Posted September 12, 2017

Thomas McAllister, M.D., Indiana University, Steven Broglio, Ph.D., University of Michigan, Michael McCrea, Ph.D., Medical College of Wisconsin

Mild traumatic brain injury (mTBI) and sport-related concussion (SRC) are major public health problems. The Concussion Assessment, Research, and Education Consortium (CARE), led by Drs. Thomas McAllister, Michael McCrea, and Steven Broglio, is an alliance between the National Collegiate Athletic Association (NCAA) and the Department of Defense (DoD) that was developed to establish a multicenter consortium to conduct the most comprehensive assessment of SRC in male and female college athletes and Military Service Academy cadets. The goal of this consortium is to perform a prospective, longitudinal, multi-site, multi-sport investigation to define the 6-month natural history of concussion and recovery and identify diagnostic and prognostic biomarkers to monitor recovery.

The CARE Consortium was recently featured in a collaborative publication in Sports Medicine (March 2017). The manuscript highlights the NCAA-DoD Grand Alliance hierarchy and illustrates the various committees, research cores, challenges, and the 30 sites that currently make up the consortium. Each of the three prime cores – Administration and Operations Core (AOC), Longitudinal Clinical Study Core (CSC), and Advanced Research Core (ARC) – is governed by its own set of parameters for assessment. The AOC, led by Dr. Thomas McAllister, oversees administrative and operations matters, such as providing and maintaining standard operating procedures, providing assistance with regulatory issues, supporting the various committees, and houses the biostatics and data management, bioinformatics, and biospecimens teams for the CSC and ARC. The CSC, under the leadership of Dr. Steven Broglio, oversees the foundational study on the longitudinal study of the natural history of concussion. The ARC, led by Dr. Michael McCrea, oversees the foundational study on the neurobiology of concussion. A formal data collection process has been designed to expedite the acquisition of data for integration and analysis. A link to the manuscript is provided below.

This study has several features that make it one of the most comprehensive and in-depth studies of concussion to date. First, while most prior studies of concussion have focused predominantly on injuries in male American football players, this study includes athletes of both genders and those engaged in all NCAA sanctioned sports. Specifically, over a third of the concussion participants in the CARE study are women, making this the largest sample of female athletes and concussions studied thus far. Additionally, this study follows participants long-term, for up to 6 months following concussion, allowing the researchers to obtain a detailed picture of the natural history of concussion, typical recovery trajectory, and injury characteristics that contribute to prolonged symptoms and poor recovery. Furthermore, there is an opportunity to leverage the CARE infrastructure and the cohort to definitively address public health concerns regarding long-term effects of concussion.

Perhaps most important is the significant inclusion of participants from the Military Service Academies, making this study highly relevant for both civilian and military populations. The consortium has enrolled over 30,000 college athletes and Military Service Academy cadets. Participation from the Military Service Academies is not limited to NCAA athletes, as nearly 40% of the enrolled cohort are non-varsity level cadets. The consortium has studied nearly 2,300 individuals with concussion, making this the largest study of concussion to date. Of particular interest, over 20% of the concussions have occurred in Military Service Academy varsity and non-varsity cadets, making this the largest cohort of its kind.

One of the most anticipated outcomes of the study will be the opportunity to learn more about the underlying neurobiology of concussion. With the ARC arm of the study, concussed athletes and cadets will undergo (1) assessment of the number and severity of head impacts associated with contact sport and concussion, (2) advanced multi-modal magnetic resonance imaging (MRI) to assess brain structure and function after concussion, (3) assessment of blood biomarkers that may ultimately improve diagnosis and recovery monitoring of concussion, and (4) genetic assessment that could be used to identify individuals who may be at risk for concussion or suffering the long-term effects of concussion and/or poor recovery from concussion.

Together, Drs. McAllister, Broglio and McCrea anticipate that the CARE project will help determine whether there is a difference between clinical recovery (when the athlete feels better) and neurophysiological recovery of the brain (when the brain has actually recovered). This will, in turn, allow for refinement of concussion management protocols and return to activity guidelines. In concert with data from other projects, the CARE data are already being used to refine athlete safety protocols in high-risk sports such as football and injury management across all the sites. The researchers expect that, as more data are analyzed, the project will make significant contributions to the knowledge of how long it takes to recover from concussion, when is it safe to return to activity, who is at risk for poor outcome, and how genetic, blood, and neuroimaging biomarkers can help in diagnosis, recovery monitoring, and outcome prediction after concussion.

Publication:

Broglio SB, McCrea M, McAllister T, Harezlak J, Katz B, Hack D, Hainline B, CARE Consortium Investigators. 2017. A National Study on the Effects of Concussion in Collegiate Athletes and US Military Service Academy Members: The NCAA-DoD Concussion Assessment, Research and Education (CARE) Consortium Structure and Methods. Sport Med 47(7):1437-1451.

https://rd.springer.com/article/10.1007%2Fs40279-017-0707-1

Link:

Public and Technical Abstracts: THE NCAA-DOD GRAND ALLIANCE: Concussion Assessment, Research, and Education Consortium (CARE)

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