Evidence-based review of TBI in sport

Experts from Johns Hopkins Medicine hosted a press conference following a continuing medical education program on the epidemiology of head injury in professional football. The program was an evidence-based review of traumatic brain injury in the sport.

The objectives of the conference on Traumatic Brain Injury in Professional Football: An Evidence-Base Perspective was to assess the current scientific knowledge on this subject and to make recommendations for the future research needed to answer the remaining questions regarding the diagnosis and treatment of traumatic brain injury (TBI).

Among the major recommendations for the future mild traumatic brain injury (MTBI) biomarkers research agenda were:
•Conduct prospective longitudinal studies evaluating the value of clinical tests, serum biomarkers, imaging, and electrophysiological tests in a.) differentiating players with and without traumatic brain damage, b.) detecting the effect of preventive/therapeutic interventions, and c.) predicting long-term cognitive and behavioral outcomes.
•The need for MRI and PET studies to determine in vivo morphological and functional correlates of physical impacts, concussions and long-term post-TBI cognitive decline.
•The need to implement MRI and electrophysiology studies to identify mechanisms of neural plasticity following MTBI.
For the area of long-term neuropsychiatric outcomes after TBI, the following research agenda was recommended:
•A study of former players, with state-of-the-art measures, to determine:
- Rates of neuropsychiatric disorders by age
- The relationship between neuropsychiatric disorders and cumulative exposure to sub-concussive or concussive impacts sustained across the player's career.
•Design and start a cohort study of retiring players for the same purpose.
Research recommendations for chronic traumatic encephalopathy (CTE) include:
•Additional study of CTE pathology and neurobiology.
•Development of biomarkers to detect CTE in vivo among former players and other athletes.
•Development of animal models to test the hypothesis that repeat injury leads to degenerative tauopathy and to identify mechanisms that can be targets for intervention.
Recommendations for mitigating the consequences of TBI in football include:
•Development of a longitudinal concussion and "hits" database to capture prior and present episodes, quantify symptoms, document evaluations for return to play and document rehabilitation strategies.