Bridging Baseline Assessment and Injury Surveillance: A Three-Study Examination of Sport-Related Concussion Monitoring in Canadian Post-Secondary Sport

Abstract

Background: Sport-related concussion (SRC) surveillance in Canadian post-secondary sport remains fragmented, limiting the ability of institutions to accurately characterize injury risk, recovery trajectories, and academic consequences. Existing systems tend to emphasize isolated components of concussion monitoring, such as pre-season baseline assessment or injury documentation, without integrating athlete-exposure (AE) data or educational outcomes, constraining epidemiologic interpretation and institutional decision-making. Purpose: This dissertation examined how differences in concussion surveillance structure influence the interpretation of SRC risk, recovery, and academic impact within Canadian post-secondary athletics. The three-study program aimed to (1) characterize baseline and historical concussion features among university athletes, (2) quantify exposure-adjusted incidence and post-injury outcomes in post-secondary sport, and (3) synthesize findings across systems to inform a harmonized concussion surveillance framework. Methods: Study 1 analyzed pre-season baseline data from university athletes participating in the Varsity Student-Athlete Data Analytics Research (VADAR) program, examining concussion history, baseline symptom presentation, and self-reported recovery duration. Study 2 evaluated retrospective injury surveillance data from Ontario Colleges Athletic Association (OCAA) athletes, incorporating AE-adjusted incidence rates, recovery duration, and documented academic accommodations. Study 3 employed a comparative analytic approach to examine differences in exposure measurement, recovery tracking, and academic outcome reporting across post-secondary surveillance systems. Results: In Study 1, 43.1% of female and 30.9% of male athletes reported a prior concussion, and female athletes were more than twice as likely to experience recovery lasting longer than 28 days (OR = 2.29, 95% CI [1.26, 4.18]). Study 2 demonstrated that sport-specific risk interpretations shifted substantially when AE denominators were applied, particularly among contact sports. Although female athletes represented 58.2% of diagnosed concussions, no significant sex difference in recovery duration was observed, and nearly half of documented concussions required formal academic accommodations. Conclusion: Surveillance design is a primary determinant of interpretability in post-secondary concussion research. Integrating baseline measures, exposure-adjusted incidence, and academic recovery indicators enhances understanding of SRC and supports decision-making across institutional, clinical, and team-level contexts. These findings inform evidence-based recommendations for a unified concussion surveillance framework tailored to Canadian post