{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T20:13:55Z","timestamp":1792700035972,"version":"4.5.0"},"reference-count":38,"publisher":"Springer Science and Business Media LLC","issue":"9","license":[{"start":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T00:00:00Z","timestamp":1746057600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T00:00:00Z","timestamp":1746057600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100013132","name":"Combat Casualty Care Research Program","doi-asserted-by":"publisher","award":["W81XWH1420151"],"award-info":[{"award-number":["W81XWH1420151"]}],"id":[{"id":"10.13039\/100013132","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sports Med"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>The influence of repetitive head impacts on collegiate football players remains unclear as prior research is often limited to small samples or short-term studies focused on single seasons.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Objective<\/jats:title>\n            <jats:p>Our objective was to determine the associations between collegiate football career or incident concussion and changes in neurocognitive function, postural stability, and physical and psychological health.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>In total, 574 football players enrolled in the Grand Alliance Concussion Assessment, Research and Education (CARE) Consortium (median age 18.0\u00a0years [interquartile range 18.0\u201319.0], 52% white race, 26% with incident concussion) completed baseline and exit evaluations (i.e., beginning and end of collegiate career) consisting of neurocognitive, postural stability, and physical\/psychological health assessments, specifically, Immediate Post-Concussion Assessment and Cognitive Testing, Standardized Assessment of Concussion, Balance Error Scoring System, Sport Concussion Assessment Tool-5 (SCAT-5) Symptom checklist, and the Brief Symptom Inventory-18. Adjusted linear regression models incorporating inverse probability of attrition weighting were used to compare changes in scores between baseline and exit evaluations overall and by incident concussion status.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Overall, athletes had small improvements in neurocognitive functioning and postural stability over time but had small increases in symptom severity. Both the incident concussion and no incident concussion groups improved similarly on neurocognitive and postural stability measures (all <jats:italic>p<\/jats:italic>\u2009&gt;\u20090.05 for difference in change over time between incident concussion groups). Individuals with incident concussion reported fewer symptoms and lower symptom severity over time than did those without incident concussion (SCAT symptom count difference\u2009\u2212\u20091.22; 95% confidence interval [CI]\u2009\u2212\u20091.89 to\u2009\u2212\u20090.54; SCAT symptom severity difference:\u2009\u2212\u20092.46; 95% CI\u2009\u2212\u20094.06 to\u2009\u2212\u20090.86; Brief Symptom Inventory-18 somatization difference:\u2009\u2212\u20090.55; 95% CI\u2009\u2212\u20090.93 to\u2009\u2212\u20090.17).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Overall, collegiate football players demonstrated small, non-clinically meaningful improvements in neurocognitive function and postural stability. Moreover, athletes who experienced a concussion reported slight improvements in physical\/psychological health symptoms over their collegiate careers.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s40279-025-02234-1","type":"journal-article","created":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T00:45:00Z","timestamp":1746060300000},"page":"2313-2322","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Associations of Collegiate Football Career and Incident Concussion with Players' Health: A Longitudinal Study from the CARE Consortium"],"prefix":"10.1007","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4599-8543","authenticated-orcid":false,"given":"Katherine J.","family":"Hunzinger","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaclyn B.","family":"Caccese","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Connor A.","family":"Law","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachael M.","family":"Wittmer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas A.","family":"Buckley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven P.","family":"Broglio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas W.","family":"McAllister","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A.","family":"McCrea","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul F.","family":"Pasquina","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea L. C.","family":"Schneider","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the CARE Consortium Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Holly J.","family":"Benjamin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"D\u2019Lauro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James T.","family":"Eckner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher C.","family":"Giza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin M.","family":"Guskiewicz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas W.","family":"Kaminski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura J.","family":"Lintner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina L","family":"Master","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"McDevitt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason P.","family":"Mihalik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Miles","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justus","family":"Ortega","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas L.","family":"Port","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margot","family":"Putukian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Susmarski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,5,1]]},"reference":[{"key":"2234_CR1","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1097\/HTR.0000000000000138","volume":"31","author":"HG Belanger","year":"2016","unstructured":"Belanger HG, Vanderploeg RD, McAllister T. Subconcussive blows to the head: a formative review of short-term clinical outcomes. J Head Trauma Rehabil. 2016;31:159\u201366.","journal-title":"J Head Trauma Rehabil"},{"key":"2234_CR2","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1097\/HTR.0000000000000767","volume":"37","author":"SJ Stephen","year":"2022","unstructured":"Stephen SJ, Hasman L, Goldenberg M, Merchant-Borna K, Kawata K, Mannix R, et al. Short-term neurologic manifestations of repetitive head impacts among athletes: a scoping review. J Head Trauma Rehabil. 2022;37:318\u201325.","journal-title":"J Head Trauma Rehabil"},{"key":"2234_CR3","doi-asserted-by":"publisher","first-page":"205","DOI":"10.4085\/1062-6050-51.4.05","volume":"51","author":"JE Simon","year":"2016","unstructured":"Simon JE, Docherty CL. Current health-related quality of life in former national collegiate athletic association division I collision athletes compared with contact and limited-contact athletes. J Athl Train. 2016;51:205\u201312.","journal-title":"J Athl Train"},{"issue":"4","key":"2234_CR4","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.8775","volume":"5","author":"A Phelps","year":"2022","unstructured":"Phelps A, Alosco ML, Baucom Z, Hartlage K, Palmisano JN, Weuve J, et al. Association of playing college American football with long-term health outcomes and mortality. JAMA Netw Open. 2022;5(4): e228775.","journal-title":"JAMA Netw Open"},{"key":"2234_CR5","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1089\/neu.2016.4413","volume":"34","author":"PH Montenigro","year":"2017","unstructured":"Montenigro PH, Alosco ML, Martin BM, Daneshvar DH, Mez J, Chaisson CE, et al. Cumulative head impact exposure predicts later-life depression, apathy, executive dysfunction, and cognitive impairment in former high school and college football players. J Neurotrauma. 2017;34:328\u201340.","journal-title":"J Neurotrauma"},{"key":"2234_CR6","doi-asserted-by":"publisher","first-page":"486","DOI":"10.1249\/MSS.0000000000001466","volume":"50","author":"AE Lincoln","year":"2018","unstructured":"Lincoln AE, Vogel RA, Allen TW, Dunn RE, Alexander K, Kaufman ND, et al. Risk and causes of death among former national football league players (1986\u20132012). Med Sci Sport Exerc. 2018;50:486\u201393.","journal-title":"Med Sci Sport Exerc"},{"key":"2234_CR7","doi-asserted-by":"publisher","first-page":"810","DOI":"10.1136\/bjsports-2023-106890","volume":"57","author":"GL Iverson","year":"2023","unstructured":"Iverson GL, Castellani RJ, Cassidy JD, Schneider GM, Schneider KJ, Echemendia RJ, et al. Examining later-in-life health risks associated with sport-related concussion and repetitive head impacts: a systematic review of case-control and cohort studies. Br J Sports Med. 2023;57:810\u201321.","journal-title":"Br J Sports Med"},{"key":"2234_CR8","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1080\/15438627.2022.2090249","volume":"32","author":"AE Walter","year":"2024","unstructured":"Walter AE, Wilkes JR, Scaramuzzo M, Johns-Bostick T, Lynch S, Sebastianelli W, et al. Head acceleration event exposure and cognitive and functional outcomes: a comparison of multiple football seasons. Res Sport Med. 2024;32:122\u201331.","journal-title":"Res Sport Med"},{"key":"2234_CR9","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1249\/MSS.0000000000001761","volume":"51","author":"TA Buckley","year":"2019","unstructured":"Buckley TA, Oldham JR, Watson DJ, Murray NG, Munkasy BA, Evans KM. Repetitive head impacts in football do not impair dynamic postural control. Med Sci Sports Exerc. 2019;51:132\u201340.","journal-title":"Med Sci Sports Exerc"},{"key":"2234_CR10","doi-asserted-by":"publisher","first-page":"205970022098316","DOI":"10.1177\/2059700220983165","volume":"4","author":"AE Walter","year":"2020","unstructured":"Walter AE, Scaramuzzo M, Bream T, Seidenberg P, Lynch S, Slobounov SM. Effect of subconcussive impacts on functional outcomes over a single collegiate football season. J Concussion. 2020;4:205970022098316.","journal-title":"J Concussion"},{"key":"2234_CR11","doi-asserted-by":"publisher","first-page":"1777","DOI":"10.1212\/WNL.0b013e3182582fe7","volume":"78","author":"TW McAllister","year":"2012","unstructured":"McAllister TW, Flashman L, Maerlender A, Greenwald R, Beckwith J, Tosteson T, et al. Cognitive effects of one season of head impacts in a cohort of collegiate contact sport athletes. Neurology. 2012;78:1777\u201384.","journal-title":"Neurology"},{"key":"2234_CR12","doi-asserted-by":"publisher","first-page":"1355","DOI":"10.1249\/MSS.0000000000001905","volume":"51","author":"JB Caccese","year":"2019","unstructured":"Caccese JB, Best C, Lamond LC, Difabio M, Kaminski TW, Watson DAN, et al. Effects of repetitive head impacts on a concussion assessment battery. Med Sci Sport Exerc. 2019;51:1355\u201361.","journal-title":"Med Sci Sport Exerc"},{"key":"2234_CR13","doi-asserted-by":"publisher","first-page":"155","DOI":"10.3928\/19425864-20140710-02","volume":"6","author":"JL Volberding","year":"2014","unstructured":"Volberding JL, Melvin D. Changes in ImPACT and graded symptom checklist scores during a division I football season. Athl Train Sport Health Care. 2014;6:155\u201360.","journal-title":"Athl Train Sport Health Care"},{"key":"2234_CR14","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1007\/s10439-011-0421-3","volume":"40","author":"SM Gysland","year":"2012","unstructured":"Gysland SM, Mihalik JP, Register-Mihalik JK, Trulock SC, Shields EW, Guskiewicz KM. The relationship between subconcussive impacts and concussion history on clinical measures of neurologic function in collegiate football players. Ann Biomed Eng. 2012;40:14\u201322.","journal-title":"Ann Biomed Eng"},{"key":"2234_CR15","doi-asserted-by":"crossref","unstructured":"Bonke EM, Southard J, Buckley TA, Reinsberger C, Koerte IK, Howell DR. The effects of repetitive head impacts on postural control: a systematic review. J Sci Med Sport. Sports Med Australia. 2021;24:247\u201357.","DOI":"10.1016\/j.jsams.2020.09.003"},{"key":"2234_CR16","unstructured":"Lynall RC, Lauro CD, Kerr ZY, Knight K, Kroshus E, Leeds DD, et al. Optimizing concussion care seeking. The influence of previous concussion diagnosis status on baseline assessment outcomes. Am J Sports Med. 2022;1\u201311."},{"key":"2234_CR17","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1007\/s40279-021-01541-7","volume":"52","author":"SP Broglio","year":"2022","unstructured":"Broglio SP, McAllister T, Katz BP, LaPradd M, Zhou W, McCrea MA, et al. The natural history of sport-related concussion in collegiate athletes: findings from the NCAA-DoD CARE Consortium. Sport Med. 2022;52:403\u201315.","journal-title":"Sport Med"},{"key":"2234_CR18","doi-asserted-by":"publisher","first-page":"1895","DOI":"10.1249\/MSS.0000000000002657","volume":"53","author":"KJ Hunzinger","year":"2021","unstructured":"Hunzinger KJ, Caccese JB, Costantini KM, Swanik CB, Buckley TA. Age of first exposure to collision sports does not affect patient reported outcomes in women and men community rugby players. Med Sci Sport Exerc. 2021;53:1895\u2013902.","journal-title":"Med Sci Sport Exerc"},{"issue":"3","key":"2234_CR19","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1136\/jnnp-2021-326602","volume":"93","author":"BL Brett","year":"2022","unstructured":"Brett BL, Kerr ZY, Walton SR, Chandran A, Defreese JD, Mannix R, et al. Longitudinal trajectory of depression symptom severity and the influence of concussion history and physical function over a 19-year period among former National Football League (NFL) players: an NFL-LONG Study. J Neurol Neurosurg Psychiatry. 2022;93(3):272\u20139.","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"2234_CR20","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1089\/neu.2015.3930","volume":"33","author":"WP Meehan","year":"2016","unstructured":"Meehan WP, Taylor AM, Berkner P, Sandstrom NJ, Peluso MW, Kurtz MM, et al. Division III collision sports are not associated with neurobehavioral quality of life. J Neurotrauma. 2016;33:254\u20139.","journal-title":"J Neurotrauma"},{"key":"2234_CR21","doi-asserted-by":"publisher","first-page":"1437","DOI":"10.1007\/s40279-017-0707-1","volume":"47","author":"SP Broglio","year":"2017","unstructured":"Broglio SP, McCrea M, McAllister T, Harezlak J, Katz B, Hack D, et al. A National Study on the effects of concussion in collegiate athletes and US Military Service Academy members: the NCAA\u2013DoD Concussion Assessment, Research and Education (CARE) Consortium structure and methods. Sport Med. 2017;47:1437\u201351.","journal-title":"Sport Med"},{"key":"2234_CR22","doi-asserted-by":"publisher","first-page":"838","DOI":"10.1136\/bjsports-2017-097699","volume":"51","author":"P Mccrory","year":"2018","unstructured":"Mccrory P, Meeuwisse W, Dvorak J, Aubry M, Bailes J, Broglio S, et al. Consensus statement on concussion in sport\u2014the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. 2018;51:838\u201347.","journal-title":"Br J Sports Med"},{"key":"2234_CR23","doi-asserted-by":"crossref","unstructured":"McCrory P, Meeuwisse WH, Aubry M, Cantu B, Dvorak J, Echemendia RJ, et al. Consensus statement on concussion in sport: the 4th international conference on concussion in Sport held in Zurich, November 2012. Br J Sports Med. 2013;47:250\u20138.","DOI":"10.1136\/bjsports-2013-092313"},{"key":"2234_CR24","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1227\/NEU.0000000000000433","volume":"75","author":"N Carney","year":"2014","unstructured":"Carney N, Ghajar J, Jagoda A, Bedrick S, Davis-O\u2019Reilly C, Du Coudray H, et al. Concussion guidelines step 1: systematic review of prevalent indicators. Neurosurgery. 2014;75:3\u201315.","journal-title":"Neurosurgery"},{"key":"2234_CR25","doi-asserted-by":"publisher","first-page":"841","DOI":"10.1542\/peds.2008-0080","volume":"121","author":"SG Rice","year":"2008","unstructured":"Rice SG, Small EW, McCambridge TM, Benjamin H, Bernhardt DT, Brenner JS, et al. Medical conditions affecting sports participation. Pediatrics. 2008;121:841\u20138.","journal-title":"Pediatrics"},{"key":"2234_CR26","doi-asserted-by":"publisher","first-page":"1970","DOI":"10.1212\/WNL.0b013e31826daf50","volume":"79","author":"EJ Lehman","year":"2012","unstructured":"Lehman EJ, Hein MJ, Baron SL, Gersic CM. Neurodegenerative causes of death among retired National Football League players. Neurology. 2012;79:1970\u20134.","journal-title":"Neurology"},{"key":"2234_CR27","doi-asserted-by":"publisher","first-page":"967","DOI":"10.1148\/radiol.2017170539","volume":"286","author":"MD Clark","year":"2018","unstructured":"Clark MD, Varangis EML, Champagne AA, Giovanello KS, Shi F, Kerr ZY, et al. Effects of career duration, concussion history, and playing position on white matter microstructure and functional neural recruitment in former college and professional football athletes. Radiology. 2018;286:967\u201377.","journal-title":"Radiology"},{"key":"2234_CR28","first-page":"168","volume":"6","author":"J Wallace","year":"2020","unstructured":"Wallace J, Worts P, Moran R, Mason J, Weise KK, Swanson M, et al. Socioeconomic status and race as social determinants of health to be considered in clinical use of pre-season vestibular and oculomotor tests for concussion. J Clin Transl Res. 2020;6:168\u201378.","journal-title":"J Clin Transl Res"},{"key":"2234_CR29","doi-asserted-by":"publisher","first-page":"1255","DOI":"10.1007\/s40279-017-0813-0","volume":"48","author":"SP Broglio","year":"2018","unstructured":"Broglio SP, Katz BP, Zhao S, McCrea M, McAllister T. Test-retest reliability and interpretation of common concussion assessment tools: findings from the NCAA-DoD CARE Consortium. Sport Med. 2018;48:1255\u201368.","journal-title":"Sport Med"},{"key":"2234_CR30","doi-asserted-by":"publisher","first-page":"1977","DOI":"10.1007\/s40279-019-01155-0","volume":"49","author":"SP Broglio","year":"2019","unstructured":"Broglio SP, Harezlak J, Katz B, Zhao S, McAllister T, McCrea M, et al. Acute sport concussion assessment optimization: a prospective assessment from the CARE Consortium. Sport Med. 2019;49:1977\u201387.","journal-title":"Sport Med"},{"issue":"4","key":"2234_CR31","doi-asserted-by":"publisher","first-page":"1106","DOI":"10.1177\/03635465211072261","volume":"50","author":"LM Ferris","year":"2022","unstructured":"Ferris LM, Kontos AP, Eagle SR, Elbin RJ, Collins MW, Mucha A, et al. Utility of VOMS, SCAT3, and ImPACT baseline evaluations for acute concussion identification in collegiate athletes: findings from the NCAA-DoD Concussion Assessment, Research and Education (CARE) Consortium. Am J Sports Med. 2022;50(4):1106\u201319.","journal-title":"Am J Sports Med"},{"key":"2234_CR32","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1249\/MSS.0000000000003063","volume":"55","author":"JB Caccese","year":"2023","unstructured":"Caccese JB, Bryk KN, Porfido T, Bretzin AC, Peek K, Kaminski TW, et al. Cognitive and behavioral outcomes in male and female NCAA soccer athletes across multiple years: a CARE Consortium Study. Med Sci Sport Exerc. 2023;55:409\u201317.","journal-title":"Med Sci Sport Exerc"},{"key":"2234_CR33","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1177\/0146167210392788","volume":"37","author":"K Byron","year":"2011","unstructured":"Byron K, Khazanchi S. A meta-analytic investigation of the relationship of state and trait anxiety to performance on figural and verbal creative tasks. Personal Soc Psychol Bull. 2011;37:269\u201383.","journal-title":"Personal Soc Psychol Bull"},{"key":"2234_CR34","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1037\/a0018883","volume":"136","author":"J Lim","year":"2010","unstructured":"Lim J, Dinges DF. A meta-analysis of the impact of short-term sleep deprivation on cognitive variables. Psychol Bull. 2010;136:375\u201389.","journal-title":"Psychol Bull"},{"key":"2234_CR35","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1037\/neu0000228","volume":"30","author":"M Masson","year":"2016","unstructured":"Masson M, East-Richard C, Cellard C. A meta-analysis on the impact of psychiatric disorders and maltreatment on cognition. Neuropsychology. 2016;30:143\u201356.","journal-title":"Neuropsychology"},{"issue":"21","key":"2234_CR36","doi-asserted-by":"publisher","first-page":"e2935","DOI":"10.1212\/WNL.0000000000010672","volume":"95","author":"JB Caccese","year":"2020","unstructured":"Caccese JB, Houck Z, Kaminski TW, Clugston JR, Iverson GL, Bryk KN, et al. Estimated age of first exposure to American football and outcome from concussion. Neurology. 2020;95(21):e2935\u201344.","journal-title":"Neurology"},{"key":"2234_CR37","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1123\/jsr.2018-0123","volume":"29","author":"CP Tomczyk","year":"2020","unstructured":"Tomczyk CP, Shaver G, Hunt TN. Does anxiety affect neuropsychological assessment in college athletes? J Sport Rehabil. 2020;29:238\u201342.","journal-title":"J Sport Rehabil"},{"key":"2234_CR38","doi-asserted-by":"publisher","first-page":"1087","DOI":"10.1007\/s40279-020-01415-4","volume":"51","author":"JB Caccese","year":"2021","unstructured":"Caccese JB, Iverson GL, Hunzinger KJ, Asken BM, Clugston JR, Cameron KL, et al. Factors associated with symptom reporting in U.S. Service Academy Cadets and NCAA student athletes without concussion: findings from the CARE Consortium. Sport Med. 2021;51:1087\u2013105.","journal-title":"Sport Med"}],"container-title":["Sports Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s40279-025-02234-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s40279-025-02234-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s40279-025-02234-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,27]],"date-time":"2025-09-27T09:54:57Z","timestamp":1758966897000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s40279-025-02234-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,1]]},"references-count":38,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2025,9]]}},"alternative-id":["2234"],"URL":"https:\/\/doi.org\/10.1007\/s40279-025-02234-1","relation":{},"ISSN":["0112-1642","1179-2035"],"issn-type":[{"value":"0112-1642","type":"print"},{"value":"1179-2035","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,1]]},"assertion":[{"value":"10 April 2025","order":1,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 May 2025","order":2,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This research was supported by the Grand Alliance CARE Consortium, funded in part by the NCAA and the DOD. This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs through the Combat Casualty Care Research Program and endorsed by the DOD, under award no. W81XWH1420151. Opinions, interpretations, conclusions, and recommendations are those of the author and not necessarily endorsed by the DOD.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Funding"}},{"value":"None declared.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Data used in this investigation are available in the Federal Interagency Traumatic Brain Injury Research Informatics System ().","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Availability of data and material"}},{"value":"All study procedures were reviewed and approved by the University of Michigan IRB, the US Army Medical Research and Material Command Human Research Protection Office, and the local IRB at each of the performance sites. The study was performed in accordance with the standards of ethics outlined in the Declaration of Helsinki. The Thomas Jefferson University IRB approved the secondary data analysis and data access for this study (iRISID-2023\u20132273) on August 7, 2023.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Participants provided written informed consent prior to participation.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Not applicable.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Not applicable.","order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Code availability"}},{"value":"KJH made substantial contributions to the conception of the study, the acquisition and interpretation of data, drafting the work, and revising it critically for important intellectual content, provided final approval of the version published, and is accountable for all aspects of the work. JBC, TAB, and ALCS made substantial contributions to the conception of the study, the analysis and interpretation of data, and revising the work critically for important intellectual content and provided final approval of the version published. CAL made substantial contributions to the analysis of the data and revising this work critically for important intellectual content and provided final approval of the version published. RMW made substantial drafting contributions, revising this work critically for important intellectual content, and providing final approval of the version published. SPB, TWM, MAM, and PFP made substantial contributions to the conception of the study, the acquisition and interpretation of data, revising the manuscript critically for important intellectual content, and providing final approval of the version published and are accountable for all aspects of the work. CARE Consortium investigators HJB, CD, JTE, CCG, KMG, TWK, LJN, CLM, JM, JPM, CM, JO, NLP, MP, and AS made substantial contributions to the acquisition of data, revising it critically for important intellectual content, and provided final approval of the version published.","order":9,"name":"Ethics","group":{"name":"EthicsHeading","label":"Author contributions"}}]}}