Epidemiological Principles in Claims of Causality: An Enquiry into Repetitive Head Impacts (RHI) and Chronic Traumatic Encephalopathy (CTE)

作     者：Fortington, Lauren V. Cassidy, J. David Castellani, Rudolph J. Gardner, Andrew J. McIntosh, Andrew S. Austen, Michael Kerr, Zachary Yukio Quarrie, Kenneth L. 

作者机构：Edith Cowan Univ Sch Med & Hlth Sci Joondalup WA Australia Univ Toronto Dalla Lana Sch Publ Hlth Div Epidemiol Toronto ON Canada Northwestern Univ Feinberg Sch Med Div Neuropathol Chicago IL USA Mesulam Ctr Cognit Neurol & Alzheimers Dis Chicago IL USA Univ Sydney Fac Med & Hlth Sydney Sch Hlth Sci Camperdown NSW Australia Monash Univ Accid Res Ctr Clayton Vic Australia Royal Australasian Coll Phys Australasian Fac Occupat & Environm Med Sydney NSW Australia Royal New Zealand Coll Urgent Care Auckland New Zealand High Court New Zealand Auckland New Zealand Univ North Carolina Chapel Hill Dept Exercise & Sport Sci Chapel Hill NC USA New Zealand Rugby 100 Molesworth St Wellington New Zealand Auckland Univ Technol Sports Performance Res Inst New Zealand SPRINZ Auckland New Zealand Univ Auckland Auckland Bioengn Inst ABI Auckland New Zealand 

出 版 物：《SPORTS MEDICINE》 (Sports Med.)

年 卷 期：2025年第55卷第2期

页      面：255-274页

核心收录：

学科分类：0403[教育学-体育学] 1002[医学-临床医学] 10[医学] 1009[医学-特种医学] 

基　　金：CAUL 

摘      要：Determining whether repetitive head impacts (RHI) cause the development of chronic traumatic encephalopathy (CTE)-neuropathological change (NC) and whether pathological changes cause clinical syndromes are topics of considerable interest to the global sports medicine community. In 2022, an article was published that used the Bradford Hill criteria to evaluate the claim that RHI cause CTE. The publication garnered international media attention and has since been promoted as definitive proof that causality has been established. Our counterpoint presents an appraisal of the published article in terms of the claims made and the scientific literature used in developing those claims. We conclude that the evidence provided does not justify the causal claims. We discuss how causes are conceptualised in modern epidemiology and highlight shortcomings in the current definitions and measurement of exposures (RHI) and outcomes (CTE). We address the Bradford Hill arguments that are used as evidence in the original review and conclude that assertions of causality having been established are premature. Members of the scientific community must be cautious of making causal claims until the proposed exposures and outcomes are well defined and consistently measured, and findings from appropriately designed studies have been published. Evaluating and reflecting on the quality of research is a crucial step in providing accurate evidence-based information to the public.