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Fehr CJ, West SW, Hagel BE, Goulet C, Emery CA. Head Contact and Suspected Concussion Rates in Youth Basketball: Time to Target Head Contact Penalties for Prevention. Clin J Sport Med 2024:00042752-990000000-00207. [PMID: 38975899 DOI: 10.1097/jsm.0000000000001249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 06/09/2024] [Indexed: 07/09/2024]
Abstract
OBJECTIVE To compare game events, head contact (HC) rates, and suspected concussion incidence rates (IRs) in boys' and girls' youth basketball. DESIGN Cross-sectional. SETTING Canadian club basketball teams (U16-U18). PARTICIPANTS Players from 24 boys' and 24 girls' Canadian club basketball teams during the 2022 season. ASSESSMENT OF RISK FACTORS Recorded games were analyzed using Dartfish video analysis software to compare sexes. MAIN OUTCOME MEASURES Poisson regression analyses were used to estimate HCs [direct (HC1) and indirect (HC2)], suspected concussion IRs, and IR ratios (IRRs). Game event, court location, and HC1 fouls were reported. RESULTS Division 1 HC rates did not differ between boys (n = 238; IR = 0.50/10 player-minutes; 95% confidence interval [CI], 0.43-0.56) and girls (n = 220; IR = 0.46/10 player-minutes; 95% CI, 0.40-0.52). Division 2 boys experienced 252 HCs (IR = 0.53/10 player-minutes; 95% CI, 0.46-0.59); girls experienced 192 HCs (IR = 0.40/10 player-minutes; 95% CI, 0.35-0.46). Division 2 boys sustained higher HC1 IRs compared with Division 2 girls (IRR = 1.42; 95% CI, 1.15-1.74). Head contacts, rates did not differ between boys and girls in either Division. Suspected concussion IRs were not significantly different for boys and girls in each Division. Head contacts occurred mostly in the key for boys and girls in each Division. Despite illegality, HC1 penalization ranged from 3.9% to 19.7%. Head contact mechanisms varied across Divisions and sexes. CONCLUSIONS Despite current safety measures, both HCs and suspected concussions occur in boys' and girls' basketball. Despite the illegality and potential danger associated with HC, only a small proportion of direct HCs were penalized and therefore targeting greater enforcement of these contacts may be a promising prevention target.
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Affiliation(s)
- Christy J Fehr
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Stephen W West
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Centre for Health, and Injury and Illness Prevention in Sport, University of Bath, Bath, United Kingdom
- UK Collaborating Centre for Illness and Injury Prevention in Sport (UKCCIIS), University of Bath, Bath, United Kingdom
| | - Brent E Hagel
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Claude Goulet
- Department of Physical Education, Faculty of Education, Université Laval, Quebec City, QC, Canada
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; and
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
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Sanclemente D, Belair JA, Talekar KS, Roedl JB, Stache S. Return to Play Following Concussion: Role for Imaging? Semin Musculoskelet Radiol 2024; 28:193-202. [PMID: 38484771 DOI: 10.1055/s-0043-1778031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
This review surveys concussion management, focusing on the use of neuroimaging techniques in return to play (RTP) decisions. Clinical assessments traditionally were the foundation of concussion diagnoses. However, their subjective nature prompted an exploration of neuroimaging modalities to enhance diagnosis and management. Magnetic resonance spectroscopy provides information about metabolic changes and alterations in the absence of structural abnormalities. Diffusion tensor imaging uncovers microstructural changes in white matter. Functional magnetic resonance imaging assesses neuronal activity to reveal changes in cognitive and sensorimotor functions. Positron emission tomography can assess metabolic disturbances using radiotracers, offering insight into the long-term effects of concussions. Vestibulo-ocular dysfunction screening and eye tracking assess vestibular and oculomotor function. Although these neuroimaging techniques demonstrate promise, continued research and standardization are needed before they can be integrated into the clinical setting. This review emphasizes the potential for neuroimaging in enhancing the accuracy of concussion diagnosis and guiding RTP decisions.
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Affiliation(s)
- Drew Sanclemente
- Medical Student, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jeffrey A Belair
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Kiran S Talekar
- Department of Radiology, Brain Mapping (fMRI and DTI) in Neuroradiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Johannes B Roedl
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Stephen Stache
- Division of Non-Operative Sports Medicine, Department of Orthopaedics and Family and Community Medicine, Rothman Orthopaedic Institute, Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, Pennsylvania
- Department of Orthopaedics and Pediatrics, University Athletics, Drexel University and Drexel College of Medicine, Philadelphia, Pennsylvania
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Hohmann E, Bloomfield P, Dvorak J, Echemendia R, Frank RM, Ganda J, Gordon L, Holtzhausen L, Kourie A, Mampane J, Makdissi M, Patricios J, Pieroth E, Putukian M, Janse van Rensburg DC, Viviers P, Williams V, de Wilde J. On-Field and Pitch-Side (Sideline) Assessment of Sports Concussion in Collision Sports: An Expert Consensus Statement Using the Modified Delphi Technique. Arthroscopy 2024; 40:449-459.e4. [PMID: 37391103 DOI: 10.1016/j.arthro.2023.06.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 06/05/2023] [Indexed: 07/02/2023]
Abstract
PURPOSE To perform a Delphi consensus for on-field and pitch-side assessment of sports-related concussion (SRC). METHODS Open-ended questions in rounds 1 and 2 were answered. The results of the first 2 rounds were used to develop a Likert-style questionnaire for round 3. If agreement at round 3 was ≤80% for an item, if panel members were outside consensus, or there were >30% neither agree/disagree responses, the results were carried forward into round 4. The level of agreement and consensus was defined as 90%. RESULTS Loss of consciousness (LOC) or suspected LOC, motor incoordination/ataxia, balance disturbance, confusion/disorientation, memory disturbance/amnesia, blurred vision/light sensitivity, irritability, slurred speech, slow reaction time, lying motionless, dizziness, headaches/pressure in the head, falling to the ground with no protective action, slow to get up after a hit, dazed look, and posturing/seizures were clinical signs of SRC and indicate removal from play. Video assessment is helpful but should not replace clinical judgment. LOC/unresponsiveness, signs of cervical spine injury, suspicion of other fractures (skull/maxillo-facial), seizures, Glasgow Coma Scale score <14 and abnormal neurologic examination findings are indications for hospitalization. Return to play should only be considered when no clinical signs of SRC are present. Every suspected concussion should be referred to an experienced physician. CONCLUSIONS Consensus was achieved for 85% of the clinical signs indicating concussion. On-field and pitch-side assessment should include the observation of the mechanism, a clinical examination, and cervical spine assessment. Of the 19 signs and red flags requiring removal from play, consensus was reached for 74%. Normal clinical examination and HIA with no signs of concussion allow return to play. Video assessment should be mandatory for professional games but should not replace clinical decision-making. Sports Concussion Assessment Tool, Glasgow Coma Scale, vestibular/ocular motor screening, Head Injury Assessment Criteria 1, and Maddocks questions are useful tools. Guidelines are helpful for non-health professionals. LEVEL OF EVIDENCE Level V, expert opinion.
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Affiliation(s)
- Erik Hohmann
- Medical School, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; Department of Orthopaedic Surgery and Sports Medicine, Burjeel Hospital for Advanced Surgery, Dubai, United Arab Emirates.
| | - Paul Bloomfield
- CMO Manly Sea Eagles, NRL Team; World Rugby Concussion Consultant; Former CMO National Rugby League, Sydney, Australia
| | - Jiri Dvorak
- Department of Neurology, Spine Unit, Schulthess Clinic, Zurich, Switzerland; Former CMO FIFA
| | - Ruben Echemendia
- Psychological & Neurobehavioral Associates, State College, Pennsylvania, U.S.A.; Department of Psychology, University of Missouri, Kansas City, Missouri, U.S.A.; Co-Chair NHL/NHLPA Concussion Subcommittee; Chair Major League Soccer Concussion Committee
| | - Rachel M Frank
- Department of Orthopaedic Surgery, University of Colorado Medical School, Aurora, Colorado, U.S.A.; Head Team Orthopaedic Surgeon Colorado Rapids, Team Physician University of Colorado Buffaloes, U.S. Soccer Network Physician
| | - Janesh Ganda
- Sports Rehab Centre, Cape Town, South Africa; Team Physician SA 7's Rugby Team; Medical Officer South African Sports Association and Olympic Committee
| | - Leigh Gordon
- Cape Sports Med Clinic, Cape Town, South Africa; Department of Sports & Exercise Medicine, Cape Town South Africa; World Rugby Concussion Consultant, Team Physician Rugby 7s, MO International Hockey Federation; Former Team Physician 7's Rugby
| | - Louis Holtzhausen
- Chief of Sports Medicine, Director Aspetar Sports Related Concussion Program; Orthopaedic and Sports Medicine Hospital, Aspetar, Doha, Qatar; Section Sports Medicine, University of Pretoria, Faculty of Health Sciences, Pretoria, South Africa; Department of Exercise and Sports Sciences, University of the Free State, Bloemfontein, South Africa; Former Team Physician South African Olympic Team and Professional Rugby, Cricket and Hockey Teams
| | - Alan Kourie
- Head of Department of Sports Medicine, Mediclinic Parkview; Dubai, United Arab Emirates; CMO Dubai Hurricanes, Former Team Doctor Natal Sharks Rugby
| | - Jerome Mampane
- CMO South African Rugby Team (Springboks); CMO Kaizer Chiefs Football Club; former CMO South African Soccer Team (Bafana Bafana)
| | - Michael Makdissi
- Olympic Park Sports Medicine Centre, Melbourne, Australia; CMO Australian Football League, Melbourne, Australia; La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia; World Rugby Concussion Consultant
| | - Jon Patricios
- Wits Sport and Health (WiSH); School of Clinical Medicine, Faculty of Health Sciences; University of the Witwatersrand, Johannesburg, South Africa; Co-Chair of the 6th International Conference on Concussion in Sports; South African and World Rugby Concussion Consultant; UEFA Head Injury Consultant; FIFA Concussion Consultant
| | - Elizabeth Pieroth
- Department of Orthopaedics, Department of Psychiatry and Behavioral Sciences; Rush Medical College, Chicago, Illinois, U.S.A.; Co-Director NFL Neuropsychology Consultant Program; Director NSW Concussion Program; Concussion Specialist for Chicago Bears, Blackhawks White Socks, Fire, Red Stars, Steel, Rockford IceHogs, Indy Fuel
| | | | - Dina C Janse van Rensburg
- Section Sports Medicine, University of Pretoria, Faculty of Health Sciences, Pretoria South Africa; Medical Advisory Panel, World Netball, Manchester, United Kingdom
| | - Pierre Viviers
- Senior Director Campus Health Service; Department of Exercise, Sport and Lifestyle Medicine, Faculty of Medicine and Health Science, Stellenbosch University, Stellenbosch, South Africa
| | - Vernon Williams
- Center for Sports Neurology & Pain Medicine, Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, California, U.S.A.; Team Neurologist Los Angeles Rams, LA Dodgers, LA Lakers, LA Clippers, LA Kings, LA Sparks; Vice-Chair California State Athletic Commission, Chair American Academy of Sports Neurology Section
| | - Jean de Wilde
- Musculoskeletal Service Emirates Airline, Dubai, United Arab Emirates; Medical Officer South African Sports Association and Olympic Committee; Former Match Day and Stadium Physician Lions Rugby Team
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Rotundo MP, Sokol-Randell D, Bleakley C, Donnelly P, Tierney G. Characteristics of potential concussive events in elite hurling: a video-analysis study. Ir J Med Sci 2023; 192:3175-3185. [PMID: 36800054 PMCID: PMC10692028 DOI: 10.1007/s11845-023-03307-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/02/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND High-impact sports such as hurling place participants at risk of sport-related concussion (SRC). AIMS This study will evaluate the characteristics of potential concussive events (PCEs) that occur in elite male hurling to acquire an understanding of how they occur. METHODS The authors recorded PCEs and their characteristics throughout two seasons of inter-county GAA competition using broadcast footage based on a previously validated protocol. RESULTS A total of 183 PCEs were identified over 82 inter-county matches (2.23 per match; 59.5 per 1000 h of exposure). PCEs that occurred in the 4th quarter were significantly more likely to result in signs of SRC. Players most often intended to receive/control the sliotar (36.4%, n = 64) prior to PCEs. The most frequently observed mechanism was shoulder-to-head (20.2%, n = 37). Impacts to the lateral aspect of the head were 2.7 times more likely to result in visible signs than impacts to anteroposterior regions. CONCLUSIONS Players appear to be at a higher risk of SRC later in the match or when receiving the sliotar. Strikes to the lateral aspect of the head and those involving the shoulder appear to produce severe events. These findings provide initial guidance for the development of targeted player protection strategies.
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Affiliation(s)
- Mario P Rotundo
- Sport and Exercise Science Research Institute, Ulster University, Belfast, UK.
- Department of Family Practice, University of British Columbia, Vancouver, Canada.
| | - Darek Sokol-Randell
- Sport and Exercise Science Research Institute, Ulster University, Belfast, UK
- Department of Neurology, Memorial University of Newfoundland, St John's, Canada
| | - Chris Bleakley
- Sport and Exercise Science Research Institute, Ulster University, Belfast, UK
| | - Paul Donnelly
- Sport and Exercise Science Research Institute, Ulster University, Belfast, UK
| | - Gregory Tierney
- Sport and Exercise Science Research Institute, Ulster University, Belfast, UK
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Field B, Waddington G, McKune A, Goecke R, Gardner AJ. Validation of an instrumented mouthguard in rugby union-a pilot study comparing impact sensor technology to video analysis. Front Sports Act Living 2023; 5:1230202. [PMID: 38053522 PMCID: PMC10694248 DOI: 10.3389/fspor.2023.1230202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 10/25/2023] [Indexed: 12/07/2023] Open
Abstract
Background To better understand the biomechanical profile of direct head impacts and the game scenarios in which they occur in Rugby Union, there is a need for an on-field validation of a new instrumented mouthguard (IMG) against the reference standard. This study considers the potential of a combined biomechanical (IMG) and video analysis approach to direct head impact recognition, both of which in isolation have limitations. The aim of this study is to assess the relationship between an instrumented mouthguard and video analysis in detection of direct head impacts in rugby union. Design Pilot Study - Observational Cohort design. Methods The instrumented mouthguard was worn by ten (3 backs, 7 forwards) professional Rugby Union players during the 2020-21 Gallagher Premiership (UK) season. Game-day video was synchronized with timestamped head acceleration events captured from the instrumented mouthguard. Direct Head Impacts were recorded in a 2 × 2 contingency table to determine sensitivity. Impact characteristics were also collected for all verified head impacts to further the understanding of head biomechanics during the game. Results There were 2018 contact events that were reviewed using video analysis. Of those 655 were categorized as direct head impacts which also correlated with a head acceleration event captured by the IMG. Sensitivity analysis showed an overall sensitivity of 93.6% and a positive predictive value (PPV of 92.4%). When false positives were excluded due to ball out of play, mouthguard removal or handling after a scoring situation or stoppage, PPV was improved (98.3%). Most verified head impacts occurred in and around the ruck contest (31.2%) followed by impacts to the primary tackler (28.4%). Conclusion This pilot validation study demonstrates that this IMG provides a highly accurate measurement device that could be used to complement video verification in the recognition of on-field direct head impacts. The frequency and magnitude of direct head impacts derived from specific game scenarios has been described and allows for greater recognition of high-risk situations. Further studies with larger sample sizes and in different populations of Rugby Union players are required to develop our understanding of head impact and enable strategies for injury mitigation.
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Affiliation(s)
- Byron Field
- Research Institute for Sport and Exercise, Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Gordon Waddington
- Research Institute for Sport and Exercise, Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Andrew McKune
- Research Institute for Sport and Exercise, Faculty of Health, University of Canberra, Canberra, ACT, Australia
- Discipline of Biokinetics, Exercise, and Leisure Sciences, School of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | - Roland Goecke
- Research Institute for Sport and Exercise, Faculty of Science and Technology, University of Canberra, Canberra, ACT, Australia
| | - Andrew J. Gardner
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
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6
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McLeod S, Tucker R, Edwards S, Jones B, Page G, Spiegelhalter M, West SW, Iverson GL, Gardner AJ. A case-control study of tackle based head impact event (HIE) risk factors from the first three seasons of the National Rugby League Women's competition. Front Sports Act Living 2023; 5:1080356. [PMID: 37334015 PMCID: PMC10272446 DOI: 10.3389/fspor.2023.1080356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 05/11/2023] [Indexed: 06/20/2023] Open
Abstract
Objective The tackle is the most injurious event in rugby league and carries the greatest risk of concussion. This study aims to replicate previous research conducted in professional men's rugby league by examining the association between selected tackle characteristics and head impact events (HIEs) in women's professional rugby league. Methods We reviewed and coded 83 tackles resulting in an HIE and every tackle (6,318 tackles) that did not result in an HIE for three seasons (2018-2020) of the National Rugby League Women's (NRLW) competition. Tackle height, body position of the tackler and ball carrier, as well as the location of head contact with the other player's body were evaluated. Propensity of each situation that caused an HIE was calculated as HIEs per 1,000 tackles. Results The propensity for tacklers to sustain an HIE was 6.60 per 1,000 tackles (95% CI: 4.87-8.92), similar to that of the ball carrier (6.13 per 1,000 tackles, 95% CI: 4.48-8.38). The greatest risk of an HIE to either the tackler or ball carrier occurred when head proximity was above the sternum (21.66 per 1,000 tackles, 95% CI: 16.55-28.35). HIEs were most common following impacts between two heads (287.23 HIEs per 1,000 tackles, 95% CI: 196.98-418.84). The lowest propensity for both tackler (2.65 per 1,000 tackles, 95% CI: 0.85-8.20) and ball carrier HIEs (1.77 per 1,000 tackles, 95% CI: 0.44-7.06) occurred when the head was in proximity to the opponent's shoulder and arm. No body position (upright, bent or unbalanced/off feet) was associated with an increased propensity of HIE to either tackler or ball carrier. Conclusions In the NRLW competition, tacklers and ball carriers have a similar risk of sustaining an HIE during a tackle, differing from men's NRL players, where tacklers have a higher risk of HIEs. Further studies involving larger samples need to validate these findings. However, our results indicate that injury prevention initiatives in women's rugby league should focus on how the ball carrier engages in contact during the tackle as well as how the tackler executes the tackle.
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Affiliation(s)
- Shreya McLeod
- School of Medicine and Public Health, College of Health, Medicine, & Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- Discipline of Physiotherapy, School of Allied Health, Australian Catholic University, Sydney, NSW, Australia
| | - Ross Tucker
- Department of Exercise, Institute of Sport and Exercise Medicine (ISEM), University of Stellenbosch, South Africa
- World Rugby Ltd., Dublin, Ireland
| | - Suzi Edwards
- Faculty of Medicine and Health, Sydney School of Health Sciences, Discipline of Exercise and Sport Science, The University of Sydney, Camperdown, NSW, Australia
| | - Ben Jones
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom
- Division of Physiological Sciences, Department of Human Biology, UCT Research Centre for Health Through Physical Activity (HPALS), Lifestyle and Sport, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- England Performance Unit, Rugby Football League, Red Hall, Leeds, United Kingdom
- Leeds Rhinos Rugby League Club, Leeds, United Kingdom
- Premiership Rugby, London, United Kingdom
| | - Georgia Page
- School of Medicine and Public Health, College of Health, Medicine, & Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
| | - Mily Spiegelhalter
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom
- England Performance Unit, Rugby Football League, Red Hall, Leeds, United Kingdom
- Leeds Rhinos Rugby League Club, Leeds, United Kingdom
| | - Stephen W. West
- Centre for Health, and Injury & Illness Prevention in Sport, University of Bath, Bath, United Kingdom
- UK Collaborating Centre on Injury and Illness Prevention in Sport (UKCCIIS), University of Bath, Bath, United Kingdom
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States
- Department of Physical Medicine and Rehabilitation, Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, MA, United States
- MassGeneral Hospital for Children Sports Concussion Program, Boston, MA, United States
| | - Andrew J. Gardner
- School of Medicine and Public Health, College of Health, Medicine, & Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- Faculty of Medicine and Health, Sydney School of Health Sciences, Discipline of Exercise and Sport Science, The University of Sydney, Camperdown, NSW, Australia
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom
- Hunter Medical Research Institute, New Lambton, NSW, Australia
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Echemendia RJ, Burma JS, Bruce JM, Davis GA, Giza CC, Guskiewicz KM, Naidu D, Black AM, Broglio S, Kemp S, Patricios JS, Putukian M, Zemek R, Arango-Lasprilla JC, Bailey CM, Brett BL, Didehbani N, Gioia G, Herring SA, Howell D, Master CL, Valovich McLeod TC, Meehan WP, Premji Z, Salmon D, van Ierssel J, Bhathela N, Makdissi M, Walton SR, Kissick J, Pardini J, Schneider KJ. Acute evaluation of sport-related concussion and implications for the Sport Concussion Assessment Tool (SCAT6) for adults, adolescents and children: a systematic review. Br J Sports Med 2023; 57:722-735. [PMID: 37316213 DOI: 10.1136/bjsports-2022-106661] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To systematically review the scientific literature regarding the acute assessment of sport-related concussion (SRC) and provide recommendations for improving the Sport Concussion Assessment Tool (SCAT6). DATA SOURCES Systematic searches of seven databases from 2001 to 2022 using key words and controlled vocabulary relevant to concussion, sports, SCAT, and acute evaluation. ELIGIBILITY CRITERIA (1) Original research articles, cohort studies, case-control studies, and case series with a sample of >10; (2) ≥80% SRC; and (3) studies using a screening tool/technology to assess SRC acutely (<7 days), and/or studies containing psychometric/normative data for common tools used to assess SRC. DATA EXTRACTION Separate reviews were conducted involving six subdomains: Cognition, Balance/Postural Stability, Oculomotor/Cervical/Vestibular, Emerging Technologies, and Neurological Examination/Autonomic Dysfunction. Paediatric/Child studies were included in each subdomain. Risk of Bias and study quality were rated by coauthors using a modified SIGN (Scottish Intercollegiate Guidelines Network) tool. RESULTS Out of 12 192 articles screened, 612 were included (189 normative data and 423 SRC assessment studies). Of these, 183 focused on cognition, 126 balance/postural stability, 76 oculomotor/cervical/vestibular, 142 emerging technologies, 13 neurological examination/autonomic dysfunction, and 23 paediatric/child SCAT. The SCAT discriminates between concussed and non-concussed athletes within 72 hours of injury with diminishing utility up to 7 days post injury. Ceiling effects were apparent on the 5-word list learning and concentration subtests. More challenging tests, including the 10-word list, were recommended. Test-retest data revealed limitations in temporal stability. Studies primarily originated in North America with scant data on children. CONCLUSION Support exists for using the SCAT within the acute phase of injury. Maximal utility occurs within the first 72 hours and then diminishes up to 7 days after injury. The SCAT has limited utility as a return to play tool beyond 7 days. Empirical data are limited in pre-adolescents, women, sport type, geographical and culturally diverse populations and para athletes. PROSPERO REGISTRATION NUMBER CRD42020154787.
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Affiliation(s)
- Ruben J Echemendia
- Concussion Care Clinic, University Orthopedics, State College, Pennsylvania, USA
- University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Joel S Burma
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Jared M Bruce
- Biomedical and Health Informatics, University of Missouri - Kansas City, Kansas City, Missouri, USA
| | - Gavin A Davis
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Cabrini Health, Malvern, Victoria, Australia
| | - Christopher C Giza
- Neurosurgery, UCLA Steve Tisch BrainSPORT Program, Los Angeles, California, USA
- Pediatrics/Pediatric Neurology, Mattel Children's Hospital UCLA, Los Angeles, California, USA
| | - Kevin M Guskiewicz
- Matthew Gfeller Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Dhiren Naidu
- Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Steven Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Simon Kemp
- Sports Medicine, Rugby Football Union, London, UK
| | - Jon S Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | | | - Roger Zemek
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Christopher M Bailey
- Neurology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Benjamin L Brett
- Neurosurgery/ Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Gerry Gioia
- Depts of Pediatrics and Psychiatry & Behavioral Sciences, Children's National Health System, Washington, District of Columbia, USA
| | - Stanley A Herring
- Department of Rehabilitation Medicine, Orthopaedics and Sports Medicine, and Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - David Howell
- Orthopedics, Sports Medicine Center, Children's Hospital Colorado, Aurora, Colorado, USA
| | | | - Tamara C Valovich McLeod
- Department of Athletic Training and School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, Arizona, USA
| | - William P Meehan
- Sports Medicine, Children's Hospital Boston, Boston, Massachusetts, USA
- Emergency Medicine, Children's Hospital Boston, Boston, Massachusetts, USA
| | - Zahra Premji
- Libraries, University of Victoria, Victoria, British Columbia, Canada
| | | | | | - Neil Bhathela
- UCLA Health Steve Tisch BrainSPORT Program, Los Angeles, California, USA
| | - Michael Makdissi
- Florey Institute of Neuroscience and Mental Health - Austin Campus, Heidelberg, Victoria, Australia
- La Trobe Sport and Exercise Medicine Research Centre, Melbourne, Victoria, Australia
| | - Samuel R Walton
- Department of Physical Medicine and Rehabilitation, School of Medicine, Richmond, Virginia, USA
| | - James Kissick
- Dept of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jamie Pardini
- Departments of Internal Medicine and Neurology, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
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Gil C, Jacota M, Caudron Y, Heynard C, Rubio E, Berkal M, Dusfour B, Faillot T, Gault N, Decq P. How is Video Efficient to Diagnose Sport-Related Concussion? A Cross-Sectional Study in the French TOP14 Rugby Championship. Clin J Sport Med 2022; 32:e261-e267. [PMID: 34516432 DOI: 10.1097/jsm.0000000000000928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 12/21/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe the frequency of clinical signs and the accuracy of video diagnosis of sport-related concussion. DESIGN An observational cross-sectional study. SETTING AND PARTICIPANTS Videos from a database of all suspected sport-related concussion in TOP14 matches (French professional male rugby Championship) were used, from 2012 to 2015 seasons. The videos were analyzed by 4 observers, blinded to the concussion diagnosis, after a training phase, and an inter-rater reliability analysis. INTERVENTIONS N/A. MAIN OUTCOME MEASURES Video analysis for clinical signs and presumed diagnosis of sport-related concussion. The observer's diagnosis was compared with the team physicians' diagnosis. RESULTS Four hundred seventeen videos were analyzed with 142 concussed players. Sport-related concussions happened mostly from an impact to the head (seen by the observers in 98.4%), against an opponent (73.2%), and during a tackle (74.6%). Video signs were observable in 98.6% for suspected loss of consciousness, tonic posturing (95%), ataxia (77.2%), dazed look (35.7%), abnormal behavior (18.2%), and seizures (96.2%). Ataxia was seen in 77.7% of concussed players, suspected loss of consciousness in 61.4%, dazed look in 63.2%, abnormal behavior in 55%, and tonic posturing in 7.1%. The observers diagnosed 79.8% of concussions. CONCLUSIONS We described the frequency of video clinical signs of sport-related concussion, with a good accuracy of the blinded observers for the diagnosis. This emphasizes the importance of pitch-side video analysis as an extra tool for sport-related concussion diagnosis.
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Affiliation(s)
- Charlotte Gil
- Georges Charpak Human Biomecanics Institute, Arts et Métiers ParisTech, Paris, France
- Departement of Rhumatology and Rehabilitation, Hopitaux Nationaux de Saint-Maurice, Saint-Maurice, France
| | - Madalina Jacota
- APHP, Department of Epidemiology, Biostatistics and Clinical Research, Bichat Hospital, Paris, France
- INSERM CIC-EC 1425, Bichat Hospital, Paris, France
| | - Yohan Caudron
- Georges Charpak Human Biomecanics Institute, Arts et Métiers ParisTech, Paris, France
| | - Caroline Heynard
- Georges Charpak Human Biomecanics Institute, Arts et Métiers ParisTech, Paris, France
| | - Elliot Rubio
- Medical Department, Association Sportive Montferrandaise Clermont Auvergne (ASM CA), Clermont- Ferrand, France
| | - Miassa Berkal
- Georges Charpak Human Biomecanics Institute, Arts et Métiers ParisTech, Paris, France
| | | | - Thierry Faillot
- Georges Charpak Human Biomecanics Institute, Arts et Métiers ParisTech, Paris, France
- Denis Diderot Paris 7 Medical Faculty Paris, France; and
- Assistance Publique Hôpitaux de Paris, Department of Neurosurgery, Beaujon Hospital, Clichy, France
| | - Nathalie Gault
- APHP, Department of Epidemiology, Biostatistics and Clinical Research, Bichat Hospital, Paris, France
- INSERM CIC-EC 1425, Bichat Hospital, Paris, France
| | - Philippe Decq
- Georges Charpak Human Biomecanics Institute, Arts et Métiers ParisTech, Paris, France
- Denis Diderot Paris 7 Medical Faculty Paris, France; and
- Assistance Publique Hôpitaux de Paris, Department of Neurosurgery, Beaujon Hospital, Clichy, France
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O'Halloran P, Goggins L, Peirce N. Observable player behaviours and playing performance following helmet strikes in elite cricket. BMJ Open Sport Exerc Med 2021; 7:e001128. [PMID: 34950503 PMCID: PMC8650467 DOI: 10.1136/bmjsem-2021-001128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Investigate the observable player behaviours and features of both concussive (HS-C) and non-concussive (HS-NC) helmet strikes and describe their impact on playing performance. METHODS Elite male cricketers sustaining helmet strikes between the 2016 and 2018 seasons were identified by the England and Wales Cricket Board. Medical records identified players sustaining a concussion and those in whom concussion was excluded. Retrospective cohort analysis was performed on batting and bowling performance data available for these players in the 2 years prior to and 3 months post helmet strike. Video analysis of available incidents was conducted to describe the characteristics of the helmet strike and subsequent observable player behaviours. The HS-C and HS-NC cohorts were compared. RESULTS Data were available for 194 helmet strikes. 56 (29%) resulted in concussion. No significant differences were seen in playing performance in the 3 months post concussive helmet strike. However, a significant decline in batting performance was seen in this period in the HS-NC group (p<0.001).Video features signifying motor incoordination were most useful in identifying concussion post helmet strike, however, typical features suggesting transient loss of consciousness were not seen. Features such as a longer duration pause prior to the batsman resuming play and the level of concern shown by other players were also useful features. CONCLUSION HS-NC may be more significant for player performance than previously thought. Guidance for using video replay to identify concussion in cricket may need to be modified when compared with other field sports.
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Affiliation(s)
- Patrick O'Halloran
- Marker Diagnostics UK Ltd, Birmingham, UK
- Musculoskeletal Medicine, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Luke Goggins
- Department for Health, University of Bath, Bath, UK
| | - Nicholas Peirce
- Science and Medicine, England and Wales Cricket Board, Loughborough, UK
- National Centre for Sports Medicine, Loughborough University, Loughborough, UK
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10
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The association of padded headgear with concussion and injury risk in junior Australian football: A prospective cohort study. J Sci Med Sport 2021; 25:312-320. [PMID: 34949511 DOI: 10.1016/j.jsams.2021.11.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 11/14/2021] [Accepted: 11/22/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To assess whether padded headgear was associated with incidence of suspected sports-related concussion, non-sports-related concussion head injury, and injuries to other body regions in junior Australian football. DESIGN Prospective cohort injury surveillance. METHODS There were 400 junior players (42.5% female) enrolled across two seasons. Suspected sports-related concussion was defined by detection of observable signs on the field and medical assessment or missed match(es) due to suspected sports-related concussion. Non-sports-related concussion head injury and injuries to other body regions were defined as those that received medical assessment or resulted in a missed match. RESULTS There were 20 teams monitored over 258 matches. 204 players (2484 player hours) wore mandated headgear throughout the season and 196 (2246 player hours) did not. The incidence rate of suspected sports-related concussion was 3.17 (95% confidence interval: 3.04-3.30) per 1000 player-hours and no differences were observed between males and females (risk ratio 1.11; 95% confidence interval: 0.40-3.06). Headgear use was not associated with suspected sports-related concussion (risk ratio 1.09; 95% confidence interval: 0.41-2.97), non-sports-related concussion head injury (risk ratio 0.27; 95% confidence interval: 0.06-1.31), or injuries to other body regions (risk ratio 1.41; 95% confidence interval: 0.79-2.53). CONCLUSIONS Headgear use was not associated with reduced risk of suspected sports-related concussion, non-sports-related concussion head injury or injuries to other body regions. There was no difference in the rate of suspected sports-related concussion in female compared to male players, however, rates of non-sports-related concussion head injury and injuries to other body regions were higher in male players.
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11
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Bernick C, Hansen T, Ng W, Williams V, Goodman M, Nalepa B, Shan G, Seifert T. Concussion occurrence and recognition in professional boxing and MMA matches: toward a concussion protocol in combat sports. PHYSICIAN SPORTSMED 2021; 49:469-475. [PMID: 33251911 DOI: 10.1080/00913847.2020.1856631] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objectives: Determine, through video reviews, how often concussions occur in combat sport matches, what influence they have on the outcome, and how well non-physician personnel can be trained to recognize concussions.Methods: This is a retrospective video analysis by an 8-person panel of 60 professional fights (30 boxing and 30 mixed martial arts). Through video review, physician and non-physician personnel recorded details about each probable concussion and determined if and when they would have stopped the fight compared to the official stoppage time.Results: A concussion was recorded in 47/60 fights. The mean number of concussions per minute of fight time was 0.061 (0.047 for boxers and 0.085 for MMA). When stratifying by outcome of the bout, the mean number of concussions per minute for the winner was 0.010 compared to the loser at 0.111 concussions per minute. The fighter that sustained the first concussion ultimately lost 98% of the time. The physician and non-physician raters had high agreement regarding the number of concussions that occurred to each fighter per match. The physician raters judged that 24 of the 60 fights (11 boxing [37%]; 13 MMA [43%]) should have been stopped sooner than what occurred.Conclusion: Recognizing that the concussions often occur in combat sport matches, that the losing fighter almost always is concussed first and tends to sustain more concussions during the fight, along with the demonstration that non-physician personnel can be taught to recognize concussion, may guide policy changes that improve brain health in combat sports.
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Affiliation(s)
- Charles Bernick
- Neurological Institute, Cleveland Clinic, Las Vegas, NV, USA.,Department of Neurology, University of Washington, Seattle, DC, USA
| | | | - Winnie Ng
- Neurological Institute, Cleveland Clinic, Las Vegas, NV, USA
| | - Vernon Williams
- Center for Sports Neurology, Cedars-Sinai Kerlan Jobe Institute, Los Angeles, CA, USA
| | | | - Bryce Nalepa
- Concussion and Sports Medicine Center, Banner Health, Phoenix, AZ, USA
| | - Guogen Shan
- School of Public Health, UNLV, Las Vegas, NV, USA
| | - Tad Seifert
- Department of Neurology, Norton Healthcare, Louisville, KY, USA
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12
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Sokol-Randell D, Rotundo MP, Tierney G, Cusimano MD, Deasy C. Video analysis of potential concussions in elite male Hurling: are players being assessed according to league guidelines? Ir J Med Sci 2021; 191:2335-2342. [PMID: 34664223 PMCID: PMC8523202 DOI: 10.1007/s11845-021-02798-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 09/28/2021] [Indexed: 12/04/2022]
Abstract
Background Hurling is a fast-paced contact sport that places players at risk of concussion. Given the consequences of repeated concussive impacts, it is imperative that concussion management guidelines are followed. Hypothesis/Purpose. The aim of this study is to determine if potential concussive events (PCEs) in elite Hurling are assessed in accordance with league management guidelines. The secondary objective is to investigate the effectiveness of current concussion training programs. Methods Investigators used a video analysis approach to identify PCEs throughout the 2018 and 2019 inter-county Hurling seasons and championships. Subsequent assessment, return to play (RTP) decision, and signs of concussion were evaluated based on previously validated methods. The results were then compared year-over-year with previous research in Gaelic Football (GF). Results A total of 183 PCEs were identified over 82 matches. PCEs were frequently assessed (86.3%, n = 158) by medical personnel. The majority of assessments were less than 1 min in duration (81.0%, n = 128). Thirteen (7.1%) players were removed following a PCE. There were 43 (23.5%) PCEs that resulted in one or more signs of concussion, of which 10 (23.3%) were removed from play. There was no difference in rate of assessment, duration of assessment, or rate of RTP between 2018 and 2019 in both Hurling and GF, suggesting that current concussion training programs have had limited success. Conclusion In Hurling, players suspected of having sustained a concussion are frequently subject to a brief assessment, and are rarely removed from play. Affirmative action is needed to ensure the consistent application of standardized concussion assessment across the Gaelic Games.
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Affiliation(s)
- Darek Sokol-Randell
- School of Medicine, University College Cork, Cork, Ireland. .,Emergency Innovation Research Network, Cork, Ireland.
| | - Mario Pasquale Rotundo
- School of Medicine, University College Cork, Cork, Ireland.,Emergency Innovation Research Network, Cork, Ireland
| | - Gregory Tierney
- School of Biomedical Sciences, University of Leeds, Leeds, UK
| | - Michael D Cusimano
- Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Conor Deasy
- School of Medicine, University College Cork, Cork, Ireland.,Emergency Innovation Research Network, Cork, Ireland.,Emergency Department, Cork University Hospital, Cork, Ireland
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13
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Sokol-Randell D, Rotundo MP, Tierney G, Deasy C, Cusimano MD. Characteristics of potential concussive events in elite male gaelic football players: A descriptive video-analysis. J Sports Sci 2021; 39:1700-1708. [PMID: 33722171 DOI: 10.1080/02640414.2021.1896455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2021] [Indexed: 10/21/2022]
Abstract
Gaelic football (GF) is a high-impact sport and Sport-Related Concussion (SRC) is an issue within the game. Our aim was to evaluate the characteristics of Potential Concussive Events (PCEs) that occur in the Gaelic Athletic Association National Football League and extrapolate this data to reduce the incidence and severity of SRC. PCEs may or may not lead to a clinical diagnosis of SRC, but represent high-risk events and therefore may be a useful indicator. A video-analysis approach was undertaken to identify PCEs throughout two seasons of play using broadcast footage, and characteristics of each PCE were measured based on previously validated methods. A total of 242 PCEs were identified over 111 matches (2.18 per match, 58.14 per 1000 hours of exposure). PCEs were frequently not anticipated by the player (40.5%, n = 98). The most common impact locations were the mandibular region (33.1%, n = 80) and the temporal region (21.1%, n = 51), and the most frequently observed mechanism was hand/fist to head (27.3%, n = 66). A second-hit was observed in 34 PCEs (14.0%). The findings provide initial guidance for the development of player protection strategies to reduce the incidence and severity of SRC in Gaelic Football.
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Affiliation(s)
| | | | | | - Conor Deasy
- Cork University Hospital Emergency Department, University College Cork, Cork, Ireland
| | - Michael D Cusimano
- Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
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14
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Gardner AJ. Reliability of Using the Proposed International Consensus Video Signs of Potential Concussion for National Rugby League Head Impact Events. Neurosurgery 2021; 88:538-543. [PMID: 33027812 DOI: 10.1093/neuros/nyaa437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 07/21/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Consensus on the definition of extant video signs of concussion have recently been proposed by representatives of international sporting codes for global consistency across professional leagues. OBJECTIVE To review the reliability of the proposed international consensus video signs of concussion in National Rugby League (NRL) head impact events (HIEs). METHODS The video signs of concussion were coded for every HIE during the 2019 NRL season. Coding was conducted blinded to the concussion status. Frequency, sensitivity, specificity, and a receiver operating characteristic curve were calculated. RESULTS There were 943 HIEs identified over the 2019 NRL season, of which 106 resulted in a diagnosed concussion. The most frequently observed video sign in concussed athletes was blank/vacant look (54%), which was also the most sensitive video sign (0.54, CI: 0.44-0.63), while the most specific was tonic posturing (0.99, CI: 0.99-1.00). In 43.4% of diagnosed concussions none of the 6 video signs were present. The 6 video signs demonstrated a "fair" ability to discriminate between concussion and nonconcussion HIEs (area under the curve = 0.76). CONCLUSION International consensus agreement between collision sports for extant video signs of concussion and the definition of those extant video signs are clinically important. The selection of signs requires rigorous assessment to examine their predictive value across all sports and within individual sports, and to determine further video signs to compliment and improve the identification of possible concussion events within various sports. The current study demonstrated that, for NRL-related HIEs, the diagnostic accuracy of video signs varies.
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Affiliation(s)
- Andrew J Gardner
- Priority Research Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter New England Local Health District Sports Concussion Program, Waratah, NSW, Australia
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15
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Kent JB, Sasser P, Austin AV, MacKnight JM. Are you missing a concussion by watching American football? Video analysis of ball location in a Division 1 football program. Brain Inj 2021; 35:880-885. [PMID: 33896298 DOI: 10.1080/02699052.2021.1917658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Action in a football game occurs quickly. Medical staff can miss a sport-related concussion (SRC) if they do not observe it directly. The objective of this study is to determine if SRCs occur more frequently at ball than away from ball during gameplay. Game-specific concussion statistics can enhance medical provider care of athletes. METHODS We used gameplay videos of an NCAA Division I football program to analyze SRCs and determine the primary tackler or ball handler during each concussion play. We compared the relative risk of SRCs for the primary ball handlers/tacklers to that of the other 10 players on the same team during that play. RESULTS Over 10 seasons, 26 SRCs occurred at ball for the primary ball handler/tackler position (0.22 SRCs/game) versus 16 away from ball (0.13 SRCs/game). The relative risk of an SRC according to exposure (at ball) vs. no exposure (away from ball) was 16.2 (CI 8.7-30.2, P < .05). Special teams had more SRCs away from ball than at ball, but this was not significant (relative risk 3.32, CI 0.90-12.3, P > .05). CONCLUSIONS The study provides medical staff guidance to more efficiently identify in-game SRCs and supports evidence for rules changes.
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Affiliation(s)
- Jeremy B Kent
- Department of Family Medicine, Team Physician, UVa Sports Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Phillip Sasser
- Department of Pediatrics, University of Wisconsin Health, Madison, WI, USA
| | - Ashley V Austin
- Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - John M MacKnight
- Team Physician and Medical Director, UVA Sports Medicine, University of Virginia Health System, Charlottesville, VA, USA
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16
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Reyes J, Mitra B, Makdissi M, Clifton P, Nguyen JVK, Harcourt P, Howard TS, Cameron PA, Rosenfeld JV, Major BP, Willmott C. Visible Signs of Concussion and Cognitive Screening in Community Sports. J Neurotrauma 2021; 39:122-130. [PMID: 33678008 DOI: 10.1089/neu.2020.7425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Video surveillance and detection of players with visible signs of concussion by experienced medical staff facilitates rapid on-field screening of suspected concussion in professional sports. This method, however has not been validated in community sports where video footage is unavailable. This study aimed to explore the utility of visible signs of concussion to identify players with decrements in performance on concussion screening measures. In this observational prospective cohort study, personnel with basic training observed live matches across a season (60 matches) of community male and female Australian football for signs of concussion outlined in the community-based Head Injury Assessment form (HIAf). Players identified to have positive signs of concussion (CoSign+) following an impact were compared with players without signs (CoSign-). Outcome measures, the Sport Concussion Assessment Tool (SCAT3) and Cogstate, were administered at baseline and post-match. CoSign+ (n = 22) and CoSign- (n = 61) groups were similar with respect to age, sex, education, baseline mood, and medical history. CoSign+ players exhibited worse orientation, concentration, and recall, and slower reaction time in attention and working memory tasks. Comparing individual change from baseline to post-match assessment revealed 100% (95% confidence interval [CI]: 84-100%) of CoSign+ players demonstrated clinically significant deficits on SCAT3 or Cogstate tasks, compared with 59% (95% CI: 46-71%) of CoSign- players. All CoSign+ players observed to have a blank/vacant look demonstrated clinically significant decline on the Standardized Assessment of Concussion (SAC). Detection of visible signs of concussion represents a rapid, real-time method for screening players suspected of concussion in community sports where video technology and medical personnel are rarely present. Consistent with community guidelines, it is recommended that all CoSign+ players be immediately removed from play for further concussion screening.
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Affiliation(s)
- Jonathan Reyes
- Turner Institute for Brain and Mental Health, Monash University, Clayton Campus, Melbourne, Victoria, Australia
| | - Biswadev Mitra
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia.,Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Clayton Campus, Melbourne, Victoria, Australia
| | - Michael Makdissi
- Florey Institute of Neuroscience and Mental Health, Austin Campus, Melbourne Brain Centre, Heidelberg, Victoria, Australia.,Olympic Park Sports Medicine Centre, Melbourne, Victoria, Australia
| | | | - Jack V K Nguyen
- Turner Institute for Brain and Mental Health, Monash University, Clayton Campus, Melbourne, Victoria, Australia
| | - Peter Harcourt
- Australian Football League, Melbourne, Victoria, Australia
| | - Teresa S Howard
- Department of Surgery, Monash University, Clayton Campus, Melbourne, Victoria, Australia
| | - Peter A Cameron
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia.,Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Clayton Campus, Melbourne, Victoria, Australia
| | - Jeffrey V Rosenfeld
- Department of Surgery, Monash University, Clayton Campus, Melbourne, Victoria, Australia.,Department of Neurosurgery, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Surgery, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Brendan P Major
- Monash University & Alfred Health, Melbourne, Victoria, Australia
| | - Catherine Willmott
- Turner Institute for Brain and Mental Health, Monash University, Clayton Campus, Melbourne, Victoria, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Victoria, Australia
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Zuckerman SL, Elbin RJ, Sills AK, Crandall JR, Lessley DJ, Moran CM, Moran CD, Solomon GS. Concussions in the National Football League: the evolution of video review for assessing the frequency and reliability of visible signs. PHYSICIAN SPORTSMED 2020; 48:424-429. [PMID: 32067541 DOI: 10.1080/00913847.2020.1731379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: The use of video review to document visible signs (VS) of sport-related concussion in the National Football League (NFL) is a novel method to recognize head injuries. Hypothesis/Purpose: The current pilot studies used varying methodologies to (1) examine the frequency of VS in concussed NFL players using the Australian Football League's (AFL) checklist, and (2) assess the reliability of VS between non-expert and expert raters. Study design: Cohort study Methods: In the first pilot study, two non-expert raters rated VS of SRC occurring in the 2015 NFL season (n = 96) using a single VS from the AFL checklist. Based on this pilot study, two expert raters then rated VS of SRC during the 2017 NFL season (n = 211) using all VS from the AFL checklist. The frequency, total percent agreement (TPA), and reliability (kappa coefficients) were calculated for all VS of concussion for the two seasons. Kappa agreement was classified as fair (.41-.60), moderate (.61-.80), or substantial (.81-1.00). Significance was set at p < .05. Results: The most frequent VS of concussion identified by both non-expert and expert raters were no behavior observed, slow to get up, and motor incoordination. The least frequent VS were impact seizure, blank/vacant look, and facial injury. For non-expert raters, the average TPA for VS ranged from 84% to 100% and kappa coefficients ranged from .52 to .68. For expert raters, the average TPA ranged from 83% to 100%, and kappa coefficients ranged from .56 to .86. Conclusion: In these preliminary analyses, use of multiple VS was a superior methodology, and the reliability of VS rating was stronger for experts. Due to the inherent differences in gameplay and protective equipment used in the NFL compared to other professional sports, it is our hope these data can generate new ways to improve existing practices and identify potentially novel VS of SRC.
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Affiliation(s)
- Scott L Zuckerman
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center , Nashville, TN, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center , Nashville, TN, USA
| | - R J Elbin
- Department of Health Human Performance and Recreation/Office for Sport Concussion Research, University of Arkansas , Fayetteville, AK, USA
| | - Allen K Sills
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center , Nashville, TN, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center , Nashville, TN, USA.,Player Health and Safety Department, National Football League , New York, NY, USA
| | - Jeff R Crandall
- Biomechanics Consulting and Research, LLC , Charlottesville, VA, USA
| | - David J Lessley
- Biomechanics Consulting and Research, LLC , Charlottesville, VA, USA
| | - Caitlin M Moran
- Player Health and Safety Department, National Football League , New York, NY, USA
| | - Caroline D Moran
- Player Health and Safety Department, National Football League , New York, NY, USA
| | - Gary S Solomon
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center , Nashville, TN, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center , Nashville, TN, USA.,Player Health and Safety Department, National Football League , New York, NY, USA.,Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center , Nashville, TN, USA.,Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center , Nashville, TN, USA
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18
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Frequent but limited assessment of potentially concussed players in Gaelic Football: an opportunity to learn from other sports. Ir J Med Sci 2020; 190:787-792. [PMID: 32997230 DOI: 10.1007/s11845-020-02390-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 09/23/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Sport-related concussion (SRC) is a potential issue within Gaelic Football. Therefore, it is essential that concussion management guidelines are adhered to. HYPOTHESIS/PURPOSE The aim of this study is to determine if potential concussive events (PCEs) in the Gaelic Athletic Association (GAA) National Football League (NFL) are assessed in accordance with GAA concussion guidelines and compare this to other sports. METHODS A descriptive video analysis approach was undertaken to identify PCEs throughout two seasons of play. Subsequent assessment, return to play (RTP) decisions, and signs of concussion were evaluated. RESULTS A total of 242 PCEs were identified over 111 matches. Most PCEs (87.2%, n = 211) were assessed by medical personnel. However, 187 (88.6%) of assessments were under 2 min in duration. Of the 242 PCEs, 189 (78.1%) returned to play after on-pitch assessment, and 12 (5.0%) were removed following a PCE. Sixty-one (25.2%) players sustaining a PCE demonstrated one or more signs of concussion, of which 9 (14.8%) were removed from play. CONCLUSION In the GAA NFL, PCEs are often briefly assessed but rarely result in player removal. Introduction of video incident analysis and concussion substitutions, as in other sports, may reduce the long-term burden of SRC on Gaelic Football players.
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19
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Peltonen K, Launes J, Koskinen S, Vartiainen M, Pajunen S, Pertab J, Laitala T, Hokkanen L. On‐field signs of concussion predict deficits in cognitive functioning: Loss of consciousness, amnesia, and vacant look. TRANSLATIONAL SPORTS MEDICINE 2020. [DOI: 10.1002/tsm2.179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Kati Peltonen
- Department of Psychology and Logopedics University of Helsinki Helsinki Finland
| | - Jyrki Launes
- Department of Psychology and Logopedics University of Helsinki Helsinki Finland
| | - Sanna Koskinen
- Department of Psychology and Logopedics University of Helsinki Helsinki Finland
| | - Matti Vartiainen
- Department of Psychology and Logopedics University of Helsinki Helsinki Finland
| | - Sara Pajunen
- Department of Psychology and Logopedics University of Helsinki Helsinki Finland
| | - Jon Pertab
- Neurosciences Institute Intermountain Medical Center Murray UT USA
| | - Tiina Laitala
- Institute of Biomedicine University of Turku Turku Finland
| | - Laura Hokkanen
- Department of Psychology and Logopedics University of Helsinki Helsinki Finland
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20
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Gardner AJ. Commentary: Sensitivity and Specificity of On-Field Visible Signs of Concussion in the National Football League. Neurosurgery 2020; 87:E298-E300. [DOI: 10.1093/neuros/nyaa158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 03/18/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Andrew J Gardner
- Priority Research Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter New England Local Health District Sports Concussion Program, Waratah, New South Wales, Australia
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21
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Elbin RJ, Zuckerman SL, Sills AK, Crandall JR, Lessley DJ, Solomon GS. Sensitivity and Specificity of On-Field Visible Signs of Concussion in the National Football League. Neurosurgery 2020; 87:530-537. [DOI: 10.1093/neuros/nyaa072] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 01/19/2020] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
On-field visible signs (VS) are used to help identify sport-related concussion (SRC) in the National Football League (NFL). However, the predictive utility of a VS checklist for SRC is unknown.
OBJECTIVE
To report the frequency, sensitivity, specificity, and predictive value of VS in a cohort of NFL athletes.
METHODS
On-field VS ratings from 2 experts who independently reviewed video footage of a cohort of 251 injury plays that resulted in an SRC diagnosis (n = 211) and no diagnosis (n = 40) from the 2017 NFL season were examined. The frequency, sensitivity, specificity, and a receiver operating characteristic (ROC) curve with area under the curve (AUC) were calculated for each VS.
RESULTS
Slow to get up (65.9%) and motor incoordination (28.4%) were the most frequent VS in concussed athletes, and slow to get up (60.0%) was the most common VS among nonconcussed athletes. The most sensitive VS was slow to get up (66%); the most specific signs in concussed NFL athletes were blank/vacant look and impact seizure (both 100%). Approximately 26% of concussed NFL players did not exhibit a VS, and the overall sensitivity and specificity for the VS checklist to detect SRC were 73% and 65%, respectively. The VS checklist demonstrated “poor” ability to discriminate between SRC and non-SRC groups (AUC = 0.66).
CONCLUSION
In the NFL, the diagnosis of concussion cannot be made from on-field VS alone. The VS checklist is one part of the comprehensive sideline/acute evaluation of concussion, and the diagnosis remains a multimodal clinical decision.
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Affiliation(s)
- Robert J Elbin
- Department of Health Human Performance and Recreation/Office for Sport Concussion Research, University of Arkansas, Fayetteville, Arkansas
| | - Scott L Zuckerman
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Allen K Sills
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- Player Health and Safety Department, National Football League, New York, New York
| | - Jeff R Crandall
- Biomechanics Consulting and Research LLC, Charlottesville, Virginia
| | - David J Lessley
- Biomechanics Consulting and Research LLC, Charlottesville, Virginia
| | - Gary S Solomon
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- Player Health and Safety Department, National Football League, New York, New York
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
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22
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Austin AV, Sasser P, Tanabe K, MacKnight JM, Kent JB. Video Analysis of Concussion Exposures in a National Collegiate Athletic Association Division I Football Team. Orthop J Sports Med 2020; 8:2325967120903294. [PMID: 32166091 PMCID: PMC7052463 DOI: 10.1177/2325967120903294] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 11/06/2019] [Indexed: 01/12/2023] Open
Abstract
Background: Research into improving player safety of sport-related concussion (SRC) in
American football has been an ongoing endeavor. In an attempt to better
understand the incidence of SRCs in American football, research has focused
on the characteristics of SRC during gameplay. Determining SRC specifics and
assessing them quantitatively can help identify high-risk scenarios and
predict exposure risk. Purpose: To identify and assess the incidence of SRCs in a National Collegiate
Athletic Association football team by comparing field location, player
positions, collision partners, and player cues. Study Design: Descriptive epidemiology study. Methods: We used physician sideline reports of diagnosed concussions from a Division I
football team from September 2010 to December 2018. Game videos were
analyzed to identify the field location where the SRC occurred, collision
partner, and player behavior postconcussion. The incidence of in-game SRCs
by position was also assessed. We used the “words of estimative probability”
model to categorize each concussion as certain, almost certain,
probable, or even on the basis of our
confidence in identifying them using game film. Results: This study examined 44 SRCs that occurred over 9 seasons. The SRC incidence
was significantly higher in the middle defense (5-20 yards from the line of
scrimmage) compared with all other field locations (relative risk, 2.46; 95%
CI, 1.14-5.29; P < .05). In-game collision partners were
most commonly defensive backs. The most common player cue was a hand to
helmet/face mask. The positions with the highest SRC incidence by
athlete-exposure, game position, and position play belonged to the defensive
backs, wide receivers, and running backs. Conclusion: The middle defense had a significantly higher incidence of SRCs than all
other field locations. We pose a new method to categorize concussions during
video analysis by using words of estimative probability. Knowledge of SRC
gameplay characteristics can potentially guide the medical staff and medical
observer to better identify them.
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Affiliation(s)
- Ashley V Austin
- Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Phillip Sasser
- Department of Family Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Kawai Tanabe
- Department of Family Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - John M MacKnight
- Department of Internal Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Jeremy B Kent
- Department of Family Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
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23
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Dec KL, Kelly KC, Gilman JB. Management of Adult Sports Concussion. Concussion 2020. [DOI: 10.1016/b978-0-323-65384-8.00011-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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24
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Davis GA, Makdissi M, Bloomfield P, Clifton P, Echemendia RJ, Falvey ÉC, Fuller GW, Green G, Harcourt P, Hill T, McGuirk N, Meeuwisse W, Orchard J, Raftery M, Sills AK, Solomon GS, Valadka A, McCrory P. International consensus definitions of video signs of concussion in professional sports. Br J Sports Med 2019; 53:1264-1267. [PMID: 30954947 DOI: 10.1136/bjsports-2019-100628] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND The use of video to assist professional sporting bodies with the diagnosis of sport-related concussion (SRC) has been well established; however, there has been little consistency across sporting codes with regards to which video signs should be used, and the definitions of each of these signs. AIM The aims of this study were to develop a consensus for the video signs considered to be most useful in the identification of a possible SRC and to develop a consensus definition for each of these video signs across the sporting codes. METHODS A brief questionnaire was used to assess which video signs were considered to be most useful in the identification of a possible concussion. Consensus was defined as >90% agreement by respondents. Existing definitions of these video signs from individual sports were collated, and individual components of the definitions were assessed and ranked. A modified Delphi approach was then used to create a consensus definition for each of the video signs. RESULTS Respondents representing seven sporting bodies (Australian Football League, Cricket Australia, Major League Baseball, NFL, NHL, National Rugby League, World Rugby) reached consensus on eight video signs of concussion. Thirteen representatives from the seven professional sports ranked the definition components. Consolidation and refinement of the video signs and their definitions resulted in consensus definitions for six video signs of possible concussion: lying motionless, motor incoordination, impact seizure, tonic posturing, no protective action-floppy and blank/vacant look. CONCLUSIONS These video signs and definitions have reached international consensus, are indicated for use by professional sporting bodies and will form the basis for further collaborative research.
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Affiliation(s)
- Gavin A Davis
- Florey Institute of Neuroscience and Mental Health-Austin Campus, Heidelberg, Victoria, Australia .,Neurosurgery, Cabrini Hospital, Malvern, Victoria, Australia
| | - Michael Makdissi
- Florey Institute of Neuroscience and Mental Health-Austin Campus, Heidelberg, Victoria, Australia.,La Trobe Sport and Exercise Medicine Research Centre, Melbourne, Victoria, Australia
| | - Paul Bloomfield
- National Rugby League (NRL), Sydney, New South Wales, Australia
| | | | | | | | - Gordon Ward Fuller
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Gary Green
- Major League Baseball, New York, New York, USA
| | - Peter Harcourt
- Australian Football League, Melbourne, Victoria, Australia
| | - Thomas Hill
- Cricket Australia, Melbourne, Victoria, Australia
| | - Nathan McGuirk
- National Rugby League, Sydney, New South Wales, Australia
| | | | - John Orchard
- Cricket Australia, Sydney, New South Wales, Australia
| | | | | | | | | | - Paul McCrory
- Melbourne Brain Centre, Florey Institute of Neuroscience and Mental Health-Austin Campus, Heidelberg, Victoria, Australia
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25
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Carey L, Stanwell P, Terry DP, McIntosh AS, Caswell SV, Iverson GL, Gardner AJ. Verifying Head Impacts Recorded by a Wearable Sensor using Video Footage in Rugby League: a Preliminary Study. SPORTS MEDICINE - OPEN 2019; 5:9. [PMID: 30874938 PMCID: PMC6419663 DOI: 10.1186/s40798-019-0182-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 02/27/2019] [Indexed: 12/04/2022]
Abstract
BACKGROUND Rugby league is a full-contact collision sport with an inherent risk of concussion. Wearable instrumented technology was used to observe and characterize the level of exposure to head impacts during game play. PURPOSE To verify the impacts recorded by the x-patch™ with video analysis. STUDY DESIGN Observational case series. METHODS The x-patch™ was used on eight men's semi-professional rugby league players during the 2016 Newcastle Rugby League competition (five forwards and three backs). Game day footage was recorded by a trained videographer using a single camera located at the highest midfield location to verify the impact recorded by the x-patch™. Videographic and accelerometer data were time synchronized. RESULTS The x-patch™ sensors recorded a total of 779 impacts ≥ 20 g during the games, of which 732 (94.0%) were verified on video. In addition, 817 impacts were identified on video that did not record an impact on the sensors. The number of video-verified impacts ≥ 20 g, per playing hour, was 7.8 for forwards and 4.8 for backs (range = 3.9-19.0). Impacts resulting in a diagnosed concussion had much greater peak linear acceleration (M = 76.1 g, SD = 17.0) than impacts that did not result in a concussion (M = 34.2g, SD = 18.0; Cohen's d = 2.4). CONCLUSIONS The vast majority (94%) of impacts ≥ 20 g captured by the x-patch™ sensor were video verified in semi-professional rugby league games. The use of a secondary source of information to verify impact events recorded by wearable sensors is beneficial in clarifying game events and exposure levels.
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Affiliation(s)
- Lauchlan Carey
- Centre for Stroke and Brain Injury, School of Health Sciences, Faculty of Health, University of Newcastle, Callaghan, New South Wales Australia
| | - Peter Stanwell
- Centre for Stroke and Brain Injury, School of Health Sciences, Faculty of Health, University of Newcastle, Callaghan, New South Wales Australia
| | - Douglas P. Terry
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA USA
- Spaulding Rehabilitation Hospital, Boston, MA USA
- MassGeneral Hospital for Children™ Sport Concussion Program, & Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, MA USA
| | - Andrew S. McIntosh
- School of Engineering and Australian Collaboration for Research into Injury in Sport and its Prevention, Edith Cowan University, Perth, Western Australia Australia
- Monash University Accident Research Centre, Monash University, Clayton, Victoria Australia
| | - Shane V. Caswell
- Sports Medicine Assessment Research & Testing (SMART) Laboratory, George Mason University, Manassas, Virginia USA
| | - Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA USA
- Spaulding Rehabilitation Hospital, Boston, MA USA
- MassGeneral Hospital for Children™ Sport Concussion Program, & Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, MA USA
| | - Andrew J. Gardner
- Hunter New England Local Health District Sports Concussion Program, New Lambton Heights, New South Wales Australia
- Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales Australia
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26
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Lessley DJ, Kent RW, Funk JR, Sherwood CP, Cormier JM, Crandall JR, Arbogast KB, Myers BS. Video Analysis of Reported Concussion Events in the National Football League During the 2015-2016 and 2016-2017 Seasons. Am J Sports Med 2018; 46:3502-3510. [PMID: 30398897 DOI: 10.1177/0363546518804498] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Concussions in American football remain a high priority of sports injury prevention programs. Detailed video review provides important information on causation, the outcomes of rule changes, and guidance on future injury prevention strategies. PURPOSE Documentation of concussions sustained in National Football League games played during the 2015-2016 and 2016-2017 seasons, including consideration of video views unavailable to the public. STUDY DESIGN Descriptive epidemiology study. METHODS All reported concussions were reviewed with all available video footage. Standardized terminology and associated definitions were developed to describe and categorize the details of each concussion. RESULTS Cornerbacks sustained the most concussions, followed by wide receivers, then linebackers and offensive linemen. Half (50%) of concussions occurred during a passing play, 28% during a rushing play, and 21% on a punt or kickoff. Tackling was found to be the most common activity of concussed players, with the side of the helmet the most common helmet impact location. The distribution of helmet impact source-the object that contacted the concussed player's helmet-differed from studies of earlier seasons, with a higher proportion of helmet-to-body impacts (particularly shoulder) and helmet-to-ground impacts and with a lower proportion of helmet-to-helmet impacts. Helmet-to-ground concussive impacts were notable for the high prevalence of impacts to the back of the helmet and their frequency during passing plays. CONCLUSION Concussion causation scenarios in the National Football League have changed over time. CLINICAL RELEVANCE The results of this study suggest the need for expanded evaluation of concussion countermeasures beyond solely helmet-to-helmet test systems, including consideration of impacts with the ground and with the body of the opposing player. It also suggests the possibility of position-specific countermeasures as part of an ongoing effort to improve safety.
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Affiliation(s)
- David J Lessley
- Biomechanics Consulting and Research (BioCore), LLC, Charlottesville, Virginia, USA
| | - Richard W Kent
- Biomechanics Consulting and Research (BioCore), LLC, Charlottesville, Virginia, USA
| | - James R Funk
- Biomechanics Consulting and Research (BioCore), LLC, Charlottesville, Virginia, USA
| | | | - Joseph M Cormier
- Biomechanics Consulting and Research (BioCore), LLC, Charlottesville, Virginia, USA
| | - Jeff R Crandall
- Biomechanics Consulting and Research (BioCore), LLC, Charlottesville, Virginia, USA
| | - Kristy B Arbogast
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Barry S Myers
- Duke University, Biomedical Engineering, Durham, North Carolina, USA
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27
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Davis GA, Makdissi M, Bloomfield P, Clifton P, Echemendia RJ, Falvey ÉC, Fuller GW, Green G, Harcourt PR, Hill T, McGuirk N, Meeuwisse W, Orchard JW, Raftery M, Sills AK, Solomon GS, Valadka A, McCrory P. International study of video review of concussion in professional sports. Br J Sports Med 2018; 53:1299-1304. [DOI: 10.1136/bjsports-2018-099727] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/29/2018] [Accepted: 08/30/2018] [Indexed: 11/03/2022]
Abstract
BackgroundVideo review has become an important tool in professional sporting codes to help sideline identification and management of players with a potential concussion.AimTo assess current practices related to video review of concussion in professional sports internationally, and compare protocols and diagnostic criteria used to identify and manage potential concussions.MethodsCurrent concussion management guidelines from professional national and international sporting codes were reviewed. Specific criteria and definitions of video signs associated with concussion were compared between codes. Rules and regulations adopted across the codes for processes around video review were also assessed.ResultsSix sports with specific diagnostic criteria and definitions for signs of concussion identified on video review participated in this study (Australian football, American football, world rugby, cricket, rugby league and ice hockey). Video signs common to all sports include lying motionless/loss of responsiveness and motor incoordination. The video signs considered by the majority of sports as most predictive of a diagnosis of concussion include motor incoordination, impact seizure, tonic posturing and lying motionless. Regulatory requirements, sideline availability of video, medical expertise of video reviewers and use of spotters differ across sports and geographical boundaries. By and large, these differences reflect a pragmatic approach from each sport, with limited underlying research and development of the video review process in some instances.ConclusionsThe use of video analysis in assisting medical staff with the diagnosis or identification of potential concussion is well established across different sports internationally. The diagnostic criteria used and the expertise of the video review personnel are not clearly established, and research efforts would benefit from a collaborative harmonisation across sporting codes.
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28
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Gardner AJ, Kohler R, McDonald W, Fuller GW, Tucker R, Makdissi M. The Use of Sideline Video Review to Facilitate Management Decisions Following Head Trauma in Super Rugby. SPORTS MEDICINE-OPEN 2018; 4:20. [PMID: 29797099 PMCID: PMC5968014 DOI: 10.1186/s40798-018-0133-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 05/07/2018] [Indexed: 12/01/2022]
Abstract
Background Sideline video review has been increasingly used to evaluate risk of concussive injury during match play of a number of collision sports, with the view to reducing the incidence of match play concussion injuries. The purpose of this study was to evaluate the effectiveness of sideline video review for identifying and evaluating head impact events in Rugby Union. Methods All Australian teams’ 2015 Super Rugby season matches were studied. Meaningful head impact events (HIEs) were identified, comprising events identified and acted upon during matches and events identified through a post-season retrospective review. Video footage of each HIE was coded by two experienced independent sports medicine clinicians to evaluate management decisions made by match-day (MDD) and team doctors (TD). HIE incidences for matches with and without sideline video were compared, and the agreement between game-day video interpretation and the independent clinician opinion calculated. Results Seventy HIEs were identified in 83 matches (47 identified during matches and 23 identified post-season), equating to 42.5 HIEs per 1000 player match hours. When video review was available, an unnoticed HIE occurred once every 4.3 matches, compared to once every 2.3 matches when the sideline video review was unavailable. Of the 47 identified in-match HIEs evaluated by TD and MDD during the season, 18 resulted in an immediate and permanent removal, 28 resulted in temporary removal for an off-field assessment, and one resulted in the player continuing the game. Game-day head injury assessment process video decisions agreed with the independent clinician view in 72% of cases, κ = 0.49 (95% CI 0.38–0.59, weak agreement). Conclusions These findings suggest that access to sideline video review is an important supplementary component to identify potential concussions; however, there is a critical need for improved systems and processes to reduce the likelihood of missing an incident.
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Affiliation(s)
- Andrew J Gardner
- Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle, Newcastle, Australia. .,Hunter New England Local Health District Sports Concussion Program, Newcastle, NSW, Australia. .,Priority Research Centre for Stroke and Brain Injury, Calvary Mater Hospital, Level 5, McAuley Building, Waratah, NSW, 2298, Australia.
| | - Ryan Kohler
- HeadSmart™ Sports Concussion Program, Head Office 4 Helensvale Road, Helensvale, Gold Coast, Australia
| | - Warren McDonald
- Australian Rugby Union (ARU), Moore Park, NSW, Australia.,Sport and Exercise Science, Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Gordon W Fuller
- Emergency Medicine Research in Sheffield Group, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Ross Tucker
- School of Management Studies, Faculty of Commerce, University of Cape Town, Cape Town, South Africa.,World Rugby, Pty (Ltd), Dublin, Ireland
| | - Michael Makdissi
- Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, VIC, Australia.,La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, VIC, Australia
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29
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Gardner AJ, Howell DR, Iverson GL. A video review of multiple concussion signs in National Rugby League match play. SPORTS MEDICINE-OPEN 2018; 4:5. [PMID: 29330738 PMCID: PMC5766475 DOI: 10.1186/s40798-017-0117-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 12/20/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Video review has been introduced in many professional sports worldwide to help recognize concussions. However, to date, there has been very little research on the accuracy of using video analysis to identify signs of concussion and the various combinations of observed signs. METHODS The objective of the study is to determine the accuracy of combinations of clinical signs of concussion identified using video analysis to identify concussions in the National Rugby League (NRL). Incidences of players using of the concussion interchange rule (CIR) (n = 156), including those where athletes were diagnosed with a concussion (n = 60), were used to calculate sensitivity and specificity of various combinations of concussion signs (unresponsiveness, slow to get up, clutching/shaking head, gait ataxia, vacant stare, and apparent seizure) and their independent association with an eventual diagnosis of concussion. RESULTS Using video analysis, players who were diagnosed with a concussion showed a significantly greater total number of signs at the time of injury (mean = 3.4, SD = 1.3) than those who were removed from play but not diagnosed with a concussion (mean = 3.0, SD = 0.9 signs; p = .046). Players who did not return to play during the same game demonstrated a significantly greater number of total signs than those who did return to play in the same game following CIR activation (mean = 3.4, SD = 1.2 versus mean = 2.9, SD = 0.9; p = 0.002). The most common combination of signs that was observed was clutching/shaking the head and slowness in getting up (17.3%). The sensitivity of the total number of signs observed decreased as the number of signs increased (range = 0.13-0.62), while the specificity increased as more signs were observed (range = 0.29-0.90). Most of the combinations of different observed signs at the time of potential injury were highly specific (> 0.80), but not sensitive to an eventual diagnosis of concussion. When considering all potential predictor variables in a logistic regression model, anticipating the oncoming collision (OR = 3.92, 95% CI = 1.28-12.03), fewer number of defenders involved in the tackle (OR = 0.58, 95% CI = 0.36-0.92), and the presence of a blank or vacant stare (OR = 2.97, 95% CI = 1.26-7.01) were each significantly associated with concussion diagnoses. CONCLUSIONS The use of video review in the NRL is challenging, but being aware of the combinations of possible concussion signs and the likelihood that various presentations result in a concussion diagnosis can provide a useful addition to sideline concussion identification and removal from play decisions.
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Affiliation(s)
- Andrew J Gardner
- Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia. .,Hunter New England Local Health District Sports Concussion Program, John Hunter Hospital, Newcastle, NSW, Australia.
| | - David R Howell
- Department of Orthopedics, Sports Medicine Center, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.,Spaulding Rehabilitation Hospital, Boston, MA, USA.,MassGeneral Hospital for Children™ Sport Concussion Program, Boston, MA, USA.,Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, MA, Australia
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30
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Gardner AJ, Howell DR, Levi CR, Iverson GL. Evidence of Concussion Signs in National Rugby League Match Play: a Video Review and Validation Study. SPORTS MEDICINE-OPEN 2017; 3:29. [PMID: 28831759 PMCID: PMC5567587 DOI: 10.1186/s40798-017-0097-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 08/11/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Many professional sports have introduced sideline video review to help recognise concussions. The reliability and validity of identifying clinical and observable signs of concussion using video analysis has not been extensively explored. This study examined the reliability and validity of clinical signs of concussion using video analysis in the National Rugby League (NRL). METHODS All 201 professional NRL matches from the 2014 season were reviewed to document six signs of possible concussion (unresponsiveness, slow to get up, clutching/shaking head, gait ataxia, vacant stare, and seizure). RESULTS A total of 127,062 tackles were reviewed. Getting up slowly was the most common observable sign (2240 times in the season, 1.8% of all tackles) but only 223 times where it appeared to be a possible concussion (0.2% of all tackles and 10.0% of the times it occurred). Additionally, clutching/shaking the head occurred 361 times (on 212 occasions this sign appeared to be due to a possible concussion), gait ataxia was observed 102 times, a vacant stare was noted 98 times, unresponsiveness 52 times, and a possible seizure 4 times. On 383 occasions, one or more of the observable signs were identified and deemed associated with a possible concussion. There were 175 incidences in which a player appeared to demonstrate two or more concussion signs, and 54 incidences where a player appeared to demonstrate three or more concussion signs. A total of 60 diagnosed concussions occurred, and the concussion interchange rule was activated 167 times. Intra-rater reliability (κ = 0.65-1.00) was moderate to perfect for all six video signs; however, the inter-rater reliability was not as strong (κ = 0.22-0.76). Most of the signs had relatively low sensitivity (0.18-0.75), but high specificity (0.85-1.00). CONCLUSIONS Using video replay, observable signs of concussion appear to be sensitive to concussion diagnoses when reviewing known injuries among professional rugby league players. When reviewing an entire season, however, certain signs occur very commonly and did not identify concussion. Thus, the implementation of video review in the NRL is challenging, but can provide a useful addition to sideline concussion identification and removal from play decisions.
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Affiliation(s)
- Andrew J Gardner
- Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle, Callaghan, Australia. .,Priority Research Centre for Stroke and Brain Injury, Level 5, McAuley Building, Calvary Mater Hospital, Waratah, NSW, 2298, Australia.
| | - David R Howell
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA.,Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, USA.,Brain Injury Center, Boston Children's Hospital, Boston, MA, USA
| | - Christopher R Levi
- Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter New England Local Health District Sports Concussion Program, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Grant L Iverson
- Center for Health and Rehabilitation, Department of Physical Medicine and Rehabilitation, Harvard Medical School, 79/96 Thirteenth Street, Charlestown Navy Yard, Charlestown, MA, USA.,Spaulding Rehabilitation Hospital, Charlestown, USA.,MassGeneral Hospital for Children™ Sport Concussion Program, and Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, MA, USA
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Saw R, Finch CF, Samra D, Baquie P, Cardoso T, Hope D, Orchard JW. Injuries in Australian Rules Football: An Overview of Injury Rates, Patterns, and Mechanisms Across All Levels of Play. Sports Health 2017; 10:208-216. [PMID: 28825878 PMCID: PMC5958447 DOI: 10.1177/1941738117726070] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
CONTEXT The nature of Australian rules football (Australian football) predisposes both unique and common injuries compared with those sustained in other football codes. The game involves a combination of tackling, kicking, high-speed running (more than other football codes), and jumping. Two decades of injury surveillance has identified common injuries at the professional level (Australian Football League [AFL]). OBJECTIVE To provide an overview of injuries in Australian rules football, including injury rates, patterns, and mechanisms across all levels of play. STUDY DESIGN A narrative review of AFL injuries, football injury epidemiology, and biomechanical and physiological attributes of relevant injuries. RESULTS The overall injury incidence in the 2015 season was 41.7 injuries per club per season, with a prevalence of 156.2 missed games per club per season. Lower limb injuries are most prevalent, with hamstring strains accounting for 19.1 missed games per club per season. Hamstring strains relate to the volume of high-speed running required in addition to at times having to collect the ball while running in a position of hip flexion and knee extension. Anterior cruciate ligament injuries are also prevalent and can result from contact and noncontact incidents. In the upper limb, shoulder sprains and dislocations account for 11.5 missed games per club per season and largely resulted from tackling and contact. Concussion is less common in AFL than other tackling sports but remains an important injury, which has notably become more prevalent in recent years, theorized to be due to a more conservative approach to management. Although there are less injury surveillance data for non-AFL players (women, community-level, children), many of these injuries appear to also be common across all levels of play. CLINICAL RELEVANCE An understanding of injury profiles and mechanisms in Australian football is crucial in identifying methods to reduce injury risk and prepare players for the demands of the game.
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Affiliation(s)
- Richard Saw
- Olympic Park Sports Medicine Centre,
Melbourne, Victoria, Australia
| | - Caroline F. Finch
- Australian Collaboration for Research
into Injury in Sport and Its Prevention, Federation University Australia, Ballarat,
Victoria, Australia
| | - David Samra
- The Stadium Sports Medicine Clinic,
Sydney, New South Walesm Australia
| | - Peter Baquie
- Olympic Park Sports Medicine Centre,
Melbourne, Victoria, Australia
| | - Tanusha Cardoso
- Alphington Sports Medicine Clinic,
Melbourne, Victoria, Australia
| | - Danielle Hope
- Peak Sports Medicine Clinic, Melbourne,
Victoria, Australia
| | - John W. Orchard
- School of Public Health, University of
Sydney, Sydney, New South Wales, Australia
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32
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Gardner AJ, Levi CR, Iverson GL. Observational Review and Analysis of Concussion: a Method for Conducting a Standardized Video Analysis of Concussion in Rugby League. SPORTS MEDICINE-OPEN 2017; 3:26. [PMID: 28710723 PMCID: PMC5511124 DOI: 10.1186/s40798-017-0093-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 06/26/2017] [Indexed: 11/10/2022]
Abstract
Background Several professional contact and collision sports have recently introduced the use of sideline video review for club medical staff to help identify and manage concussions. As such, reviewing video footage on the sideline has become increasingly relied upon to assist with improving the identification of possible injury. However, as yet, a standardized method for reviewing such video footage in rugby league has not been published. The aim of this study is to evaluate whether independent raters reliably agreed on the injury characterization when using a standardized observational instrument to record video footage of National Rugby League (NRL) concussions. Methods Video footage of 25 concussions were randomly selected from a pool of 80 medically diagnosed concussions from the 2013–2014 NRL seasons. Four raters (two naïve and two expert) independently viewed video footage of 25 NRL concussions and completed the Observational Review and Analysis of Concussion form for the purpose of this inter-rater reliability study. The inter-rater reliability was calculated using Cohen’s kappa (κ) and intra-class correlation (ICC) statistics. The two naïve raters and the two expert raters were compared with one another separately. Results A considerable number of components for the naïve and expert raters had almost perfect agreement (κ or ICC value ≥ 0.9), 9 of 22 (41%) components for naïve raters and 21 of 22 (95%) components for expert raters. For the concussion signs, however, the majority of the rating agreement was moderate (κ value 0.6–0.79); both the naïve and expert raters had 4 of 6 (67%) concussion signs with moderate agreement. The most difficult concussion sign to achieve agreement on was blank or vacant stare, which had weak (κ value 0.4–0.59) agreement for both naïve and expert raters. Conclusions There appears to be value in expert raters, but less value for naive raters, in using the new Observational Review and Analysis of Concussion (ORAC) Form. The ORAC Form has high inter-rater agreement for most data elements, and it can be used by expert raters evaluating video footage of possible concussion in the NRL.
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Affiliation(s)
- Andrew J Gardner
- Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia. .,Hunter New England Local Health District Sports Concussion Program, John Hunter Hospital, Newcastle, New South Wales, Australia.
| | - Christopher R Levi
- Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter New England Local Health District Sports Concussion Program, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA.,MassGeneral Hospital for Children™ Sport Concussion Program, Boston, MA, USA.,Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, MA, USA
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