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Comment & Response
April 2017

Correct Data and Meta-analytic Approaches Show the Reduced Risk of Concussion for Athletes Playing at Higher Altitudes

Author Affiliations
  • 1The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
  • 2Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio
  • 3Department of Orthopaedics, University of Pennsylvania, Philadelphia
  • 4The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts
  • 5Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, Ohio
  • 6College of Medicine, University of Cincinnati, Cincinnati, Ohio
  • 7Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio

Copyright 2017 American Medical Association. All Rights Reserved.

JAMA Neurol. 2017;74(4):484-485. doi:10.1001/jamaneurol.2016.6065

To the Editor We read with interest “Risk of Concussion for Athletes in Contact Sports at Higher Altitude vs at Sea Level: A Meta-analysis.”1 Unfortunately, Zavorsky and Smogila1 made errors that invalidate their meta-analysis. The authors mistakenly used altitude (in feet) as the number of adverse events.2 Detailed in Table 11 were 842 concussions used for the low altitude group and 52 concussions used for the high altitude group (which were actually median altitudes in feet, not incident concussions) taken from the original report that only had 284 total concussions.2 The authors also excluded relevant concussion data from Lynall et al,3 ignoring the incident concussions between 178 m and 284 m, thus inaccurately increasing the relative effect size3 compared with the 2 larger studies included in their analysis.2,4

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