Document is current

Article History

Accepted: 18 August 2025

First Online: 3 October 2025

Declarations

:

: The research reported in this work was supported by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health Award No. R01NS100952 (Dr. Howell). Data collected from the University of Delaware were collected under Award No. 1R21NS122033 and R03NS104377 (Dr. Buckley). The funding bodies were not included or consulted in the interpretation and reporting of the results.

: All disclosures below are not directly related to the current article but are reported for full transparency to readers. Dr. Lempke has received current or prior (< 5 years) funding from the National Athletic Trainers’ Association (NATA), American College of Sports Medicine (ACSM), Eastern Athletic Trainers’ Association (EATA), VALD, internally from university affiliations; has received various speaker honorarium and travel reimbursement for talks given, and supports projects funded by the Department of Defense (DoD), Veterans Affairs, National Collegiate Athletic Association (NCAA), and National Football League (NFL). Dr. Buckley has received funding from the NIH, Highmark Blue Cross, State Space Inc, and the Henry M. Jackson Foundation for the Advancement of Military Medicine. Dr. Shumski has received funding support from the National Athletic Trainers’ Association (NATA) Research and Education doctoral student grant program in support of his dissertation (Award #:AWD00016656). Dr. Lynall has received funding unrelated to the manuscript from the DoD, the NIH, Football Research Inc., and NATA. Dr. Howell has received research support from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R03HD094560, R01HD108133), the National Institute of Neurological Disorders And Stroke (R01NS100952, R43NS108823), the National Institute of Arthritis and Musculoskeletal and Skin Diseases (1R13AR080451), 59th Medical Wing Department of the Air Force, MINDSOURCE Brain Injury Network, the Tai Foundation, the Colorado Clinical and Translational Sciences Institute (UL1 TR002535‐05), and the Denver Broncos Foundation. Dr. Oldham has received funding from the Thrasher Research Fund and the Building Interdisciplinary Research Careers in Women’s Health (BIRCWH) grant (8K12AR084233-03) through the National Institutes of Health. Dr. Meehan receives royalties from ABC-Clio publishing for the sale of the books,  Kids, Sports, and Concussion: A guide for coaches and parents,  and  Concussions;  from Springer International for the book  Head and Neck Injuries in Young Athlete;  and from Wolters Kluwer for working as an author for  UpToDate . Dr. Meehan’s research is funded, in part, by philanthropic support from the National Hockey League Alumni Association through the Corey C. Griffin Pro-Am Tournament and a grant from a grant from the National Football League.

: All methods were approved by the Boston Children’s Hospital (P00016469), University of Georgia’s (STUDY00001479), and University of Delaware’s (804454) Institutional Review Boards. All included participants provided written and informed consent. All procedures performed in our study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

: All participants provided written and informed consent prior to participation.

: Not applicable.

: The R code used for analysis is available upon reasonable request to the first author.

: Data are available upon reasonable request to the first author.

: EJS was responsible for initiating the project, carrying out statistical analyses, drafting the initial manuscript, and preparing the final manuscript. All authors were involved in the development of the methods, providing input on the statistical analyses and interpretation, revising manuscript drafts, and reading and approving the final manuscript.