Comparing Concussion Mechanism And Presentation In Civilian Student-athletes And Military Cadets: Care Consortium Findings

Concussion management strategies for military populations often draw from studies on intercollegiate civilian (IC) student-athletes. Unique exposures in military populations may alter concussion mechanisms and presentations, challenging the generalizability of these recommendations. PURPOSE: To compare concussion mechanism and immediate presentation between IC student-athletes and military cadets. METHODS: Civilian student-athletes and cadets were enrolled in the CARE Consortium and placed in IC student-athletes (n = 3272, 20.2 ± 1.3 yr), IC military cadets (n = 748, 20.2 ± 1.1 yr), or non-IC military cadet (n = 1464, 20.1 ± 1.5 yr) groups. We classified injury mechanism as physical activity related or not due to unique military exposures. Immediate presentation was portrayed by presence of motor impairment (yes/no), altered mental status (yes/no), delayed symptom onset (yes/no), symptom severity, and SAC total score. Group comparisons were conducted using one-way ANOVA’s with Tukey post-hoc or Chi-squared (alpha = 0.05). RESULTS: Table 1 displays comparison data. SAC total score was worse in IC student-athletes than both cadet groups (p < 0.001), but not between cadet groups (p = 0.868). Symptom severity was lower in IC military cadets than IC student-athletes (p = 0.008) and non-IC military cadets (p < 0.001) but not between IC student-athletes and non-IC military cadets (p = 0.132). Non-IC military cadets had the greatest proportion of altered mental status (p < 0.001), motor impairment (p < 0.001), and physical activity related concussions (p < 0.001) with no differences observed for delayed symptom onset (p = 0.763). CONCLUSION: Military concussion management strategies often rely on recommendations from studies of IC student-athletes. Our findings show disparities in mechanism and presentation between IC student-athletes and military cadets. Future research should explore if differences persist across other clinical measures and during recovery. Table 1. - Comparison of concussion mechanism and immediate presentation between groups Variable Group Mean (SD) Interactionp-value Post Hoc Comparisons Sig. Effect size (Cohen’s d) SAC Total Score* IC 26.39 (2.6) <0.001 Civilian IC vs Military IC* <0.001 0.32 Military IC 27.17 (2.3) Civilian IC vs Military non-IC* <0.001 0.34 Military non-IC 27.23 (2.3) Military IC vs Military non-IC 0.868 0.03 Symptom Severity* IC 28.07 (22.3) <0.001 Civilian IC vs Military IC* 0.008 0.13 Military IC 25.26 (19.5) Civilian IC vs Military non-IC 0.132 0.06 Military non-IC 29.47 (21.5) Military IC vs Military non-IC* <0.001 0.21 Variable Group Yes No x 2 Sig. Delayed Onset IC 31.0% (n = 995) 69.0%(n = 2210) 1.85 0.763 Military IC 30.6% (n = 223) 69.4%(n = 505) Military non-IC 31.3% (n = 446) 68.7%(n = 980) Altered Mental Status* IC 45.6% (n = 1462) 54.4%(n = 1744) 85.75 <0.001 Military IC 57.3% (n = 418) 42.7%(n = 312) Military non-IC 58.9% (n = 839) 41.1%(n = 586) Motor Impairment* IC 12.6% (n = 319) 87.4% (n = 2219) 139.18 <0.001 Military IC 20.4% (n = 126) 79.6%(n = 493) Military non-IC 25.3% (n = 314) 74.7%(n = 929) Physical Activity related* IC 86.7% (n = 2831) 13.3%(n = 436) 91.4 <0.001 Military IC 93.9% (n = 702) 6.1%(n = 46) Military non-IC 94.9% (n = 1390) 5.1%(n = 74)