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The Effects of On-Field Heat Index and Altitude on Concussion Assessments and Recovery Among NCAA Athletes

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A Correction to this article was published on 25 January 2021

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Abstract

Background

Recent literature has indicated altitude may be a protective factor for concussion but it is unknown whether altitude or heat index affects recovery.

Objective

To examine whether on-field heat index and altitude at the time of injury alter acute (< 48 h) concussion assessments, days-to-asymptomatic, and days-to-return-to-play in collegiate athletes following concussion.

Methods

Collegiate athletes (n = 187; age = 19.7 ± 1.4 years; male = 70.6%) underwent baseline assessments across 30 universities and experienced a concussion in this retrospective cohort study. Altitude (m) and heat index (°C) at the time and location of injury were determined using valid online database tools. Acute concussion assessments included the Sport Concussion Assessment Tool (SCAT) symptom inventory, Balance Error Scoring System (BESS), and the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). We used multiple linear regression models to determine whether heat index and altitude predicted each acute assessment outcome, days-to-asymptomatic, and days-to-return-to-play.

Results

Collegiate athletes were concussed at a 181.1 m (range − 0.6 to 2201.9 m) median altitude and 17.8 °C (range − 6.1 to 35.6 °C) median heat index. Altitude did not predict (p ≥ 0.265) any outcomes. Every one-degree increase in heat index reduced days-to-asymptomatic (p = 0.047; R2 = 0.06) and days-to-return-to-play (p = 0.006; R2 = 0.09) by 0.05 and 0.14 days, respectively. Heat index and altitude did not explain significant variance in SCAT, BESS, and ImPACT composite scores (p’s = 0.20–0.922).

Conclusion

Our findings suggest that on-field altitude and heat index at the time of injury do not contribute to clinically meaningful changes on acute assessments or concussion recovery. On-field altitude and heat index do not appear to significantly alter assessment outcomes or clinical recovery, suggesting that environmental factors at altitudes below < 2500 m are negligible outcomes for researchers and clinicians to consider post-concussion.

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Author information

Authors and Affiliations

  1. UGA Concussion Research Laboratory, Department of Kinesiology, Ramsey Student Center, University of Georgia, 330 River Rd., Athens, GA, 30602, USA

    Landon B. Lempke, Robert C. Lynall, Rachel K. Le & Julianne D. Schmidt

  2. Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA

    Michael McCrea

  3. Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA

    Michael McCrea

  4. Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA

    Thomas McAllister

Authors
  1. Landon B. Lempke
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  2. Robert C. Lynall
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  3. Rachel K. Le
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  4. Michael McCrea
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  5. Thomas McAllister
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  6. Julianne D. Schmidt
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Consortia

CARE Consortium Investigators

  • M. Allison Brooks
  • , Megan N. Houston
  • , Steven J. Svoboda
  • , Darren E. Campbell
  • , Johnathan C. Jackson
  • , Jay R. Clugston
  • , Jane McDevitt
  • , April Marie Hoy
  • , Joseph B. Hazzard Jr.
  • , Louise A. Kelly
  • , Justus D. Ortega
  • , Nicholas Port
  • , Margot Putukian
  • , T. Dianne Langford
  • , Ryan Tierney
  • , Christopher C. Giza
  • , Joshua T. Goldman
  • , Holly J. Benjamin
  • , Thomas Buckley
  • , Thomas W. Kaminski
  • , James R. Clugston
  • , Julianne D. Schmidt
  • , Luis A. Feigenbaum
  • , Steven P. Broglio
  • , James T. Eckner
  • , Kevin Guskiewicz
  • , Jason P. Mihalik
  • , Jessica Dysart Miles
  • , Scott A. Anderson
  • , Christina L. Master
  • , Micky Collins
  • , Anthony P. Kontos
  • , Jeffrey J. Bazarian
  • , Sara P. O. Chrisman
  • , Alison Brooks
  • , Jonathan Jackson
  • , Gerald McGinty
  • , Patrick O’Donnell
  • , Kenneth L. Cameron
  • , Megan N. Houston
  • , Adam J. Susmarski
  • , Stefan Duma
  • , Steve Rowson
  • , Christopher Todd Bullers
  • , Christopher M. Miles
  • , Brian H. Dykhuizen
  •  & Laura Lintner

Corresponding author

Correspondence to Landon B. Lempke.

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Author Contributions

All authors contributed to the study conception, study design, critical review and interpretation of findings, and drafting and/or critique of the manuscript. All authors read and approved the final manuscript. Specifically, Landon B. Lempke contributed to conceptualization, methodology, data analysis, and original and revised manuscript drafts. Robert C. Lynall and Rachel K. Le contributed to conceptualization, analysis interpretation, and original and revised manuscript drafting. Michael McCrea and Thomas McAllister contributed to conceptualization, methodology, data analysis and manuscript critique, and funding acquisition. Julianne D. Schmidt contributed to conceptualization, analysis interpretation, original and revised manuscript drafting, and funding acquisition. The CARE Consortium Investigators contributed to critical critique and review of methodology, data analysis, and original manuscript review.

Acknowledgements

We would like to thank Aashka J. Sheth and Anoop S. Gundala for their efforts in extracting the environmental variables (air temperature, relative humidity, and altitude). We would also like to thank Jody Harland, Janetta Matesan, Larry Riggen (Indiana University); Ashley Rettmann (University of Michigan); Melissa Koschnitzke (Medical College of Wisconsin); Michael Jarrett, Vibeke Brinck and Bianca Byrne (Quesgen); and the research and medical staff at each of the participating sites. This study was made possible, in part, with support from the Grand Alliance Concussion Assessment, Research, and Education Consortium, funded by the National Collegiate Athletic Association and the Department of Defense. The US Army Medical Research Acquisition Activity, 820 Chandler Street, Fort Detrick, MD 21702-5014, USA is the awarding and administering acquisition office. This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs through the Psychological Health and Traumatic Brain Injury Program under Award no. W81XWH-14-2-0151. Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the Department of Defense (Defense Health Program funds). Contributing CARE Consortium Investigators include: Scott A. Anderson, ATC (University of Oklahoma); Holly J. Benjamin, MD (University of Chicago); M. Allison Brooks, MD, MPH (University of Wisconsin-Madison); Thomas Buckley, EdD, ATC and Thomas W. Kaminski, PhD, ATC (University of Delaware); Kenneth L. Cameron, PhD, MPH, ATC, Megan N. Houston, PhD, ATC, and Steven J. Svoboda, MD (United States Military Academy); Darren E. Campbell, MD, Johnathan C. Jackson, MD and Gerald McGinty, PT, DPT (United States Air Force Academy); Sara P. D. Chrisman, MD, MPH (University of Washington); Jay R. Clugston (University of Florida); Micky Collins and Anthony P. Kontos, PhD (University of Pittsburgh); Stefan Duma, PhD and Steve Rowson, PhD (Virginia Tech); Luis A. Feigenbaum, PT, DPT, ATC (University of Miami); Christopher C. Giza, MD and Joshua T. Goldman, MD, MBA (University of California – Los Angeles); Joseph B. Hazzard Jr., EdD, ATC (Bloomsburg University); Louise A. Kelly, PhD (California Lutheran University); Laura Lintner, DO and Chris Miles, MD (Wake Forest University); Christina L. Master, MD (University of Pennsylvania); Jane McDevitt, PhD, ATC (Temple University); Jason P. Mihalik, PhD, CAT(C), ATC (University of North Carolina at Chapel Hill); Jessica D. Miles, PhD, ATC (University of North Georgia); Justus Ortega, PhD (Humboldt State University); Nicholas Port, PhD (Indiana University); Margot Putukian, MD (Princeton University); and Adam J. Susmarski, DO (United States Naval Academy). CARE Consortium Investigators are listed alphabetically by institution: April Marie (Reed) Hoy, MS, ATC (Azusa Pacific University); Joseph B. Hazzard Jr., EdD, ATC (Bloomsburg University); Louise A. Kelly, PhD (California Lutheran University); Justus D. Ortega, PhD (Humboldt State University); Nicholas Port, PhD (Indiana University); Margot Putukian MD (Princeton University); T. Dianne Langford, PhD, and Ryan Tierney, PhD, ATC (Temple University); Christopher C. Giza, MD and Joshua T. Goldman, MD, MBA (University of California, Los Angeles); Holly J. Benjamin MD (University of Chicago); Thomas Buckley, EdD, ATC, and Thomas W. Kaminski, PhD, ATC (University of Delaware); James R. Clugston, MD, MS (University of Florida); Julianne D. Schmidt, PhD, ATC (University of Georgia); Luis A. Feigenbaum, DPT, ATC (University of Miami); Steven P. Broglio, PhD, ATC and James T. Eckner, MD, MS (University of Michigan); Kevin Guskiewicz, PhD, ATC, and Jason P. Mihalik, PhD, CAT(C), ATC (University of North Carolina at Chapel Hill); Jessica Dysart Miles, PhD, ATC (University of North Georgia); Scott Anderson, ATC (University of Oklahoma); Christina L. Master, MD (University of Pennsylvania); Micky Collins, PhD, and Anthony P. Kontos, PhD (University of Pittsburgh Medical Center); Jeffrey J. Bazarian, MD, MPH (University of Rochester); Sara P.O. Chrisman, MD, MPH (University of Washington); Alison Brooks, MD, MPH (University of Wisconsin-Madison); Jonathan Jackson, MD, and Gerald McGinty, DPT (United States Air Force Academy); Patrick O’Donnell, MHA (United States Coast Guard Academy); Kenneth Cameron, PhD, MPH, ATC; Megan N. Houston, PhD, ATC (United States Military Academy); Adam Susmarski, MD (United States Naval Academy); Stefan Duma, PhD and Steve Rowson, PhD (Virginia Tech); Christopher Todd Bullers, MD, and Christopher M. Miles, MD (Wake Forest University); Brian H. Dykhuizen, MS, ATC (Wilmington College); Laura Lintner DO (Winston-Salem University).

Funding

This study was made possible, in part, with support from the Grand Alliance Concussion Assessment, Research, and Education Consortium, funded by the National Collegiate Athletic Association and the Department of Defense. The US Army Medical Research Acquisition Activity, 820 Chandler Street, Fort Detrick, MD 21702–5014, USA is the awarding and administering acquisition office. This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs through the Psychological Health and Traumatic Brain Injury Program under Award no. W81XWH-14–2-0151. Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the Department of Defense (Defense Health Program funds).

Conflicts of Interest

Landon B. Lempke, Robert C. Lynall, Rachel K. Le, Michael McCrea, Thomas McAllister and Julianne D. Schmidt declare that they have no additional conflicts of interest relevant to the content of this review.

Availability of Data and Material

The CARE Consortium datasets generated and analyzed during the current study are available in the Federal Interagency Traumatic Brain Injury Research repository (https://fitbir.nih.gov/).

Research Involving Human Participants

The study was performed in accordance with the standards of ethics outlined in the Declaration of Helsinki.

Informed Consent

All study procedures were reviewed and approved by the University of Michigan IRB, the US Army Medical Research and Materiel Command Human Research Protection Office (HRPO), as well the local IRB at each of the performance sites. Participants provided written informed consent prior to participation.

Code Availability

Not applicable.

Additional information

This article is part of a Collection on The NCAA-DoD Concussion Assessment, Research and Education (CARE) Consortium.

Members of the ‘CARE Consortium Investigators’ are given in the Acknowledgements section.

The original article has been updated: Due to affiliation update.

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Lempke, L.B., Lynall, R.C., Le, R.K. et al. The Effects of On-Field Heat Index and Altitude on Concussion Assessments and Recovery Among NCAA Athletes. Sports Med 51, 825–835 (2021). https://doi.org/10.1007/s40279-020-01395-5

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