of the sports-related traumatic brain injury group. Error bars indicate 95% CIs. CT indicates computed tomography; ED, emergency department; and ICU, intensive care unit. ^aSignificant at P < .05 level.

Figure 2.. Percentages of Impaired Outcomes at 3 and 6 Months for Sports-Related and Non–Sports-Related Traumatic Brain Injury (TBI) in 3 Severity Groups (All Severities of Injury, Mild TBI, and Mild TBI With Negative Computed Tomography [CT] Results)

GAD-7, Generalized Anxiety Disorder–7; GOSE, Glasgow Outcome Score–Extended; MCS, mental component summary; PCL-5, Posttraumatic Stress Disorder Checklist for DSM-5; PCS, physical component summary; PHQ-9, Patient Health Questionnaire–9; RPQ, Rivermead Post-concussion Symptoms Questionnaire. Error bars indicate 95 CIs. ^aSignificant at the P < .05 level after adjustment for covariates and false discovery rate correction. The bars are paired, and the comparison is between the sports-related TBI bar indicated and the corresponding non–sports-related TBI bar immediately to the right. ^bToo few positive cases for analysis.

Figure 3.. Odds Ratios for Comparison of Sports-Related Traumatic Brain Injury (TBI) vs Non–Sports-Related TBI on Outcomes at 3 and 6 Months, After Injury Adjusting for Covariates

Larger odds ratios indicate better outcomes in the sports-related TBI group. P values are corrected for a false discovery rate of 5%. Error bars indicate 95% CIs. CT indicates computed tomography; GAD-7, Generalized Anxiety Disorder–7; GOSE, Glasgow Outcome Score–Extended; MCS, mental component summary; PCL-5, Posttraumatic Stress Disorder Checklist for DSM-5; PCS, physical component summary; PHQ-9, Patient Health Questionnaire–9; RPQ, Rivermead Post-concussion Symptoms Questionnaire. ^aSignificant at the P < .05 level after adjustment for covariates and false discovery rate correction. ^bToo few positive cases for analysis.