Author Response: Association of Position Played and Career Duration and Chronic Traumatic Encephalopathy at Autopsy in Elite Football and Hockey Players

We completely share Dr. Dams-O’Connor’s hope for replication studies and increasingly complete and accurate data.1 In our cohort of 35 former elite athletes, we did not think it surprising to have uncovered no history of moderate-severe traumatic brain injury (TBI)—as commonly defined2—nor did we find it to be in stark contrast to population-based studies. Indeed, our reading of the study cited to suggest a high (>20%) prevalence in the general population of more severe TBI is that only 192/6,998 respondents (2.7%) recollected a TBI with loss of consciousness >30 minutes—the definition used in that study for moderate-severe TBI.3 At that rate (about 1/37), it would not be unexpected to find 0% prevalence in a cohort of 35 individuals. Moreover, from the data cited on intercollegiate athletes using the Brain Injury Screening Questionnaire, showing that 12/90 recollected a TBI with loss of consciousness lasting several minutes to an hour, interpreted as clinically significant TBI, it cannot be ascertained whether any of those individuals had a moderate, as opposed to a mild, TBI.4 In our common quest for scientific rigor, it is important that the value of a structured TBI screening tool be neither understated nor overstated.

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