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Article History

Accepted: 4 June 2026

First Online: 30 June 2026

Declarations

:

: AEC: No competing interests. RC: No competing interests. BLB: Dr Brett is a part-time employee of the National Hockey League. DLH: No competing interests. JH: No competing interests. JMG: No competing interests. PP: No competing interests. SPB: Dr Broglio has current research funding from the National Institutes of Health; Centers for Disease Control and Prevention; Department of Defense—USA Medical Research Acquisition Activity, and National Collegiate Athletic Association. He has past research funding from the National Athletic Trainers’ Association Foundation; National Football League/Under Armour/GE; Simbex; and ElmindA. He has consulted for US Soccer (paid), US Cycling (unpaid), University of Calgary SHRed Concussions external advisory board (unpaid), and is the President of the Concussion in Sport Group (unpaid). He has received compensation for medico-legal litigation, and received speaker honorarium and travel reimbursements for talks given. He is co-author of “Biomechanics of Injury (3rd edition, Human Kinetics),” holds patents on “Brain Metabolism Monitoring Through CCO Measurements Using All-Fiber-Integrated Super-Continuum Source” (U.S. US 11, 529, 091 B2) and “Organ Or Tissue Hemodynamic And Metabolic Function Measured Using Super-Continuum Light Sources” (US 12,089,945 B2), and is on the scientific advisory board for C3Logix (stock options). He is/was on the editorial boards (all unpaid) for Journal of Athletic Training (2015 to present), Concussion (2014 to present), Athletic Training & Sports Health Care (2008 to present), British Journal of Sports Medicine (2008 to 2019). TWM: Dr McAllister reports research funding from the US Dept. of Defense, NCAA, and NIH, and book royalites from American Psychiatric Association Publishing, Inc. MAM: Dr McCrea reports research funding from the US Dept. of Defense and NCAA to the Medical College of Wisconsin (MCW) during the conduct of the study as well as research grants to MCW from the NIH, VA, Centers for Disease Control (CDC), Abbott Laboratories, and NFL outside the submitted work. TBM: Dr Meier reports in-kind research support from Abbott and has previously received compensation as a member of the Clinical and Scientific Advisory Board for Quadrant Biosciences Inc.

: Clinical, demographic, and Quanterix biomarker data are publicly available from the Federal Interagency Traumatic Brain Injury Research Informatics System. Additional deidentified biomarker data are available from the corresponding author on reasonable request with execution of data use agreements.

: AEC: analysis and interpretation of the work, drafting the work; RC: analysis and interpretation of the work, drafting the work; BLB: contribution to conception of the work, analysis and interpretation of data, drafting the work; DLH: analysis and interpretation of the work, reviewing the work for intellectual content; JH: analysis and interpretation of the work, reviewing the work for intellectual content; JMG: acquisition and analysis of data, reviewing the work for intellectual content; PP: contributions to the design of the work, reviewing the work for intellectual content; SPB: contributions to the design of the work, reviewing the work for intellectual content; TWM: contributions to the design of the work, reviewing the work for intellectual content; MAM: contributions to the design of the work, reviewing the work for intellectual content; TBM: contributions to the conception and design of the work, analysis and interpretation of the data, drafting the work. All authors read and approved the final version.

: All aspects of this study were approved by the institutional review board at the Medical College of Wisconsin (PRO00023196) and the US Army Medical Research and Development Command Human Research Protection office; all participants provided written informed consent. This study was performed in accordance with ethical standards established by the HHS Common Rule.