Time To Unrestricted Return To Play Time Between Sport-related Concussions In Helmeted And Non-helmeted Sports

Sport-related concussions (SRCs) are prevalent across National Collegiate Athletic Association (NCAA) sports, with participants in specific sports being required to wear helmets to lower serious head injury risk. Considering the suggested protective characteristics helmets offer in reducing head injuries by dampening transmitted forces, it is unclear if the presence of a helmet effects SRC recovery (time to unrestricted return to play time [URTP]). PURPOSE: To compare time to URTP across between helmeted and non-helmeted SRCs. METHODS: Post-injury data from 1921 NCAA athletes collected by the Concussion, Assessment, Research and Education (CARE) Consortium between 2014-2020 were examined. Helmeted sports (HELM; n = 933) included: men’s football/lacrosse, and men’s/women’s ice hockey. Non-helmeted sports (NOHELM; n = 988) included: men’s baseball, women’s beach volleyball/golf, men’s/women’s basketball/cheerleading/cross-country/diving/track and field/soccer/swimming/tennis/volleyball. A Kaplan Meier curve was constructed to evaluate median days from injury date to URTP by sport helmet status (HELM, NOHELM), and a log-rank test was used to evaluate differential URTP between groups. Weibull accelerated failure time models were used to examine differential URTP between groups, after adjusting for covariates (sport contact category [contact, limited, non-contact], sex [male, female], event type [practice, competition], median baseline and post-injury symptom severity score difference [<25, ≥25], concussion history [<2, ≥3], altered mental status [yes, no], and loss of consciousness [yes, no]). Statistical significance of parameter estimates was evaluated using the empirical Wald test (α = 0.05). RESULTS: Median time to URTP was one day earlier in HELM- (12; 95% CI: 12, 13) compared to NOHELM SRCs (13; 95% CI: 13, 14; p < 0.01). The estimated time spent recovering was ~11% longer (parameter estimate: -0.11; SE: 0.05) for SRCs in NOHELM as compared to SRCs in HELM. CONCLUSIONS: Sport helmet status appears to be marginally related to time to URTP, where time for URTP was about a shorter among athletes in helmeted sports. Future studies should explore resulting clinical presentations and athlete characteristics across HELM and NOHELM SRCs. Supported by NCAA and DoD Award# W81XWH-14-2-0151.