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C1-02
GENDER DIFFERENCES IN EXPOSURE TO AND OUT-
COMES OF MILD TRAUMATIC BRAIN INJURY IN AMA-
TEUR ADULT SOCCER PLAYERS
Eva Catenaccio
1
, Weiya Mu
1
, Namhee Kim
1
, Molly Zimmerman
1
,
Mark Wagshul
1
, Roman Fleysher
1
, Tamar Glattsein
1
, Malka Zughaft
1
,
Walter Stewart
4
, Richard Lipton
3
, Michael Lipton
1,2
1
Albert Einstein College of Medicine, GMRRC, Bronx, USA
2
Montefiore Medical Center, Radiology, Bronx, USA
3
Montefiore Medical Center, Neurology, Bronx, USA
4
Sutter Healthcare, R&D, Sacromento, USA
Female athletes are at increased risk for sports-related mild traumatic
brain injury (mTBI) and at increased risk for poor mTBI outcomes,
relative to males. Heading in soccer represents a source of repetitive
subconcussive head impacts. Previous research has shown that
heading exposure above a threshold of approximately 1800 headers/
year is associated with deficits in cognitive function including de-
creased verbal memory performance. This study assesses the role of
gender as a predictor of mTBI-associated functional outcomes, in-
cluding cognitive function and post concussive symptoms (PCS), in a
cohort of amateur soccer players. 82 players (41 females and 41 age-
and educated-matched males, ages 18–52) were drawn from an on-
going longitudinal study of sub-concussive and concussive mTBI in
amateur soccer players. All subjects underwent a battery of cognitive
tests and symptoms assessments. Group differences were calculated
between men and women using the Mann-Whitney U-test for heading
exposure, history of concussion, cognitive performance and PCS at
their enrollment visit. Results were corrected for multiple compari-
sons using false discovery rate (FDR) correction (alpha
=
0.05). Men
reported more soccer play and more heading during the 12 months
prior to enrollment (p
=
0.003). Women, however, reported more prior
concussions (p
=
0.001), Women also endorsed significantly more
acute PCS (headaches, dizziness, and nausea/vomiting) than men
(p
=
0.018). However, men demonstrate decreased performance on a
verbal memory task (p
=
0.001). All reported results survived FDR-
correction. These data suggest that women are at increased risk for
concussion and PCS, despite lesser overall frequency of soccer play
and heading. Men, who report greater exposure to heading, show
poorer verbal memory, which is consistent with prior results associ-
ating greater heading exposure with deficits in verbal memory.
Keywords: Gender, Sports Related TBI, Concussion, Post Con-
cussive Symptoms
C1-03
MILITARY DEPLOYMENT INCREASES THE RISK FOR TBI
FOLLOWING DEPLOYMENT
Donald Marion
, Lemma Regasa, Mike Thomas, Ranjodh Gill, Brian
Ivins
Defense and Veterans Brain Injury Center, Clinical Affairs, Silver
Spring, USA
The objective of this study was to compare rates of traumatic brain
injury (TBI) diagnosis before and after overseas military deployment.
We conducted a retrospective examination of a cohort of 119,353
active duty United States military service members (Army, Navy, Air
Force, and Marines) whose
first lifetime
overseas deployment began at
any time between January 1, 2011 and December 31, 2011 and lasted
for at least 30 days. For this cohort, TBI diagnoses were examined
during the 76 weeks prior to deployment, during deployment, and for
76 weeks following the end of deployment. The main outcome
measure was the rate of TBI diagnosis at sequential 4 week intervals.
We found that the risk of being diagnosed with TBI within 4 weeks
after returning from deployment was 8.4 times higher than the average
risk before deployment. The risk gradually decreased thereafter up to
40 weeks post deployment. During the 41 to 76 weeks following
deployment the risk stabilized. The
pre-deployment incidence
of TBI
diagnosis was 119.8/100,00 for all services, and was highest for Army
(147/100,000).
Following deployment
the incidence of TBI diagnosis
was initially as high as 400/100,000 and declined to approximately
200/100,000 at 40 weeks after deployment. At that point the risk ratio
for TBI diagnosis stabilized to 1.7 (95% CI: 1.6–1.8) during the 41 to
76 weeks after injury, compared to the pre-deployment risk. These
data suggest an increased rate of TBI diagnosis following deployment
which, during the first 40 weeks, is most likely a result of a delay in
the diagnosis of TBIs that actually occurred while service members
were deployed. Both the Department of Defense and the Department
of Veterans Affairs have mechanisms for aggressive post-deployment
identification of concussions that occured during deployment. How-
ever, the stable but increased rate of TBI diagnoses observed at 40–76
weeks following deployment suggests that the
experience of deploy-
ment
may increase risk taking behaviors of service members, leading
to an increased incidence of TBIs.
Keywords: concussion, Military, deployment, concussion risk,
garrison concussion
C1-04
VERY EARLY ADMINISTRATION OF PROGESTERONE
DOES NOT IMPROVE COGNITIVE OUTCOMES IN PA-
TIENTS WITH MODERATE TO SEVERE TBI
Felicia Goldstein
1
, Angela Caveney
3
, Vicki Hertzberg
2
, Robert
Silbergleit
3
, Sharon Yeatts
5
, Yuko Palesch
5
, Harvey Levin
4
,
David
Wright
1
1
Emory, Emergency/Neurology, Atlanta, US
2
Michigan, Emergency, Ann Arbor, US
3
Baylor, PM&R, Houston, US
4
South Carolina, Statistics, Charleston, US
5
Rollins, Biostatistics, Atlanta, US
Objectives:
Despite promising Phase II clinical trial data, early ad-
ministration of progesterone did not improve gross functional out-
comes or mortality in two recent large confirmatory phase III trials of
patients with moderate to severe TBI. However, these outcomes may
be insufficiently sensitive to treatment effects. This analysis of sec-
ondary neuropsychological outcomes evaluates whether progesterone
is associated with improved recovery of cognitive functioning.
Methods:
A Phase III, double-blind, placebo-controlled trial
(ProTECT III) was conducted at 49 Level I trauma centers in the
United States. Adults with moderate to severe TBI (GCS score 4 to
12) were randomized to intravenous progesterone or placebo initiated
within 4 hours of injury and administered for 96 hours. At 6 months
(
–
30 days), participants capable of testing underwent evaluation of
memory, executive functioning, attention, and language.
Results:
546 subjects were testable (263 progesterone, 283 placebo).
Analyses of covariance, controlling for potential confounders, did not
reveal significant treatment effects for Buschke immediate (41.8 SD-
11 progesterone, 42.3 SD-12 placebo) or delayed (5.7 SD-3 proges-
terone, 5.7 SD-3 placebo) word recall, Trails A sequencing speed
(36.5 SD-18 progesterone, 37.0 SD-19 placebo) and Trails B set
shifting speed (94.3 SD-54 progesterone, 95.2 SD-57 placebo), digit
span forward (9.2 SD-2.1 progesterone, 9.4 SD2.4 placebo) and
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