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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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2
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Smoliga JM, Deshpande SK, Binney ZO. Interaction of Surface Type, Temperature, and Week of Season on Concussion Risk in the National Football League: A Bayesian Analysis. Epidemiology 2023; 34:807-816. [PMID: 37732833 DOI: 10.1097/ede.0000000000001657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
BACKGROUND Artificial turf fields and environmental conditions may influence sports concussion risk, but existing research is limited by uncontrolled confounding factors, limited sample size, and the assumption that risk factors are independent of one another. The purpose of this study was to examine how playing surface, time of season, and game temperature relate to diagnosed concussion risk in the National Football League (NFL). METHODS This retrospective cohort study examined data from the 2012 to the 2019 NFL regular season. We fit Bayesian negative binomial regression models to relate how playing surface, game temperature, and week of the season independently related to diagnosed concussion risk and any interactions among these factors. RESULTS We identified 1096 diagnosed concussions in 1830 games. There was a >99% probability that concussion risk was reduced on grass surface (median incidence rate ratio [IRR] = 0.78 [95% credible interval: 0.68, 0.89]), >99% probability that concussion risk was lower at higher temperatures (IRR = 0.85 [0.76,0.95] for each 7.9 °C), and >91% probability that concussion risk increased with each week of the season (IRR = 1.02 [1.00,1.04]). There was an >84% probability for a surface × temperature interaction (IRR = 1.01 [0.96, 1.28]) and >75% probability for a surface × week interaction (IRR = 1.02 [0.99, 1.05]). CONCLUSIONS Diagnosed concussion risk is increased on artificial turf compared with natural grass, and this is exacerbated in cold weather and, independently, later in the season. The complex interplay between these factors necessitates accounting for multiple factors and their interactions when investigating sports injury risk factors and devising mitigation methods.
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Affiliation(s)
- James M Smoliga
- From the Department of Physical Therapy, One University Parkway, High Point University, High Point, NC
- Doctor of Physical Therapy Program (Seattle), Tufts University School of Medicine, Boston, MA
| | - Sameer K Deshpande
- Department of Statistics, University of Wisconsin, 7225B Medical Sciences Center, Madison, WI
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Iverson GL, Gaudet CE, Kissinger-Knox A, Gardner AJ. Examining Whether Loss of Consciousness Is Associated With Worse Performance on the SCAT5 and Slower Clinical Recovery After Concussion in Professional Athletes. J Neurotrauma 2023; 40:2330-2340. [PMID: 36541353 DOI: 10.1089/neu.2022.0043] [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] [Indexed: 12/24/2022] Open
Abstract
Video surveillance has almost universally been employed by professional sports to identify signs of concussion during competition. This study examined associations between video-identified possible loss of consciousness (LOC), acute concussion evaluation findings, and recovery time in concussed professional rugby league players. Medical personnel and sideline video operators identified head impact events sustained during three seasons of National Rugby League (NRL) matches to determine the need for further medical evaluation. If a concussion was suspected, players were removed from play and underwent a Head Injury Assessment, including the Sports Concussion Assessment Tool, Fifth Edition (SCAT5). Video footage was later examined to identify signs of possible LOC (i.e., observed LOC, no protective action in the fall, and unresponsiveness or lying motionless). Possible LOC was identified in 99 of the 1706 head impact events (5.8%). The median duration of apparent unresponsiveness was 4.2 sec (M = 7.4, standard deviation [SD] = 12.8, interquartile range [IQR] = 2.5-6.6). In the 661 athletes for whom SCAT5 data were available, those with possible LOC endorsed more SCAT5 symptoms and performed worse on Maddocks questions, Standardized Assessment of Concussion (SAC) total scores, orientation, immediate recall, concentration, and delayed recall. For the 255 players with medically diagnosed concussions, SCAT5 data were available for 245. Concussed players with possible LOC performed significantly worse on Maddocks questions. However, there were no group differences in SCAT5 symptom endorsement, SAC total scores, orientation, immediate recall, concentration, delayed recall, or the modified version of the Balance Error Scoring System (mBESS) total errors. Further, the presence or absence of possible LOC was not associated with number of games missed or time to medical clearance for match play. The duration of possible LOC was not associated with the number of games missed or time to medical clearance for match play. According to video review in NRL players, brief LOC might be more common than previously thought. The present study reveals possible LOC is not predictive of missed games or time to recover following concussion.
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Affiliation(s)
- Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- MassGeneral Hospital for Children Sports Concussion Program, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, Massachusetts, USA
| | - Charles E Gaudet
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
| | - Alicia Kissinger-Knox
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- MassGeneral Hospital for Children Sports Concussion Program, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
| | - Andrew J Gardner
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
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Li Y, Tang J, Zhang X, Cao D, Lyu T. Investigation of concussion knowledge and attitudes of Chinese amateur adolescent soccer athletes. Medicine (Baltimore) 2023; 102:e33972. [PMID: 37335627 DOI: 10.1097/md.0000000000033972] [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] [Indexed: 06/21/2023] Open
Abstract
Concussions are a common traumatic brain injury in soccer games but are often ignored by coaches and athletes. The purpose of our study is to assess the concussion knowledge and attitudes among amateur adolescent soccer athletes in China. Data was collected from questionnaire surveying (Rosenbaum Concussion Knowledge and Attitudes Survey (Student Version)) and semi-structured interviews completed by 69 amateur adolescent soccer athletes who participated in the U17 and U15 male groups of the 2022 China Youth Soccer League. The study followed a mixed methodology cross sectional study design. The concussion knowledge index (0-25) and concussion attitude index (15-75) scores were derived from the questionnaire and descriptive statistics were used for data analysis. The mean score of concussion knowledge is 16.8 ± 2.4 (range 10-22), and the mean score of concussion attitude is 61.3 ± 8.8 (range 45-77). Thematic analysis was used to categorize the participant's responses of the semi-structured interview and the results were compared with their survey answers of questionnaire. Interestingly, the interviews revealed the inconsistencies between the questionnaire responses and intended behaviors, and multiple factors (injury severity, the importance of the game and substitution rules) influencing concussion-reporting behaviors were identified. In addition, athletes hope to acquire concussion knowledge through formal education. Our study lay the foundation for educational interventions to potentially improve concussion-reporting behaviors among amateur adolescent soccer athletes.
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Affiliation(s)
- Yue Li
- School of Physical Education, Huaibei Normal University, Huaibei, China
| | - Jiaxing Tang
- School of Physical Education, Shanghai University of Sport, Shanghai, China
| | - Xiaomin Zhang
- School of Electronic and Information Engineering, Huaibei Institute of Technology, Huaibei, China
| | - Dawei Cao
- School of Physical Education, Huaibei Normal University, Huaibei, China
| | - Teng Lyu
- Graduate School, University of Perpetual Help System Dalta, Manila, Philippines
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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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Weber J, Ernstberger A, Reinsberger C, Popp D, Nerlich M, Alt V, Krutsch W. Video analysis of 100 matches in male semi-professional football reveals a heading rate of 5.7 headings per field player and match. BMC Sports Sci Med Rehabil 2022; 14:132. [PMID: 35842676 PMCID: PMC9288693 DOI: 10.1186/s13102-022-00521-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 07/06/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Heading is an integral part of football and frequent media reports and previous studies about potential danger of heading and head trauma in football fuelled discussions. Epidemiological data and video analyses regarding headings situation and associated head injuries are still missing in male adult professional football. METHODS In a prospective cohort study in the male fourth German football league, 100 official matches of the 2015-2016 season were assessed by video analysis and a standardized protocol. Heading situations and concomitant circumstances as well as incidents with a propensity of injury (critical incidents) were analyzed. Critical incidents (CI) and seasonal reported head injuries were cross-referenced. RESULTS Overall, 11,514 headings were analysed in detail. Video analysis yielded a mean of 5.7 headings per player and match (SD: 1.2; range 0-15). Heading was predominantly performed with the frontal part of the head (76.8%), and nearly two thirds of all headings occurred during defending (65.8%). 71.0% of all headings occured during tacklings, of which 71.9% involved body contact with the opponent player. Video analysis yielded 31 CI on the head due to heading (incidence: 1.02 per 1000 h match exposure and player). 29 CI occurred during heading duels (odds ratio: 5.91), 30 CI with body contact (odds ratio: 28.8) and 6 CI with elbow contact (odds ratio: 6.13). CONCLUSION Heading frequency in male semi-professional football could be determined with a rate of 5.7 headings per match and field player. Cross referencing CI and seasonal reported head injuries revealed a very low number of reported head injuries.
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Affiliation(s)
- Johannes Weber
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
| | - Andreas Ernstberger
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Claus Reinsberger
- Institute of Sports Medicine, University of Paderborn, Paderborn, Germany
| | - Daniel Popp
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Michael Nerlich
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Volker Alt
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Werner Krutsch
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
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Multi-Output Sequential Deep Learning Model for Athlete Force Prediction on a Treadmill Using 3D Markers. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12115424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Reliable and innovative methods for estimating forces are critical aspects of biomechanical sports research. Using them, athletes can improve their performance and technique and reduce the possibility of fractures and other injuries. For this purpose, throughout this project, we proceeded to research the use of video in biomechanics. To refine this method, we propose an RNN trained on a biomechanical dataset of regular runners that measures both kinematics and kinetics. The model will allow analyzing, extracting, and drawing conclusions about continuous variable predictions through the body. It marks different anatomical and reflective points (96 in total, 32 per dimension) that will allow the prediction of forces (N) in three dimensions (Fx, Fy, Fz), measured on a treadmill with a force plate at different velocities (2.5 m/s, 3.5 m/s, 4.5 m/s). In order to obtain the best model, a grid search of different parameters that combined various types of layers (Simple, GRU, LSTM), loss functions (MAE, MSE, MSLE), and sampling techniques (down-sampling, up-sampling) helped obtain the best performing model (LSTM, MSE, down-sampling) achieved an average coefficient of determination of 0.68, although when excluding Fz it reached 0.92.
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8
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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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9
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Survey on Video-Based Biomechanics and Biometry Tools for Fracture and Injury Assessment in Sports. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12083981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This work presents a survey literature review on biomechanics, specifically aimed at the study of existent biomechanical tools through video analysis, in order to identify opportunities for researchers in the field, and discuss future proposals and perspectives. Scientific literature (journal papers and conference proceedings) in the field of video-based biomechanics published after 2010 were selected and discussed. The most common application of the study of biomechanics using this technique is sports, where the most reported applications are american football, soccer, basketball, baseball, jumping, among others. These techniques have also been studied in a less proportion, in ergonomy, and injury prevention. From the revised literature, it is clear that biomechanics studies mainly focus on the analysis of angles, speed or acceleration, however, not many studies explore the dynamical forces in the joints. The development of video-based biomechanic tools for force analysis could provide methods for assessment and prediction of biomechanical force associated risks such as injuries and fractures. Therefore, it is convenient to start exploring this field. A few case studies are reported, where force estimation is performed via manual tracking in different scenarios. This demonstration is carried out using conventional manual tracking, however, the inclusion of similar methods in an automated manner could help in the development of intelligent healthcare, force prediction tools for athletes and/or elderly population. Future trends and challenges in this field are also discussed, where data availability and artificial intelligence models will be key to proposing new and more reliable methods for biomechanical analysis.
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10
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Leddy JJ, Haider MN, Noble JM, Rieger B, Flanagan S, McPherson JI, Shubin-Stein K, Saleem GT, Corsaro L, Willer B. Clinical Assessment of Concussion and Persistent Post-Concussive Symptoms for Neurologists. Curr Neurol Neurosci Rep 2021; 21:70. [PMID: 34817724 DOI: 10.1007/s11910-021-01159-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Concussion produces a variety of signs and symptoms. Most patients recover within 2-4 weeks, but a significant minority experiences persistent post-concussive symptoms (PPCS), some of which may be from associated cervical or persistent neurologic sub-system (e.g., vestibular) dysfunction. This review provides evidence-based information for a pertinent history and physical examination of patients with concussion. RECENT FINDINGS The differential diagnosis of PPCS is based on the mechanism of injury, a thorough medical history and concussion-pertinent neurological and cervical physical examinations. The concussion physical examination focuses on elements of autonomic function, oculomotor and vestibular function, and the cervical spine. Abnormalities identified on physical examination can inform specific forms of rehabilitation to help speed recovery. Emerging data show that there are specific symptom generators after concussion that can be identified by a thorough history, a pertinent physical examination, and adjunct tests when indicated.
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Affiliation(s)
- John J Leddy
- UBMD, Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, 160 Farber Hall, Buffalo, NY, 14214, USA.
| | - Mohammad Nadir Haider
- UBMD, Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, 160 Farber Hall, Buffalo, NY, 14214, USA.,Department of Neuroscience, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, 160 Farber Hall, Buffalo, NY, 14214, USA
| | - James M Noble
- Department of Neurology, Taub Institute for Research On Alzheimer's Disease and the Aging Brain, and G.H. Sergievsky Center, Columbia University, New York, NY, USA
| | - Brian Rieger
- Department of Physical Medicine and Rehabilitation, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Steven Flanagan
- Department of Rehabilitation Medicine, Rusk Institute of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
| | - Jacob I McPherson
- Department of Rehabilitation Sciences, School of Public Health and Health Professions, State University of New York at Buffalo, 160 Farber Hall, Buffalo, NY, 14214, USA
| | | | - Ghazala T Saleem
- Department of Rehabilitation Sciences, School of Public Health and Health Professions, State University of New York at Buffalo, 160 Farber Hall, Buffalo, NY, 14214, USA
| | - Louis Corsaro
- Northern Westchester and Southern Putnam County School Districts, New York, NY, USA
| | - Barry Willer
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, 160 Farber Hall, Buffalo, NY, 14214, USA
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Theilen TM, Mueller-Eising W, Bettink PW, Rolle U. Video Analysis of Acute Injuries in Elite Field Hockey. Clin J Sport Med 2021; 31:448-452. [PMID: 32032161 DOI: 10.1097/jsm.0000000000000785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 07/02/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE With this study, we aim to determine the value of video assessment of acute injuries in field hockey. DESIGN Retrospective video analysis for acute injuries. SETTING Professional field hockey. PARTICIPANTS Seven women and men's field hockey tournaments (World League, Champions Trophy) in 2015. INTERVENTIONS Not applicable. OUTCOME MEASURES An injury was defined as any new musculoskeletal complaint leading to time stoppage and medical attention. The outcome measures were time at play, location on the pitch, type of injury, injured body part, and injury mechanism. RESULTS A total of 190 injuries occurred in 179 matches (55/73 female and 135/106 male matches). There were 0.75 injuries per match for women [confidence interval (CI, 0.31-1.13)] and 1.27 injuries per match for men (CI, 0.88-1.61). The number of injuries per 1000 player match hours was 34.20 for women (CI, 14.04-51.29) and 57.89 for men (CI, 29.78-73.12). The highest injury frequency occurred within the third quarter and within the circle. Contusion was the most common injury type (90.9% in women and 96.3% in men). The leading causes of injuries were hits by the ball or stick and collisions with another player. The head/face was the most affected body part in both sex groups (32.7% in women and 29.6% in men). CONCLUSIONS Video analysis revealed data on injury incidence within the same range of previous reports in elite field hockey. Its advantages, such as slow motion and repetitive play of injury scenes, could contribute valuable information if incorporated into the injury recording process.
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Affiliation(s)
- Till-Martin Theilen
- Department of Paediatric Surgery and Paediatric Urology, University Hospital Frankfurt, Frankfurt, Germany ; and
| | - Wiebke Mueller-Eising
- Fédération Internationale de Hockey (FIH), Health and Safety Panel, Lausanne, Switzerland
| | - Peter W Bettink
- Fédération Internationale de Hockey (FIH), Health and Safety Panel, Lausanne, Switzerland
| | - Udo Rolle
- Department of Paediatric Surgery and Paediatric Urology, University Hospital Frankfurt, Frankfurt, Germany ; and
- Fédération Internationale de Hockey (FIH), Health and Safety Panel, Lausanne, Switzerland
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12
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Krutsch V, Krutsch W, Härtl J, Bloch H, Alt V, Klein C, Reinsberger C, Seiffert R, Huber L, Weber J. Head injuries in professional football (soccer): Results of video analysis verified by an accident insurance registry. PLoS One 2021; 16:e0255695. [PMID: 34379643 PMCID: PMC8357092 DOI: 10.1371/journal.pone.0255695] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/22/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Video analysis is one of the most commonly applied methods for analysing football injuries. PURPOSE The objective of this study was to assess the accuracy of video analysis for recording head injuries in professional football from official matches in the four highest men's professional football leagues in Germany. METHODS In this cohort study, head injuries detected by means of video analysis of all official matches over one season (2017-18) were compared to head injuries registered with the German statutory accident insurance. RESULTS Our video analysis yielded 359 head injuries of 287 players. The comparison of head injuries found in our video analysis to those registered with the accident insurance only yielded a match in 23.1% (n = 83), which presents a rather low verification rate. The verification rates varied between the leagues (7.0-30.8%). All injuries documented in the accident insurance registry were found in the video analysis (100%). The types of head injury most often verified by the accident insurance registry (n = 83) were contusion (43.4%), bone fractures (19.3%) and skin lacerations (18.1%). Only 66 of the 359 head injuries (18.4%) resulted in absence from at least one training session and involved a mean time loss of 18.5 days (1-87 days). CONCLUSION The mismatch between the number of head injuries found in the video analysis and head injuries registered with the accident insurance is an important methodological issue in scientific research. The low verification rate seems to be due to the unclear correlation between injury severity and clinical consequences of head injuries detected by means of video analysis and the failure of football clubs to register minor head injuries with the accident insurance.
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Affiliation(s)
- Volker Krutsch
- Department of Otorhinolaryngology, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Werner Krutsch
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
- SportDocsFranken, Nuremberg, Germany
| | - Jonas Härtl
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Hendrik Bloch
- Department of Sports Injury Prevention, VBG, Germany, Statutory Accident Insurance for the Administrative Sector, Hamburg, Germany
| | - Volker Alt
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Christian Klein
- Department of Sports Injury Prevention, VBG, Germany, Statutory Accident Insurance for the Administrative Sector, Hamburg, Germany
| | - Claus Reinsberger
- Department of Sports Medicine, University of Paderborn, Paderborn, Germany
| | - Robin Seiffert
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Lorenz Huber
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Johannes Weber
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
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13
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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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14
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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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15
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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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16
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Reyes J, Mitra B, McIntosh A, Clifton P, Makdissi M, Nguyen JVK, Harcourt P, Howard TS, Cameron PA, Rosenfeld JV, Willmott C. An Investigation of Factors Associated With Head Impact Exposure in Professional Male and Female Australian Football Players. Am J Sports Med 2020; 48:1485-1495. [PMID: 32255667 DOI: 10.1177/0363546520912416] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Exposure to head acceleration events (HAEs) has been associated with player sex, player position, and player experience in North American football, ice hockey, and lacrosse. Little is known of these factors in professional Australian football. Video analysis allows HAE verification and characterization of important determinants of injury. PURPOSE To characterize verified HAEs in the nonhelmeted contact sport of professional Australian football and investigate the association of sex, player position, and player experience with HAE frequency and magnitude. STUDY DESIGN Descriptive epidemiology study. METHODS Professional Australian football players wore a nonhelmeted accelerometer for 1 match, with data collected across 14 matches. HAEs with peak linear accelerations (PLAs) ≥30g were verified with match video. Verified HAEs were summarized by frequency and median PLA and compared between the sexes, player position, and player experience. Characterization of match-related situations of verified HAEs was conducted, and the head impact rate per skill execution was calculated. RESULTS 92 male and 118 female players were recruited during the 2017 season. Male players sustained more HAEs (median, 1; IQR, 0-2) than female players (median, 0; IQR, 0-1; P = .007) during a match. The maximum PLAs incurred during a match were significantly higher in male players (median, 61.8g; IQR, 40.5-87.1) compared with female players (median, 44.5g; IQR, 33.6-74.8; P = .032). Neither player position nor experience was associated with HAE frequency. Of all verified HAEs, 52% (n = 110) occurred when neither team had possession of the football, and 46% (n = 98) were caused by contact from another player attempting to gain possession of the football. A subset of HAEs (n = 12; 5.7%) resulted in players seeking medical aid and/or being removed from the match (median PLA, 58.8g; IQR, 34.0-89.0), with 2 (male) players diagnosed with concussion after direct head impacts and associated PLAs of 62g and 75g, respectively. In the setting of catching (marking) the football, female players exhibited twice the head impact rate (16 per 100 marking contests) than male players (8 per 100 marking contests). CONCLUSION Playing situations in which players have limited control of the football are a common cause of impacts. Male players sustained a greater exposure to HAEs compared with female players. Female players, however, sustained higher exposure to HAEs than male players during certain skill executions, possibly reflecting differences in skill development. These findings can therefore inform match and skill development in the emerging professional women's competition of Australian football.
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Affiliation(s)
- Jonathan Reyes
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton Campus, Melbourne, Australia
| | - Biswadev Mitra
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia.,Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia.,Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia
| | - Andrew McIntosh
- Monash University Accident Research Centre, Monash University, Melbourne, Australia.,School of Engineering and Australian Collaboration for Research Into Injury in Sport and Its Prevention, Edith Cowan University, Joondalup, Australia
| | | | - Michael Makdissi
- Florey Institute of Neuroscience and Mental Health, Austin Campus, Melbourne Brain Centre, Heidelberg, Victoria, Australia.,Olympic Park Sports Medicine Centre, Melbourne, Australia
| | - Jack V K Nguyen
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton Campus, Melbourne, Australia
| | | | - Teresa S Howard
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia.,Department of Surgery, Monash University, Melbourne, Australia
| | - Peter A Cameron
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia.,Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia.,Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia
| | - Jeffrey V Rosenfeld
- Department of Surgery, Monash University, Melbourne, Australia.,Department of Neurosurgery, The Alfred Hospital, Melbourne, Australia.,Department of Surgery, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Catherine Willmott
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton Campus, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Australia
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17
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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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18
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Reyes J, Willmott C, McIntosh A, Howard TS, Clifton P, Makdissi M, Harcourt P, Cameron P, Rosenfeld JV, Nguyen JVK, Mitra B. The potential of head acceleration measurement to augment current best practice in concussion screening in professional Australian football players. Phys Ther Sport 2020; 43:210-216. [PMID: 32248080 DOI: 10.1016/j.ptsp.2020.03.007] [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: 02/17/2020] [Revised: 03/23/2020] [Accepted: 03/23/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To explore the potential utility of head acceleration event (HAE) measurements to augment identification of players for further concussion screening in non-helmeted contact sport. DESIGN Prospective observational pilot study. PARTICIPANTS 210 (118 female) professional Australian football players in 2017 season. METHODS Players wore the X-Patch® accelerometer for one match each with data collected across 14 matches. Players with HAEs above thresholds associated with concussion, 95 g (males) or 85.5 g (females), were compared to players identified to have suspected concussion by club personnel during the inspected matches. Video review of matches was undertaken by a physician blinded to HAEs to identify players with concussive signs. RESULTS Among 26 players (50% female) with HAEs above threshold, two players were screened for concussion. Of the remaining 24 players, nine were not visible on video at the HAE time, six sustained verifiable head impacts, and nine sustained verifiable body impacts with no head impacts. Among 184 players with HAEs below threshold, five players were screened. CONCLUSION Players were identified to have head impacts and suspected concussion in the absence of HAEs above threshold. Use of X-Patch® was not sufficiently reliable for identifying players for further concussion screening in professional Australian football. Video review of head impacts remains essential in concussion screening.
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Affiliation(s)
- Jonathan Reyes
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton Campus, Melbourne, Australia.
| | - Catherine Willmott
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton Campus, Melbourne, Australia; Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Australia.
| | - Andrew McIntosh
- School of Engineering and Australian Collaboration for Research into Injury in Sport and its Prevention, Edith Cowan University, Joondalup, Australia; Monash University Accident Research Centre, Monash University, Melbourne, Australia.
| | - Teresa S Howard
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia; Department of Surgery, Monash University, Melbourne, 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.
| | | | - Peter Cameron
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia; Emergency & Trauma Centre, The Alfred Hospital, Australia; Department of Epidemiology & Preventive Medicine, Monash University, Australia.
| | - Jeffrey V Rosenfeld
- Department of Surgery, Monash University, Melbourne, Australia; Department of Neurosurgery, The Alfred Hospital, Australia; Department of Surgery, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
| | - Jack V K Nguyen
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton Campus, Melbourne, Australia.
| | - Biswadev Mitra
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia; Emergency & Trauma Centre, The Alfred Hospital, Australia; Department of Epidemiology & Preventive Medicine, Monash University, Australia.
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19
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Harris SA, Chivers PT, McIntyre FL, Piggott B, Bulsara M, Farringdon FH. Exploring the association between recent concussion, subconcussive impacts and depressive symptoms in male Australian Football players. BMJ Open Sport Exerc Med 2020; 6:e000655. [PMID: 32201617 PMCID: PMC7061895 DOI: 10.1136/bmjsem-2019-000655] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2020] [Indexed: 12/23/2022] Open
Abstract
Objectives To explore the association between depressive symptoms and recent head-related trauma (diagnosed concussion, subconcussive impacts) in semiprofessional male Australian Football (AF) players. Methods Sixty-nine semiprofessional male players from a West Australian Football League (WAFL) club participated in the study (Mage=21.81, SD=2.91 years). Depressive symptoms were measured using the Centre for Epidemiological Studies Depression Scale. Injuries and potential confounding variables (eg, pre-existing mental health condition; alcohol or drug hangovers; experiencing a stressful event) were self-reported anonymously using the WAFL Injury Report Survey. Both tools were administered every 2-weeks over the first 22-weeks of the WAFL season. Controlling for potential confounding variables and other injuries, a repeated measures generalised estimating equations model assessed the risk of clinically relevant depressive symptoms occurring, when diagnosed concussion or subconcussive impacts were experienced. Results A total of 10 concussions and 183 subconcussive impacts were reported. Players who experienced a concussion were almost nine times more likely to experience clinically relevant depressive symptoms (OR 8.88, 95% CI 2.65 to 29.77, p<0.001). Although elevated, depressive symptoms following subconcussive impacts were not statistically significant (OR 1.13, 95% CI 0.67 to 1.92, p=0.641). Conclusion These findings indicate that semiprofessional AF athletes may be at risk of experiencing depressive symptoms after concussion. Severity (concussion vs subconcussive impacts) and dose (number of impacts) appear to have an important relationship with depressive symptom outcomes in this cohort and should be considered for further research and management of player welfare.
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Affiliation(s)
- Sarah Ann Harris
- School of Health Sciences, The University of Notre Dame Australia, Fremantle, Western Australia, Australia.,Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Paola T Chivers
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia.,Exercise Medicine Research Institute and School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Fleur L McIntyre
- School of Health Sciences, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Ben Piggott
- School of Health Sciences, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Max Bulsara
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Fiona H Farringdon
- School of Health Sciences, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
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20
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Fu W, Liang J, Wang L, Xu R, Xiao F. Teacher-student interaction in a special school for students with developmental disabilities in Chinese context. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2020; 68:168-181. [PMID: 35309700 PMCID: PMC8928830 DOI: 10.1080/20473869.2020.1729018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/21/2020] [Accepted: 02/04/2020] [Indexed: 06/14/2023]
Abstract
This paper analyzes interactions between teachers and students with developmental disabilities in a special education school in China, which is still the main educational placement for the disabled in China. Video observation data collected from six students in second grade and one teacher, were coded by an improved Flanders Interaction Analysis System (iFIAS). Results indicate that the teacher played the dominant role in the class while her/his instruction was student-oriented, several evidence-based strategies were used to motivate students' engagement, including questioning, timely feedback, reinforcement, game teaching, students' self-determination. Few peer interactions happened due to homogeneous grouping. Besides, the frequency of interaction patterns between teachers and students with developmental disabilities (DD) of different learning ability was similar while the interaction patterns were different. There were more non-academic interactions between the teacher and students with most serious disabilities in the class than others, while there existed more cognitive extension-partial and full interactions between teachers and students with least serious disabilities in the class than others. The results shed light on how teachers interact with students who have DD, and how interactions can be differentially delivered to students with DD of various learning abilities.
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Affiliation(s)
- Wangqian Fu
- China Institute of Education and Social Development, Beijing Normal University, Beijing, P. R. China
| | - Jili Liang
- Institute of Special Education, Faculty of Education, Beijing Normal University, Beijing, P. R. China
| | - Lihong Wang
- Institute of Special Education, Faculty of Education, Beijing Normal University, Beijing, P. R. China
| | - Ran Xu
- Institute of Special Education, Faculty of Education, Beijing Normal University, Beijing, P. R. China
| | - Fei Xiao
- Institute of Special Education, Faculty of Education, Beijing Normal University, Beijing, P. R. China
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21
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McNeel C, Clark GM, Davies CB, Major BP, Lum JAG. Concussion incidence and time-loss in Australian football: A systematic review. J Sci Med Sport 2020; 23:125-133. [PMID: 31722842 DOI: 10.1016/j.jsams.2019.10.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 08/26/2019] [Accepted: 10/15/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Australian football is associated with a risk of concussion. However, despite the extensive and varied nature of literature devoted to this issue, concussion incidence has not been systematically evaluated. To address this, we aimed to conduct a meta-analysis of concussion incidence in Australian football. DESIGN Systematic review. Prospero registration number: CRD42017064290. METHODS A systematic search of 14 databases using the terms 'concussion', and 'Australian football' (and variations) was used to obtain records that reported concussion incidence per 1000 players hours across age, sex, and level-of-play. Data were grouped based on how time-loss was applied to the concussion definition. RESULTS Forty-two studies met inclusion criteria. Incidence rates based on a possible time-loss definition per 1000 player hours, ranged from 2.24 to 17.63 at the elite level, and 0.35 to 14.77 at the community/amateur level. Return-to-play details were reported by six studies and only two studies measured head-impacts in real-time. Several limitations were identified with this literature. First, insufficient return-to-play details precluded a meta-analysis of incidence rates. Second, no longitudinal studies across levels-of-play were found. Third, concussion incidence data for junior and female players were notably scarce. CONCLUSIONS There was limited scope to determine concussion burden (i.e., incidence and severity) and only preliminary data for player exposure to head-impacts. To address these limitations, injury surveillance should capture sufficient information to permit comparisons within and across levels-of-play. This will also help determine the influence of interventions aimed at reducing the frequency and severity of concussive-injuries.
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Affiliation(s)
- Claire McNeel
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, VIC, 3220, Australia.
| | - Gillian M Clark
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, VIC, 3220, Australia
| | - Charlotte B Davies
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, VIC, 3220, Australia
| | - Brendan P Major
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, VIC, 3220, Australia
| | - Jarrad A G Lum
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, VIC, 3220, Australia
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22
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Mack C, Sendor RR, Solomon G, Ellenbogen RG, Myers E, Berger M, Sills A. Enhancing Concussion Management in the National Football League: Evolution and Initial Results of the Unaffiliated Neurotrauma Consultants Program, 2012-2017. Neurosurgery 2019; 87:312-319. [DOI: 10.1093/neuros/nyz481] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 08/28/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The real-time detection of concussive injury in professional sports can be challenging for the healthcare provider on the sideline. It can be difficult to monitor all on-field players during active game play and diagnose complex injuries such as concussion during a fast-paced athletic event.
Objective
To enhance the in-game identification of potentially concussed professional athletes, the National Football League (NFL) initiated an Unaffiliated Neurotrauma Consultants (UNC) program in 2013, which, in tandem with other in-arena spotters and live video review systems, is designed to improve the safety of the players through enhanced concussion detection efforts.
Methods
This paper reports on the evolution of the UNC program, describes its participants and training requirements, details the role of UNC involvement, and delineates the systematic revisions and enhancements completed each year in the program.
Results
UNC reporting compliance has increased from 56% in 2014 to 100% in 2017. During the 2016 and 2017 seasons, (1) UNCs submitted an average of 1.9 evaluations per game, and (2) the UNC concussion assessments yielded sensitivity (93.4%-97.4%) and specificity (81.0%-88.3%) values.
Conclusion
The UNC program has enhanced the detection of concussion in NFL players. Directions for research and future program improvements are addressed.
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Affiliation(s)
| | | | - Gary Solomon
- Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
- National Football League, New York, New York
| | - Richard G Ellenbogen
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Emily Myers
- National Football League, New York, New York
| | - Mitchel Berger
- Department of Neurological Surgery, University of California-San Francisco School of Medicine, San Francisco, California
| | - Allen Sills
- Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
- National Football League, New York, New York
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23
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Premkumar A, Farley KX, Anastasio AT, Lee SW, Mirza F, Gottschalk MB, Xerogeanes J. Video Assessment of the Frequency and Evaluations of Head Collision Events During the 2018 World Cup Tournament. JAMA Neurol 2019; 76:232-234. [PMID: 30419116 DOI: 10.1001/jamaneurol.2018.3462] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ajay Premkumar
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | | | | | - Su-Wei Lee
- Emory University School of Medicine, Atlanta, Georgia
| | | | - Michael B Gottschalk
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - John Xerogeanes
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
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24
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Abraham KJ, Casey J, Subotic A, Tarzi C, Zhu A, Cusimano MD. Medical assessment of potential concussion in elite football: video analysis of the 2016 UEFA European championship. BMJ Open 2019; 9:e024607. [PMID: 31147360 PMCID: PMC6549745 DOI: 10.1136/bmjopen-2018-024607] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The objective is to determine if suspected concussions in elite football are medically assessed according to the International Conferences on Concussion in Sport consensus statement recommendations. SETTING Men's Union of European Football Association (UEFA) Football Championship. PARTICIPANTS All professional football players in the UEFA 2016 Championship Tournament. DESIGN Observational study. OUTCOME MEASURES Potential concussive events (PCEs) were defined as direct head collision incidents resulting in the athlete being unable to immediately resume play following impact. PCEs identified and description of PCE assessment and outcome were accomplished through direct standardised observation of video footage by trained observers in 51 games played in the Men's UEFA European Championship (10 June-10 July 2016). RESULTS Sixty-nine total PCEs (1.35 per match) were identified in 51 games played during the 2016 Men's UEFA European Championship. Forty-eight PCEs (69.6%) resulted in two observable signs of concussion, 13 (18.8%) resulted in three signs and 1 (1.4%) resulted in four signs in the injured athletes. Nineteen (27.5%) PCEs were medically assessed by sideline healthcare personnel while 50 (72.5%) were not. Of the 50 PCEs that were not medically assessed, 44 (88%) PCEs resulted in two or more signs of concussion among injured athletes. Of the 19 medically assessed PCEs, 8 resulted in 3 signs of concussion, and 1 resulted in 4 signs; all assessments concluded in the same-game return for the injured athletes. CONCLUSIONS PCEs were frequent events in the 2016 UEFA Euro championship, but were rarely assessed concordant with the International Conferences on Concussion in Sport consensus statement recommendations. There is an imperative need to improve the assessment and management of players suspected of concussion in elite football.
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Affiliation(s)
| | - Julia Casey
- Neurosurgery, St. Michael’s Hospital, Toronto, Ontario, Canada
| | | | | | - Alice Zhu
- Neurosurgery, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Michael D Cusimano
- Neurosurgery, St. Michael’s Hospital, Toronto, Ontario, Canada
- Public Health, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
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25
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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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26
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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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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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Kuo C, Wu L, Loza J, Senif D, Anderson SC, Camarillo DB. Comparison of video-based and sensor-based head impact exposure. PLoS One 2018; 13:e0199238. [PMID: 29920559 PMCID: PMC6007917 DOI: 10.1371/journal.pone.0199238] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 06/04/2018] [Indexed: 11/18/2022] Open
Abstract
Previous research has sought to quantify head impact exposure using wearable kinematic sensors. However, many sensors suffer from poor accuracy in estimating impact kinematics and count, motivating the need for additional independent impact exposure quantification for comparison. Here, we equipped seven collegiate American football players with instrumented mouthguards, and video recorded practices and games to compare video-based and sensor-based exposure rates and impact location distributions. Over 50 player-hours, we identified 271 helmet contact periods in video, while the instrumented mouthguard sensor recorded 2,032 discrete head impacts. Matching video and mouthguard real-time stamps yielded 193 video-identified helmet contact periods and 217 sensor-recorded impacts. To compare impact locations, we binned matched impacts into frontal, rear, side, oblique, and top locations based on video observations and sensor kinematics. While both video-based and sensor-based methods found similar location distributions, our best method utilizing integrated linear and angular position only correctly predicted 81 of 217 impacts. Finally, based on the activity timeline from video assessment, we also developed a new exposure metric unique to American football quantifying number of cross-verified sensor impacts per player-play. We found significantly higher exposure during games (0.35, 95% CI: 0.29-0.42) than practices (0.20, 95% CI: 0.17-0.23) (p<0.05). In the traditional impacts per player-hour metric, we observed higher exposure during practices (4.7) than games (3.7) due to increased player activity in practices. Thus, our exposure metric accounts for variability in on-field participation. While both video-based and sensor-based exposure datasets have limitations, they can complement one another to provide more confidence in exposure statistics.
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Affiliation(s)
- Calvin Kuo
- Department of Mechanical Engineering, Stanford University, Stanford CA, United States of America
| | - Lyndia Wu
- Department of Bioengineering, Stanford University, Stanford CA, United States of America
| | - Jesus Loza
- Department of Mechanical Engineering, Stanford University, Stanford CA, United States of America
| | - Daniel Senif
- Stanford Sports Medicine, Stanford University, Stanford CA, United States of America
| | - Scott C. Anderson
- Stanford Sports Medicine, Stanford University, Stanford CA, United States of America
| | - David B. Camarillo
- Department of Mechanical Engineering, Stanford University, Stanford CA, United States of America
- Department of Bioengineering, Stanford University, Stanford CA, United States of America
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29
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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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30
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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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31
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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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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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Tucker R, Raftery M, Fuller GW, Hester B, Kemp S, Cross MJ. A video analysis of head injuries satisfying the criteria for a head injury assessment in professional Rugby Union: a prospective cohort study. Br J Sports Med 2017; 51:1147-1151. [DOI: 10.1136/bjsports-2017-097883] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2017] [Indexed: 11/04/2022]
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Tucker R, Raftery M, Kemp S, Brown J, Fuller G, Hester B, Cross M, Quarrie K. Risk factors for head injury events in professional rugby union: a video analysis of 464 head injury events to inform proposed injury prevention strategies. Br J Sports Med 2017. [PMID: 28642222 DOI: 10.1136/bjsports-2017-097895] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The tackle is responsible for the majority of head injuries during rugby union. In order to address head injury risk, risk factors during the tackle must first be identified. This study analysed tackle characteristics in the professional game in order to inform potential interventions. METHODS 464 tackles resulting in a head injury assessment (HIA) were analysed in detail, with tackle type, direction, speed, acceleration, nature of head contact and player body position the characteristics of interest. RESULTS Propensity to cause an HIA was significantly greater for active shoulder tackles, front-on tackles, high speeder tackles and an accelerating tackler. Head contact between a tackler's head and ball carrier's head or shoulder was significantly more likely to cause an HIA than contact below the level of the shoulder (incident rate ratio (IRR) 4.25, 95%-CI 3.38 to 5.35). The tackler experiences the majority (78%) of HIAs when head-to-head contact occurs. An upright tackler was 1.5 times more likely to experience an HIA than a bent at the waist tackler (IRR 1.44, 95% CI 1.18 to 1.76). CONCLUSIONS This study confirms that energy transfer in the tackle is a risk factor for head injury, since direction, type and speed all influence HIA propensity. The study provides evidence that body position and the height of tackles should be a focus for interventions, since lowering height and adopting a bent at the waist body position is associated with reduced risk for both tacklers and ball carriers. To this end, World Rugby has implemented law change based on the present data.
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Affiliation(s)
| | | | | | - James Brown
- University of Cape Town, Cape Town, South Africa
| | | | | | - Matthew Cross
- World Rugby, Dublin, Ireland.,Department for Health, University of Bath, Bath, UK
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Bruce JM, Echemendia RJ, Meeuwisse W, Hutchison MG, Aubry M, Comper P. Development of a risk prediction model among professional hockey players with visible signs of concussion. Br J Sports Med 2017; 52:1143-1148. [DOI: 10.1136/bjsports-2016-097091] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2017] [Indexed: 11/04/2022]
Abstract
BackgroundLittle research examines how to best identify concussed athletes. The purpose of the present study was to develop a preliminary risk decision model that uses visible signs (VS) and mechanisms of injury (MOI) to predict the likelihood of subsequent concussion diagnosis.MethodsCoders viewed and documented VS and associated MOI for all NHL games over the course of the 2013–2014 and 2014–2015 regular seasons. After coding was completed, player concussions were identified from the NHL injury surveillance system and it was determined whether players exhibiting VS were subsequently diagnosed with concussions by club medical staff as a result of the coded event.ResultsAmong athletes exhibiting VS, suspected loss of consciousness, motor incoordination or balance problems, being in a fight, having an initial hit from another player’s shoulder and having a secondary hit on the ice were all associated with increased risk of subsequent concussion diagnosis. In contrast, having an initial hit with a stick was associated with decreased risk of subsequent concussion diagnosis. A risk prediction model using a combination of the above VS and MOI was superior to approaches that relied on individual VS and associated MOI (sensitivity=81%, specificity=72%, positive predictive value=26%).ConclusionsCombined use of VS and MOI significantly improves a clinician’s ability to identify players who need to be evaluated for possible concussion. A preliminary concussion prediction log has been developed from these data. Pending prospective validation, the use of these methods may improve early concussion detection and evaluation.
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Davis G, Makdissi M. Use of video to facilitate sideline concussion diagnosis and management decision-making. J Sci Med Sport 2016; 19:898-902. [DOI: 10.1016/j.jsams.2016.02.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 01/11/2016] [Accepted: 02/11/2016] [Indexed: 11/26/2022]
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