1
|
Caswell SV, Kelshaw PM, Hacherl SL, Lincoln AE, Herman DC. Headgear mandates in high school girls' lacrosse: investigating differences in impact rates and game play behaviors. Ann Med 2024; 56:2362862. [PMID: 38902979 PMCID: PMC11195452 DOI: 10.1080/07853890.2024.2362862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 03/08/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND/OBJECTIVE Headgear designed to protect girls' lacrosse athletes is widely available and permitted for voluntary use; however, it remains unknown how policies mandating headgear use may change the sport and, particularly regarding impacts during game-play. Therefore, this study compares the impact rates and game play characteristics of girls' high school lacrosse in Florida which mandates headgear use (HM), with states having no headgear mandate (NHM). MATERIALS AND METHODS Video from 189 randomly-selected games (HM: 64, NHM: 125) were analyzed. Descriptive statistics, Impact Rates (IR), Impact Rate Ratios (IRR), Impact Proportion Ratios (IPR), and 95% Confidence Intervals (CI) were calculated. IRRs and IPRs with corresponding CIs that excluded 1.00 were deemed statistically significant. RESULTS 16,340 impacts (HM:5,821 NHM: 10,519; 86.6 impacts/game, CI: 88.6-93.3) were identified using the Lacrosse Incident Analysis Instrument (LIAI). Most impacts directly struck the body (n = 16,010, 98%). A minority of impacts directly struck a player's head (n = 330, 2%). The rate of head impacts was significantly higher in the HM cohort than NHM cohort (IRR = 2.1; 95% CI = 1.7-2.6). Most head impacts (n = 271, 82%) were caused by stick contact in both groups. There was no difference in the proportion of penalties administered for head impacts caused by stick contact between the HM and NHM cohorts (IPR IRRHM/NHM = 0.98; CI = 0.79-1.16). However, there was a significantly greater proportion of head impacts caused by player contact that resulted in a penalty administered in the HM cohort (IPR = 1.44 CI = 1.17-1.54). CONCLUSION These findings demonstrate that mandating headgear use was associated with a two-fold greater likelihood of sustaining a head impact during game play compared to NHM states. A majority of head impacts in both HM and NHM states were caused by illegal stick contact that did not result in penalty.
Collapse
Affiliation(s)
- Shane V. Caswell
- School of Kinesiology, Athletic Training Program, George Mason University, Manassas, VA, USA
- Sports Medicine Assessment, Research & Testing Laboratory, George Mason University, Manassas, VA, USA
- Virginia Concussion Intiative, George Mason University, Manassas, VA, USA
| | - Patricia M. Kelshaw
- Virginia Concussion Intiative, George Mason University, Manassas, VA, USA
- Department of Kinesiology, Brain Research & Assessment Initiative of New Hampshire, University of New Hampshire, Durham, NH
| | - Samantha L. Hacherl
- School of Kinesiology, Athletic Training Program, George Mason University, Manassas, VA, USA
- Sports Medicine Assessment, Research & Testing Laboratory, George Mason University, Manassas, VA, USA
| | - Andrew E. Lincoln
- Virginia Concussion Intiative, George Mason University, Manassas, VA, USA
- Special Olympics International, Washington, DC
| | - Daniel C. Herman
- Virginia Concussion Intiative, George Mason University, Manassas, VA, USA
- Department of Physical Medicine and Rehabilitation, University of California at Davis, Sacramento, CA, US
| |
Collapse
|
2
|
McLaren JRM, Makdissi M, Hearps SJC, Davis GA. The effect of assessor expertise on reliability of analysis of video signs associated with concussion in Australian football. J Sci Med Sport 2024:S1440-2440(24)00485-7. [PMID: 39217069 DOI: 10.1016/j.jsams.2024.08.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 06/08/2024] [Accepted: 08/09/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVES To determine whether spotters with medical training and experience in managing concussion have higher inter-rater reliability and accuracy than non-medical personnel when identifying video signs associated with concussion in Australian football. DESIGN Retrospective cohort study. METHODS Video clips were collected of all impacts potentially resulting in concussion during 2012 and 2013 Australian Football League (AFL) seasons. Raters were divided into medical doctors and a non-medical group comprising allied health practitioners (physiotherapists) and non-medical/non-allied health personnel (performance analysts). Raters assessed 102 randomly selected videos for signs of concussion. The inter-rater reliability was calculated. Sensitivity, specificity, positive and negative predictive values were calculated by comparing the rater responses to the consensus opinion from two highly experienced clinicians with expertise in concussion. RESULTS No statistically significant difference in inter-rater reliability was observed between the medical doctors and the non-medical group. Both groups demonstrated good to excellent agreement for slow to get up, clutching at head/face and facial injury. Both groups displayed intra-class coefficient >0.55 for no protective action-floppy, loss of responsiveness, and motor incoordination, and displayed lowest agreement for no protective action-tonic posturing, impact seizure and blank/vacant look. No statistically significant difference was found between the groups for sensitivity, specificity, positive and negative predictive values for correctly classifying video signs compared to the expert consensus opinion. CONCLUSIONS After completing sufficient standardised training and testing, medical and non-medical personnel demonstrate comparable reliability in identifying video signs of concussion in professional Australian football and may be suitable for the role of video spotter.
Collapse
Affiliation(s)
| | - Michael Makdissi
- Australian Football League, Australia; Florey Institute of Neuroscience and Mental Health, Austin Campus, Melbourne Brain Centre, Australia; La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Australia
| | | | - Gavin A Davis
- Brain & Mind, Murdoch Children's Research Institute, Australia; Department of Neurosurgery, Austin Hospital, Australia; Department of Neurosurgery, Cabrini Health, Australia
| |
Collapse
|
3
|
Zimmerman KA, Cournoyer J, Lai H, Snider SB, Fischer D, Kemp S, Karton C, Hoshizaki TB, Ghajari M, Sharp DJ. The biomechanical signature of loss of consciousness: computational modelling of elite athlete head injuries. Brain 2023; 146:3063-3078. [PMID: 36546554 PMCID: PMC10316777 DOI: 10.1093/brain/awac485] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 11/17/2022] [Accepted: 12/02/2022] [Indexed: 08/27/2023] Open
Abstract
Sports related head injuries can cause transient neurological events including loss of consciousness and dystonic posturing. However, it is unknown why head impacts that appear similar produce distinct neurological effects. The biomechanical effect of impacts can be estimated using computational models of strain within the brain. Here, we investigate the strain and strain rates produced by professional American football impacts that led to loss of consciousness, posturing or no neurological signs. We reviewed 1280 National Football League American football games and selected cases where the team's medical personnel made a diagnosis of concussion. Videos were then analysed for signs of neurological events. We identified 20 head impacts that showed clear video signs of loss of consciousness and 21 showing clear abnormal posturing. Forty-one control impacts were selected where there was no observable evidence of neurological signs, resulting in 82 videos of impacts for analysis. Video analysis was used to guide physical reconstructions of these impacts, allowing us to estimate the impact kinematics. These were then used as input to a detailed 3D high-fidelity finite element model of brain injury biomechanics to estimate strain and strain rate within the brain. We tested the hypotheses that impacts producing loss of consciousness would be associated with the highest biomechanical forces, that loss of consciousness would be associated with high forces in brainstem nuclei involved in arousal and that dystonic posturing would be associated with high forces in motor regions. Impacts leading to loss of consciousness compared to controls produced higher head acceleration (linear acceleration; 81.5 g ± 39.8 versus 47.9 ± 21.4; P = 0.004, rotational acceleration; 5.9 krad/s2 ± 2.4 versus 3.5 ± 1.6; P < 0.001) and in voxel-wise analysis produced larger brain deformation in many brain regions, including parts of the brainstem and cerebellum. Dystonic posturing was also associated with higher deformation compared to controls, with brain deformation observed in cortical regions that included the motor cortex. Loss of consciousness was specifically associated with higher strain rates in brainstem regions implicated in maintenance of consciousness, including following correction for the overall severity of impact. These included brainstem nuclei including the locus coeruleus, dorsal raphé and parabrachial complex. The results show that in head impacts producing loss of consciousness, brain deformation is disproportionately seen in brainstem regions containing nuclei involved in arousal, suggesting that head impacts produce loss of consciousness through a biomechanical effect on key brainstem nuclei involved in the maintenance of consciousness.
Collapse
Affiliation(s)
- Karl A Zimmerman
- UK Dementia Research Institute, Care Research & Technology Centre, Imperial College London, London, UK
- Department of Brain Sciences, Hammersmith Hospital, Imperial College London, London, UK
- HEAD Lab, Dyson School of Design Engineering, Imperial College London, London, UK
| | - Janie Cournoyer
- Neurotrauma Impact Science Laboratory, University of Ottawa, Ottawa, ON, Canada
| | - Helen Lai
- UK Dementia Research Institute, Care Research & Technology Centre, Imperial College London, London, UK
- Department of Brain Sciences, Hammersmith Hospital, Imperial College London, London, UK
| | - Samuel B Snider
- Division of Neurocritical care, Department of Neurology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - David Fischer
- Division of Neurocritical Care, Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Simon Kemp
- Rugby Football Union, Twickenham, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | - Clara Karton
- Neurotrauma Impact Science Laboratory, University of Ottawa, Ottawa, ON, Canada
| | - Thomas B Hoshizaki
- Neurotrauma Impact Science Laboratory, University of Ottawa, Ottawa, ON, Canada
| | - Mazdak Ghajari
- HEAD Lab, Dyson School of Design Engineering, Imperial College London, London, UK
| | - David J Sharp
- UK Dementia Research Institute, Care Research & Technology Centre, Imperial College London, London, UK
- Department of Brain Sciences, Hammersmith Hospital, Imperial College London, London, UK
- The Royal British Legion Centre for Blast Injury Studies and the Department of Bioengineering, Imperial College London, London, UK
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Lucas D, Stokes K, McGuigan P, Hill J, Cazzola D. Consensus on a jockey's injury prevention framework for video analysis: a modified Delphi study. BMJ Open Sport Exerc Med 2022; 8:e001441. [PMID: 36530598 PMCID: PMC9756174 DOI: 10.1136/bmjsem-2022-001441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
Professional horse racing is a high-risk and dangerous sport with a high incidence of falls and injuries. While falls in horse racing are considered somewhat inevitable and carry an inherent occupational risk, little is known about the actual mechanisms of jockey injuries. Establishing injury aetiology and mechanism is a fundamental step in informing the design and implementation of future injury prevention strategies. Despite the availability of horse racing video footage, the use of video analysis to examine injury mechanisms is an underused practice. Using an expert consensus-based approach, an industry expert steering committee was assembled to develop a framework for video analysis research in horse racing. The aim of the framework is to encourage and facilitate the use of video analysis in the sport and to ensure consistency and quality of future application. To achieve consensus, a systematic review and modified Delphi method study design was used. Responses of the steering committee to two open-ended questions regarding the risk factors of falls and injury were collated and combined with findings from a literature search strategy. Appropriate descriptors and definitions were then formulated that defined and described key features of a jockey fall in horse racing and grouped into six discrete phases of an inciting event. Each member of the steering committee then examined the framework of proposed descriptors and definitions and rated their level of agreement on the 5-point Likert scale. A consensus was achieved on a total of 73 horse racing-specific descriptors and 268 associated definitions. The framework outlined in this study provides a valuable starting point for further research and practice within this area, while the recommendations and implications documented aim to facilitate the practical application of video analysis in horse racing.
Collapse
Affiliation(s)
- Daloni Lucas
- Department for Health, University of Bath, Bath, UK,Centre for Health and Injury and Illness Prevention in Sport (CHi2PS), University of Bath, Bath, UK
| | - Keith Stokes
- Department for Health, University of Bath, Bath, UK,Centre for Health and Injury and Illness Prevention in Sport (CHi2PS), University of Bath, Bath, UK
| | - Polly McGuigan
- Department for Health, University of Bath, Bath, UK,Centre for the Analysis of Motion, Entertainment Research & Applications (CAMERA), University of Bath, Bath, UK
| | - Jerry Hill
- Medical Department, British Horseracing Authority, London, UK
| | - Dario Cazzola
- Department for Health, University of Bath, Bath, UK,Centre for Health and Injury and Illness Prevention in Sport (CHi2PS), University of Bath, Bath, UK,Centre for the Analysis of Motion, Entertainment Research & Applications (CAMERA), University of Bath, Bath, UK
| | | |
Collapse
|
6
|
Gaudet CE. Immediate Post-Concussion and Cognitive Testing (ImPACT): Effects of Data Integration Strategies on Classification Accuracy. J Head Trauma Rehabil 2022; 37:E319-E326. [PMID: 34698687 DOI: 10.1097/htr.0000000000000740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The current study aimed to evaluate varying data integration procedures and their effects on the classification accuracy of Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). SETTING Data were collected from an independent secondary school that included students in grades 9 to 12. PARTICIPANTS The study examined 300 consecutive ImPACT score reports generated by secondary school students between 2010 and 2015. DESIGN To appraise ImPACT's utility as a serialized measure, standardized regression-based equations were formulated to compute reliable change index scores. Discriminant function analyses (DFAs) consisting of varying combinations of ImPACT composite scores were conducted and their accuracy was compared to that produced by the standard interpretive procedure. MAIN MEASURES Varying combinations of scores produced on Verbal Memory, Visual Memory, Visual Motor Speed, Reaction Speed, and the Postconcussion Symptom Scale were included in analyses. RESULTS DFAs yielded sensitivities ranging from 31% to 49%, specificities from 88% to 95%, positive predictive values (PPVs) from 61% to 83%, and negative predictive values (NPVs) from 67% to 75%. Conversely, the standard interpretive procedure yielded a sensitivity of 73%, specificity of 43%, PPV of 45%, and NPV of 72%. CONCLUSION The standard interpretive procedure produced a higher sensitivity than the DFAs; however, its PPV did not exceed chance levels. Conversely, DFA equations produced superior PPVs; however, their sensitivity hovered around 50%, leaving a substantial proportion of individuals with concussion undetected. Cognitive composite scores did not appear to offer significant incremental utility in relation to symptom self-report. Base rate conditions and psychometric factors appeared to contribute to ImPACT's limited classification accuracy.
Collapse
Affiliation(s)
- Charles E Gaudet
- Department of Psychology, University of Rhode Island, Kingston, and Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| |
Collapse
|
7
|
Tajima T, Ota O, Nagayama M, Takahashi M, Yamada M, Ishiyama N, Yoshida I, Takemura M, Hara K, Akama T, Mitsumori N, Higashihara J, Toyama Y, Furuya M, Chosa E, Nakamura A. Head Injury Assessment in the Elite Level Rugby Union in Japan: Review of 3 Seasons. Int J Sports Med 2022; 43:889-894. [PMID: 35672000 DOI: 10.1055/a-1810-6509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Head Injury Assessment (HIA) is the screening tool for head injury during a rugby game. The purpose of this study was to investigate the epidemiology of HIA in the Japan Rugby Top League (JRTL). The incidences of HIA, defined concussion (per 1,000 player-hours) and repeated concussions were evaluated in three seasons (2016-17, 2017-18, 2018-19; total 360 games). The HIA incidence rates were 12.7 (95% confidence interval 9.5-15.9), 20.8 (16.8-24.9), and 25.0 (20.5-29.5) in each season. HIA-1 criteria 2, which is applied for suspected concussion cases, was performed for 46 cases in the 2016-17 season, 81 cases in the 2017-18 season, and 88 cases in the 2018-19 season. The concussion incidence rates were significantly greater in the 2017-18 season (9.6/1000 player-hours, 95% confidence interval 6.8-12.4) and the 2018-19 season (14.4, 11-17.8) compared to the 2016-17 season (4.8, 2.8-6.8). The number of repeated concussion cases in the same season was 1 in the 2016-17 season and 4 in both the 2017-18 and 2018-19 seasons. This study confirmed significantly higher HIA and concussion incidence rates over time. Although the HIA system might have been established in the three seasons in JRTL, comprehensive management needs to be improved to prevent repeated concussions.
Collapse
Affiliation(s)
- Takuya Tajima
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.,Medical control committee, Japan Rugby Top League, Tokyo, Japan
| | - Osamu Ota
- Japan Rugby Top League, Japan Rugby Football Union, Tokyo, Japan
| | - Masataka Nagayama
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Medical control committee, Japan Rugby Top League, Tokyo, Japan
| | - Masayasu Takahashi
- Department of Orthopaedic Surgery, Konan Medical center, Kobe, Japan.,Medical control committee, Japan Rugby Top League, Tokyo, Japan
| | - Mutsuo Yamada
- Injury prevention & Research unit, Japan Rugby Football Union, Tokyo, Japan.,Faculty of Health and Sports Sciences, Ryutsu Keizai University, Ryugasaki, Japan
| | - Nobuo Ishiyama
- Faculty of Medical Science, Nippon Sport Science University, Setagaya-ku, Japan.,Medical control committee, Japan Rugby Top League, Tokyo, Japan
| | - Ichiro Yoshida
- Medical control committee, Japan Rugby Top League, Tokyo, Japan
| | - Masahiro Takemura
- Faculty of Health and Sports Sciences, University of Tsukuba, Tsukuba, Japan.,Medical control committee, Japan Rugby Top League, Tokyo, Japan
| | - Kenji Hara
- Department of Sports Medicine and Science, Faculty of Human Health, Kurume University, Kurume, Japan.,Medical control committee, Japan Rugby Top League, Tokyo, Japan
| | - Takao Akama
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan.,Medical control committee, Japan Rugby Top League, Tokyo, Japan
| | - Norio Mitsumori
- Department of Surgery, Jikei University School of Medicine, Minato-ku, Japan.,Medical control committee, Japan Rugby Top League, Tokyo, Japan
| | - Junichiro Higashihara
- Gynecology, Higashihara clinic, Fukuoka, Japan.,Medical control committee, Japan Rugby Top League, Tokyo, Japan
| | - Yukimasa Toyama
- Orthopaedic surgery, Toyama Orthopaedic clinic, Osaka, Japan.,Medical control committee, Japan Rugby Top League, Tokyo, Japan
| | - Masahiro Furuya
- Orthopaedic Surgery, Furuya Orhopaedic clinic, Yokohama, Japan.,Medical control committee, Japan Rugby Top League, Tokyo, Japan
| | - Etsuo Chosa
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Akihiko Nakamura
- Department of Surgery, Nakamura Surgery and Pediatrics clinic, Tokyo, Japan.,Medical control committee, Japan Rugby Top League, Tokyo, Japan
| |
Collapse
|
8
|
O'Halloran P, Goggins L, Peirce N. Observable player behaviours and playing performance following helmet strikes in elite cricket. BMJ Open Sport Exerc Med 2021; 7:e001128. [PMID: 34950503 PMCID: PMC8650467 DOI: 10.1136/bmjsem-2021-001128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Investigate the observable player behaviours and features of both concussive (HS-C) and non-concussive (HS-NC) helmet strikes and describe their impact on playing performance. METHODS Elite male cricketers sustaining helmet strikes between the 2016 and 2018 seasons were identified by the England and Wales Cricket Board. Medical records identified players sustaining a concussion and those in whom concussion was excluded. Retrospective cohort analysis was performed on batting and bowling performance data available for these players in the 2 years prior to and 3 months post helmet strike. Video analysis of available incidents was conducted to describe the characteristics of the helmet strike and subsequent observable player behaviours. The HS-C and HS-NC cohorts were compared. RESULTS Data were available for 194 helmet strikes. 56 (29%) resulted in concussion. No significant differences were seen in playing performance in the 3 months post concussive helmet strike. However, a significant decline in batting performance was seen in this period in the HS-NC group (p<0.001).Video features signifying motor incoordination were most useful in identifying concussion post helmet strike, however, typical features suggesting transient loss of consciousness were not seen. Features such as a longer duration pause prior to the batsman resuming play and the level of concern shown by other players were also useful features. CONCLUSION HS-NC may be more significant for player performance than previously thought. Guidance for using video replay to identify concussion in cricket may need to be modified when compared with other field sports.
Collapse
Affiliation(s)
- Patrick O'Halloran
- Marker Diagnostics UK Ltd, Birmingham, UK
- Musculoskeletal Medicine, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Luke Goggins
- Department for Health, University of Bath, Bath, UK
| | - Nicholas Peirce
- Science and Medicine, England and Wales Cricket Board, Loughborough, UK
- National Centre for Sports Medicine, Loughborough University, Loughborough, UK
| |
Collapse
|
9
|
Powell D, Stuart S, Godfrey A. Sports related concussion: an emerging era in digital sports technology. NPJ Digit Med 2021; 4:164. [PMID: 34857868 PMCID: PMC8639973 DOI: 10.1038/s41746-021-00538-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/19/2021] [Indexed: 11/24/2022] Open
Abstract
Sports-related concussion (SRC) is defined as a mild traumatic brain injury (mTBI) leading to complex impairment(s) in neurological function with many seemingly hidden or difficult to measure impairments that can deteriorate rapidly without any prior indication. Growing numbers of SRCs in professional and amateur contact sports have prompted closer dialog regarding player safety and welfare. Greater emphasis on awareness and education has improved SRC management, but also highlighted the difficulties of diagnosing SRC in a timely manner, particularly during matches or immediately after competition. Therefore, challenges exist in off-field assessment and return to play (RTP) protocols, with current traditional (subjective) approaches largely based on infrequent snapshot assessments. Low-cost digital technologies may provide more objective, integrated and personalized SRC assessment to better inform RTP protocols whilst also enhancing the efficiency and precision of healthcare assessment. To fully realize the potential of digital technologies in the diagnosis and management of SRC will require a significant paradigm shift in clinical practice and mindset. Here, we provide insights into SRC clinical assessment methods and the translational utility of digital approaches, with a focus on off-field digital techniques to detect key SRC metrics/biomarkers. We also provide insights and recommendations to the common benefits and challenges facing digital approaches as they aim to transition from novel technologies to an efficient, valid, reliable, and integrated clinical assessment tool for SRC. Finally, we highlight future opportunities that digital approaches have in SRC assessment and management including digital twinning and the "digital athlete".
Collapse
Affiliation(s)
- Dylan Powell
- Department of Computer and Information Sciences, Faculty of Engineering and Environment, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK
| | - Sam Stuart
- Department of Sports, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Alan Godfrey
- Department of Computer and Information Sciences, Faculty of Engineering and Environment, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK.
| |
Collapse
|
10
|
Zimmerman KA, Laverse E, Samra R, Yanez Lopez M, Jolly AE, Bourke NJ, Graham NSN, Patel MC, Hardy J, Kemp S, Morris HR, Sharp DJ. White matter abnormalities in active elite adult rugby players. Brain Commun 2021; 3:fcab133. [PMID: 34435188 PMCID: PMC8381344 DOI: 10.1093/braincomms/fcab133] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/05/2021] [Accepted: 05/12/2021] [Indexed: 11/13/2022] Open
Abstract
The recognition, diagnosis and management of mild traumatic brain injuries are difficult and confusing. It is unclear how the severity and number of injuries sustained relate to brain injuries, such as diffuse axonal injury, diffuse vascular injury and progressive neurodegeneration. Advances in neuroimaging techniques enable the investigation of neuropathologies associated with acute and long-term effects of injury. Head injuries are the most commonly reported injury seen during professional rugby. There is increased vigilance for the immediate effects of these injuries in matches, but there has been surprisingly little research investigating the longer-term effects of rugby participation. Here, we present a longitudinal observational study investigating the relationship of exposure to rugby participation and sub-acute head injuries in professional adult male and female rugby union and league players using advanced MRI. Diffusion tensor imaging and susceptibility weighted imaging was used to assess white matter structure and evidence of axonal and diffuse vascular injury. We also studied changes in brain structure over time using Jacobian Determinant statistics extracted from serial volumetric imaging. We tested 41 male and 3 female adult elite rugby players, of whom 21 attended study visits after a head injury, alongside 32 non-sporting controls, 15 non-collision-sport athletic controls and 16 longitudinally assessed controls. Eighteen rugby players participated in the longitudinal arm of the study, with a second visit at least 6 months after their first scan. Neuroimaging evidence of either axonal injury or diffuse vascular injury was present in 23% (10/44) of players. In the non-acutely injured group of rugby players, abnormalities of fractional anisotropy and other diffusion measures were seen. In contrast, non-collision-sport athletic controls were not classified as showing abnormalities. A group level contrast also showed evidence of sub-acute injury using diffusion tensor imaging in rugby players. Examination of longitudinal imaging revealed unexpected reductions in white matter volume in the elite rugby players studied. These changes were not related to self-reported head injury history or neuropsychological test scores and might indicate excess neurodegeneration in white matter tracts affected by injury. Taken together, our findings suggest an association of participation in elite adult rugby with changes in brain structure. Further well-designed large-scale studies are needed to understand the impact of both repeated sports-related head impacts and head injuries on brain structure, and to clarify whether the abnormalities we have observed are related to an increased risk of neurodegenerative disease and impaired neurocognitive function following elite rugby participation.
Collapse
Affiliation(s)
- Karl A Zimmerman
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Hammersmith Hospital, Imperial College London, London W12 0NN, UK.,Care Research & Technology Centre, UK Dementia Research Institute, London W12 0BZ, UK
| | - Etienne Laverse
- Department of Clinical and Movement Neuroscience, University College London, London NW3 2PF, UK
| | - Ravjeet Samra
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Hammersmith Hospital, Imperial College London, London W12 0NN, UK
| | - Maria Yanez Lopez
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London SE1 7EH, UK
| | - Amy E Jolly
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Hammersmith Hospital, Imperial College London, London W12 0NN, UK.,Care Research & Technology Centre, UK Dementia Research Institute, London W12 0BZ, UK
| | - Niall J Bourke
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Hammersmith Hospital, Imperial College London, London W12 0NN, UK.,Care Research & Technology Centre, UK Dementia Research Institute, London W12 0BZ, UK
| | - Neil S N Graham
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Hammersmith Hospital, Imperial College London, London W12 0NN, UK.,Care Research & Technology Centre, UK Dementia Research Institute, London W12 0BZ, UK
| | - Maneesh C Patel
- Imaging Department, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK
| | - John Hardy
- Department of Neurodegenerative Disease, Reta Lila Weston Laboratories, Queen Square Genomics, UCL Dementia Research Institute, London WC1N 3BG, UK
| | - Simon Kemp
- Rugby Football Union, Twickenham, London TW2 7BA, UK.,Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Huw R Morris
- Department of Clinical and Movement Neuroscience, University College London, London NW3 2PF, UK
| | - David J Sharp
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Hammersmith Hospital, Imperial College London, London W12 0NN, UK.,Care Research & Technology Centre, UK Dementia Research Institute, London W12 0BZ, UK.,The Royal British Legion Centre for Blast Injury Studies, Imperial College London SW7 2AZ, UK
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Dechambre X, Carling C, Mrozek S, Pillard F, Decq P, Piscione J, Yrondi A, Brauge D. What Is the Impact of Physical Effort on the Diagnosis of Concussion? Clin J Sport Med 2021; 31:e144-e149. [PMID: 31219927 DOI: 10.1097/jsm.0000000000000757] [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: 11/04/2018] [Accepted: 03/19/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Sport-related concussion commonly occurs in contact sports such as rugby. To date, diagnosis is based on the realization of clinical tests conducted pitch-side. Yet, the potential effect of prior physical effort on the results of these tests remains poorly understood. The purpose of this study was to determine whether preceding physical effort can influence the outcome of concussion assessments. DESIGN Prospective observational study. SETTING University Medicine Center. PATIENTS A cohort of 40 subjects (20 rugby players and 20 athletes from a range of sports). INTERVENTION A concussion assessment was performed immediately after physical activity. After a period of 6 months and under the same experimental conditions, the same cohort performed the same tests in resting conditions. MAIN OUTCOME MEASURES Results of concussion tests. RESULTS In both cohorts, the comparison for postexercise and rest assessments demonstrated a most likely moderate-to-very large increase in the number of symptoms, severity of symptoms, and balance error scoring system score. In the rugby cohort, scores for concentration, delayed memory and standardized assessment of concussion (SAC), likely-to-most likely decreased following completion of physical activity compared with baseline values. The between-cohort comparison reported a most likely greater impact after exercise in the rugby players for delayed recall (0.73 ± 0.61) and SAC score (0.75 ± 0.41). CONCLUSIONS Physical activity altered the results of concussion diagnostic tests in athletes from a range of sports and notably in rugby players. Therefore, physical efforts before the concussion incident should be accounted for during pitch-side assessments and particularly during rugby competition and training.
Collapse
Affiliation(s)
- Xavier Dechambre
- Department of General Medicine, University Hospital of Toulouse, Toulouse, France
| | - Christopher Carling
- Institute of Coaching and Performance, University of Central Lancashire, Preston, United Kingdom
| | - Ségolène Mrozek
- Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, Toulouse, France
| | - Fabien Pillard
- Department of Exploration of Respiratory Function and Sports Medicine, University Hospital of Toulouse, Toulouse, France
| | - Philippe Decq
- Department of Neurosurgery, Assistance Publique des Hôpitaux de Paris, University Hospital of Beaujon, Clichy, France
| | - Julien Piscione
- Research Department, French Rugby Union Federation, Marcoussis, France
| | - Antoine Yrondi
- Department of Psychiatry, University Hospital of Toulouse, Toulouse, France; and
| | - David Brauge
- Department of Neurosurgery, University Hospital of Toulouse, Toulouse, France
| |
Collapse
|
13
|
Rosenbloom C, Broman D, Chu W, Chatterjee R, Okholm Kryger K. Sport-related concussion practices of medical team staff in elite football in the United Kingdom, a pilot study. SCI MED FOOTBALL 2021; 6:127-135. [DOI: 10.1080/24733938.2021.1892174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Craig Rosenbloom
- The Football Association, Technical Directorate, Burton-upon-Trent, UK
- Queen Mary University of London, Sport and Exercise Medicine, London, UK
| | | | - Wing Chu
- Imperial College Healthcare NHS Trust, St Mary’s Hospital, London, UK
| | - Robin Chatterjee
- Institute of Sport, Exercise and Health, London, UK
- British Association of Sport and Exercise Medicine, 3 Jetstream Dr, Doncaster, UK
| | - Katrine Okholm Kryger
- Queen Mary University of London, Sport and Exercise Medicine, London, UK
- St Mary’s University, Faculty of Sport, Health and Applied Science, London, UK
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
Bailey AM, Sherwood CP, Funk JR, Crandall JR, Carter N, Hessel D, Beier S, Neale W. Characterization of Concussive Events in Professional American Football Using Videogrammetry. Ann Biomed Eng 2020; 48:2678-2690. [DOI: 10.1007/s10439-020-02637-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 09/22/2020] [Indexed: 11/29/2022]
|
16
|
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
| |
Collapse
|
17
|
Hendricks S, Till K, den Hollander S, Savage TN, Roberts SP, Tierney G, Burger N, Kerr H, Kemp S, Cross M, Patricios J, McKune AJ, Bennet M, Rock A, Stokes KA, Ross A, Readhead C, Quarrie KL, Tucker R, Jones B. Consensus on a video analysis framework of descriptors and definitions by the Rugby Union Video Analysis Consensus group. Br J Sports Med 2020; 54:566-572. [DOI: 10.1136/bjsports-2019-101293] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2020] [Indexed: 01/12/2023]
Abstract
Using an expert consensus-based approach, a rugby union Video Analysis Consensus (RUVAC) group was formed to develop a framework for video analysis research in rugby union. The aim of the framework is to improve the consistency of video analysis work in rugby union and help enhance the overall quality of future research in the sport. To reach consensus, a systematic review and Delphi method study design was used. After a systematic search of the literature, 17 articles were used to develop the final framework that described and defined key actions and events in rugby union (rugby). Thereafter, a group of researchers and practitioners with experience and expertise in rugby video analysis formed the RUVAC group. Each member of the group examined the framework of descriptors and definitions and rated their level of agreement on a 5-point agreement Likert scale (1:strongly disagree; 2:disagree; 3:neither agree or disagree; 4:agree; 5: strongly agree). The mean rating of agreement on the five-point scale (1:strongly disagree; 5:strongly agree) was 4.6 (4.3–4.9), 4.6 (4.4–4.9), 4.7 (4.5–4.9), 4.8 (4.6–5.0) and 4.8 (4.6–5.0) for the tackle, ruck, scrum, line-out and maul, respectively. The RUVAC group recommends using this consensus as the starting framework when conducting rugby video analysis research. Which variables to use (if not all) depends on the objectives of the study. Furthermore, the intention of this consensus is to help integrate video data with other data (eg, injury surveillance).
Collapse
|
18
|
Dec KL, Kelly KC, Gilman JB. Management of Adult Sports Concussion. Concussion 2020. [DOI: 10.1016/b978-0-323-65384-8.00011-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
19
|
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.
Collapse
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
| |
Collapse
|
20
|
Suzuki K, Nagai S, Ogaki R, Iwai K, Furukawa T, Miyakawa S, Takemura M. Video analysis of tackling situations leading to concussion in collegiate rugby union. THE JOURNAL OF PHYSICAL FITNESS AND SPORTS MEDICINE 2019. [DOI: 10.7600/jpfsm.8.79] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Keita Suzuki
- Division of Sports Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba
- Center of Humanities and Sciences, Ibaraki Prefectural University of Health Sciences
| | - Satoshi Nagai
- Department of Physical Therapy, Faculty of Health Sciences, Tsukuba International University
| | - Ryo Ogaki
- Department of Business Management, Faculty of Modern Life, Teikyo Heisei University
| | - Koichi Iwai
- Center of Humanities and Sciences, Ibaraki Prefectural University of Health Sciences
| | - Takuo Furukawa
- Faculty of Health and Sport Science, University of Tsukuba
| | | | | |
Collapse
|
21
|
Abstract
Sport-related concussion (SRC) is a common injury in recreational and organized sport. Over the past 30 years, there has been significant progress in our scientific understanding of SRC, which in turn has driven the development of clinical guidelines for diagnosis, assessment, and management of SRC. In addition to a growing need for knowledgeable health care professionals to provide evidence-based care for athletes with SRC, media attention and legislation have created awareness and, in some cases, fear about many issues and unknowns surrounding SRC. The American Medical Society for Sports Medicine formed a writing group to review the existing literature on SRC, update its previous position statement, and address current evidence and knowledge gaps regarding SRC. The absence of definitive outcomes-based data is challenging and requires relying on the best available evidence integrated with clinical experience and patient values. This statement reviews the definition, pathophysiology, and epidemiology of SRC, the diagnosis and management of both acute and persistent concussion symptoms, the short- and long-term risks of SRC and repetitive head impact exposure, SRC prevention strategies, and potential future directions for SRC research. The American Medical Society for Sports Medicine is committed to best clinical practices, evidence-based research, and educational initiatives that positively impact the health and safety of athletes.
Collapse
|
22
|
Putukian M, Echemendia RJ, Chiampas G, Dvorak J, Mandelbaum B, Lemak LJ, Kirkendall D. Head Injury in Soccer: From Science to the Field; summary of the head injury summit held in April 2017 in New York City, New York. Br J Sports Med 2019; 53:1332. [DOI: 10.1136/bjsports-2018-100232] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2019] [Indexed: 12/15/2022]
Abstract
There has been an increased focus and awareness of head injury and sport-related concussion (SRC) across all sports from the medical and scientific communities, sports organisations, legislators, the media and the general population. Soccer, in particular, has been a focus of attention due to the popularity of the game, the frequency of SRC and the hypothesised effects of repetitive heading of the ball. Major League Soccer, US Soccer and the National Women’s Soccer League jointly hosted a conference entitled, ‘Head Injury in Soccer: From Science to the Field’, on 21–22 April 2017 in New York City, New York. The mission of this conference was to identify, discuss and disseminate evidence-based science related to the findings and conclusions of the fifth International Conference on Concussion in Sport held by the Concussion in Sport Group and apply them to the sport of soccer. In addition, we reviewed information regarding the epidemiology and mechanism of head injuries in soccer at all levels of play, data regarding the biomechanics and effects of repetitive head impacts and other soccer-specific considerations. We discussed how to release the information raised during the summit to key stakeholders including athletes, parents, coaches and healthcare providers. We identified future areas for research and collaboration to enhance the health and safety of soccer (football) players.
Collapse
|
23
|
Harmon KG, Clugston JR, Dec K, Hainline B, Herring S, Kane SF, Kontos AP, Leddy JJ, McCrea M, Poddar SK, Putukian M, Wilson JC, Roberts WO. American Medical Society for Sports Medicine position statement on concussion in sport. Br J Sports Med 2019; 53:213-225. [DOI: 10.1136/bjsports-2018-100338] [Citation(s) in RCA: 217] [Impact Index Per Article: 43.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2018] [Indexed: 12/14/2022]
Abstract
Sport-related concussion (SRC) is a common injury in recreational and organised sport. Over the past 30 years, there has been significant progress in our scientific understanding of SRC, which in turn has driven the development of clinical guidelines for diagnosis, assessment and management of SRC. In addition to a growing need for knowledgeable healthcare professionals to provide evidence-based care for athletes with SRC, media attention and legislation have created awareness and, in some cases, fear about many issues and unknowns surrounding SRC. The American Medical Society for Sports Medicine (AMSSM) formed a writing group to review the existing literature on SRC, update its previous position statement, and to address current evidence and knowledge gaps regarding SRC. The absence of definitive outcomes-based data is challenging and requires relying on the best available evidence integrated with clinical experience and patient values. This statement reviews the definition, pathophysiology and epidemiology of SRC, the diagnosis and management of both acute and persistent concussion symptoms, the short-term and long-term risks of SRC and repetitive head impact exposure, SRC prevention strategies, and potential future directions for SRC research. The AMSSM is committed to best clinical practices, evidence-based research and educational initiatives that positively impact the health and safety of athletes.
Collapse
|
24
|
Tierney GJ, Simms CK. Can tackle height influence head injury assessment risk in elite rugby union? J Sci Med Sport 2018; 21:1210-1214. [DOI: 10.1016/j.jsams.2018.05.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/19/2018] [Accepted: 05/08/2018] [Indexed: 11/30/2022]
|
25
|
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.
Collapse
|
26
|
Tierney GJ, Denvir K, Farrell G, Simms CK. Does ball carrier technique influence tackler head injury assessment risk in elite rugby union? J Sports Sci 2018; 37:262-267. [DOI: 10.1080/02640414.2018.1494952] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Gregory J Tierney
- Trinity Centre for Bioengineering, Trinity College Dublin, Dublin, Ireland
| | | | | | - Ciaran K Simms
- Trinity Centre for Bioengineering, Trinity College Dublin, Dublin, Ireland
| |
Collapse
|
27
|
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.
Collapse
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
| |
Collapse
|
28
|
Patricios JS, Ardern CL, Hislop MD, Aubry M, Bloomfield P, Broderick C, Clifton P, Echemendia RJ, Ellenbogen RG, Falvey ÉC, Fuller GW, Grand J, Hack D, Harcourt PR, Hughes D, McGuirk N, Meeuwisse W, Miller J, Parsons JT, Richiger S, Sills A, Moran KB, Shute J, Raftery M. Implementation of the 2017 Berlin Concussion in Sport Group Consensus Statement in contact and collision sports: a joint position statement from 11 national and international sports organisations. Br J Sports Med 2018; 52:635-641. [PMID: 29500252 PMCID: PMC5931244 DOI: 10.1136/bjsports-2018-099079] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2018] [Indexed: 01/25/2023]
Abstract
The 2017 Berlin Concussion in Sport Group Consensus Statement provides a global summary of best practice in concussion prevention, diagnosis and management, underpinned by systematic reviews and expert consensus. Due to their different settings and rules, individual sports need to adapt concussion guidelines according to their specific regulatory environment. At the same time, consistent application of the Berlin Consensus Statement's themes across sporting codes is likely to facilitate superior and uniform diagnosis and management, improve concussion education and highlight collaborative research opportunities. This document summarises the approaches discussed by medical representatives from the governing bodies of 10 different contact and collision sports in Dublin, Ireland in July 2017. Those sports are: American football, Australian football, basketball, cricket, equestrian sports, football/soccer, ice hockey, rugby league, rugby union and skiing. This document had been endorsed by 11 sport governing bodies/national federations at the time of being published.
Collapse
Affiliation(s)
- Jon S Patricios
- University of Pretoria, Section of Sports Medicine, Faculty of Health Sciences, Johannesburg, South Africa
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Clare L Ardern
- Department of Physiotherapy, Linköping University, Linköping, Sweden
- School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | | | - Mark Aubry
- International Ice Hockey Federation, Zurich, Switzerland
| | | | | | - Patrick Clifton
- Australian Football League, Melbourne, Victoria, Australia
- Australian Institute of Sport, Canberra, Australia
| | - Ruben J Echemendia
- National Hockey League, New York, USA
- University Orthopedic Center, Concussion Care Clinic, State College, Pennsylvania, USA
- University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Richard G Ellenbogen
- National Football League, New York, USA
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | | | - Gordon Ward Fuller
- Centre for Urgent and Emergency Care Research, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Dallas Hack
- National Collegiate Athletic Association, Indianapolis, Indiana, USA
| | | | - David Hughes
- Australian Football League, Melbourne, Victoria, Australia
- Australian Institute of Sport, Canberra, Australia
| | - Nathan McGuirk
- National Rugby League, Sydney, New South Wales, Australia
| | | | | | - John T Parsons
- National Collegiate Athletic Association, Indianapolis, Indiana, USA
| | | | - Allen Sills
- National Football League, New York, USA
- Fédération Equestre Internationale, Lausanne, Switzerland
| | | | - Jenny Shute
- Fédération Internationale de Ski, Oberhofen and Thunersee, Switzerland
| | | |
Collapse
|
29
|
TIERNEY GREGORYJ, DENVIR KARL, FARRELL GARRETH, SIMMS CIARANK. The Effect of Tackler Technique on Head Injury Assessment Risk in Elite Rugby Union. Med Sci Sports Exerc 2018; 50:603-608. [DOI: 10.1249/mss.0000000000001461] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
30
|
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]
|
31
|
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.
Collapse
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
| | | |
Collapse
|
32
|
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.
Collapse
|