RESUMEN
Introduction Diagnosing a concussion is challenging because of complex and variable symptoms. Establishing a viable biomarker of injury may rely on physiologic measurements rather than symptomology. Volatile organic compounds (VOCs) such as breath acetone have been identified as potential physiological markers that can capture changes in the utilization of energy substrates post-concussion. Here, we aimed to explore whether differences in VOCs exist between concussed and non-concussed athletes at the initial and later stages of injury recovery. Methods Six (N=6) non-concussed athletes were enrolled as control participants prior to the competitive season. Control participants' breath acetone, heart rate, and anthropometric measures were obtained at rest and throughout a single exercise challenge by breathalyzer. Six (N=6) athletes diagnosed with concussion during the competitive season had breath acetone measured daily until cleared to return to activity or approximately four weeks following enrollment where they participated in an exit exercise challenge having breath acetone, heart rate, and anthropometric measures obtained. Comparisons were made between at-rest measures of concussed and non-concussed participants at multiple time points during the recovery period. Paired t-test comparisons with individuals serving as their own control were used to determine individual differences in recovery. Visual graphs were used to demonstrate differences in obtained measures amongst individuals and between groups during the exercise challenges. Results Results demonstrated statistically significant differences in breath acetone between concussed and control participants when the highest day measured during the first week of concussion was compared to the control participant's resting values (P=0.017). Additionally, when the concussed participants served as their own control and their highest measured day of the first week post-concussion was compared to values when cleared to return to activity or at 26 days post-concussion, there was a significant difference in breath acetone (P=0.028). Comparing breath acetone during exercise between non-concussed and cleared concussed participants or four weeks post-injury, demonstrated no significant differences throughout the challenge or at rest prior. Visual graph comparisons in a single participant before and after concussion suggest differences may appear following exercise during the recovery period. Discussion These results suggest VOCs, particularly breath acetone, have the potential to serve as diagnostic markers of concussion. However, longitudinal research within larger cohorts and with equipment able to expel VOCs other than acetone from measures are needed to make informed recommendations.
RESUMEN
Concussion policies are increasingly being developed and adopted among professional sports organizations. We sought to compare the policies of the National Hockey League (NHL), the National Basketball Association (NBA), the National Football League (NFL), and Major League Baseball (MLB). Our objective was to summarize each policy and evaluate the extent to which each policy is organization-specific and/or consistent with medical guidelines. We visited websites for the NHL, NBA, NFL, and MLB. We searched media articles reporting concussion policy. We utilized only publically available data. We collected information on each league's approach to the definition of concussion, education provided about concussion, baseline testing requirements, minimum return to play time and return to play protocol. We found that concussion policies vary across these organizations. Most organizations utilize the Concussion in Sport Group (CISG) definition (2013) to define concussion. The NFL and NBA mandate preseason education. All organizations require some type of baseline testing. All organizations require sideline evaluation after suspected concussion. The NFL and MLB require Sport Concussion Assessment Tool (SCAT) testing for sideline evaluation of suspected concussion. MLB is the only organization to require minimum time before return to play. There is a return to play protocol in place for each organization. The NFL and MLB require independent neurologic consultation as part of their return to play protocol. There is variability in concussion policy among the professional sports organizations. The most pronounced variation from the CISG consensus statement is the variability in the minimum time to return to play. Further, the rules of the individual sports have a role in how concussion policy can be designed and implemented. Professional sports set an example for thousands of recreational sports enthusiasts so their publically available policies on concussion have a large impact.