title: Timing of concussion diagnosis is related to head impact exposure prior to injury.
abstract: OBJECTIVE
  Concussions are commonly undiagnosed in an athletic environment because the postinjury signs and symptoms may be mild, masked by the subject, or unrecognized. This study compares measures of head impact frequency, location, and kinematic response before cases of immediate and delayed concussion diagnosis.
  
  
  METHODS
  Football players from eight collegiate and six high school teams wore instrumented helmets during play (n = 1208), of which 95 were diagnosed with concussion (105 total cases). Acceleration data recorded by the instrumented helmets were reduced to five kinematic metrics: peak linear and rotational acceleration, Gadd severity index, head injury criterion, and change in head velocity (Δv). In addition, each impact was assigned to one of four general location regions (front, back, side, and top), and the number of impacts sustained before injury was calculated over two periods (1 and 7 days).
  
  
  RESULTS
  All head kinematic measures associated with injury, except peak rotational acceleration (P = 0.284), were significantly higher for cases of immediate diagnosis than delayed diagnosis (P < 0.05). Players with delayed diagnosis sustained a significantly higher number of head impacts on the day of injury (32.9 ± 24.9, P < 0.001) and within 7 d of injury (69.7 ± 43.3, P = 0.006) than players with immediate diagnosis (16.5 ± 15.1 and 50.2 ± 43.6). Impacts associated with concussion occurred most frequently to the front of the head (46%) followed by the top (25%), side (16%), and back (13%) with the number of impacts by location independent of temporal diagnosis (χ(3) = 4.72, P = 0.19).
  
  
  CONCLUSIONS
  Concussions diagnosed immediately after an impact event are associated with the highest kinematic measures, whereas those characterized by delayed diagnosis are preceded by a higher number of impacts.
authors.affiliation: Simbex, Lebanon, NH 03766, USA. jbeckwith@simbex.com
authors.forename: Jonathan G
authors.initials: JG
authors.lastname: Beckwith
authors.forename: Richard M
authors.initials: RM
authors.lastname: Greenwald
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Chu
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Crisco
authors.forename: Steven
authors.initials: S
authors.lastname: Rowson
authors.forename: Stefan M
authors.initials: SM
authors.lastname: Duma
authors.forename: Steven P
authors.initials: SP
authors.lastname: Broglio
authors.forename: Thomas W
authors.initials: TW
authors.lastname: McAllister
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Guskiewicz
authors.forename: Jason P
authors.initials: JP
authors.lastname: Mihalik
authors.forename: Scott
authors.initials: S
authors.lastname: Anderson
authors.forename: Brock
authors.initials: B
authors.lastname: Schnebel
authors.forename: P Gunnar
authors.initials: PG
authors.lastname: Brolinson
authors.forename: Michael W
authors.initials: MW
authors.lastname: Collins
mesh_terms: D000293:Adolescent; D001924:Brain Concussion / Q000175:diagnosis* / Q000209:etiology*; D057210:Delayed Diagnosis; D004781:Environmental Exposure; D005538:Football / Q000293:injuries*; D016489:Head Injuries, Closed / Q000453:epidemiology*; D006260:Head Protective Devices; D006801:Humans; D008297:Male; D013686:Telemetry / Q000295:instrumentation; D013997:Time Factors; D055815:Young Adult