Concussion Risk Between Individual Football Players: Survival Analysis of Recurrent Events and Non-events
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Annals of Biomedical Engineering (Ó 2020) https://doi.org/10.1007/s10439-020-02675-x
Concussion Biomechanics in Football
Concussion Risk Between Individual Football Players: Survival Analysis of Recurrent Events and Non-events STEVEN ROWSON ,1 EAMON T. CAMPOLETTANO,1 STEFAN M. DUMA,1 BRIAN STEMPER,2 ALOK SHAH,2 JAROSLAW HAREZLAK,3 LARRY RIGGEN,4 JASON P. MIHALIK,5 ALISON BROOKS,6 KENNETH L. CAMERON,7,8 STEVEN J. SVOBODA,7 MEGAN N. HOUSTON,7 THOMAS MCALLISTER,9 STEVEN BROGLIO,10 and MICHAEL MCCREA2 1
Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA; 2Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA; 3Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, IN, USA; 4Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA; 5Department of Exercise and Sport Science, Matthew Gfeller Sport-Related Traumatic Brain Injury Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; 6Department of Orthopedics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA; 7Department of Orthopaedic Surgery, Keller Army Community Hospital, United States Military Academy, West Point, NY, USA; 8Department of Sports Medicine, United States Air Force Academy, Colorado Springs, CO, USA; 9Department of Psychiatry, Indiana School of Medicine, Indianapolis, IN, USA; and 10Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA (Received 23 August 2020; accepted 21 October 2020) Associate Editor Joel Stitzel oversaw the review of this article.
Abstract—Concussion tolerance and head impact exposure are highly variable among football players. Recent findings highlight that head impact data analyses need to be performed at the subject level. In this paper, we describe a method of characterizing concussion risk between individuals using a new survival analysis technique developed with realworld head impact data in mind. Our approach addresses the limitations and challenges seen in previous risk analyses of football head impact data. Specifically, this demonstrative analysis appropriately models risk for a combination of leftcensored recurrent events (concussions) and right-censored recurrent non-events (head impacts without concussion). Furthermore, the analysis accounts for uneven impact sampling between players. In brief, we propose using the Consistent Threshold method to develop subject-specific risk curves and then determine average risk point estimates between subjects at injurious magnitude values. We describe an approach for selecting an optimal cumulative distribution function to model risk between subjects by minimizing injury prediction error. We illustrate that small differences in distribution fit can result in large predictive errors. Given the vast amounts of on-field data researchers are collecting across sports, this approach can be applied to develop population-specific risk curves that can ultimately inform interventions that redu
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