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Hutchison MG, Di Battista AP, Meeuwisse W, Bruce JM, Echemendia RJ, Delaney JS, Comper P. Concussion Characteristics in the National Hockey League Before and After the Introduction of Rule 48. JAMA Netw Open 2023; 6:e2344399. [PMID: 37991764 PMCID: PMC10665971 DOI: 10.1001/jamanetworkopen.2023.44399] [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: 06/15/2023] [Accepted: 10/12/2023] [Indexed: 11/23/2023] Open
Abstract
Importance A rule prohibiting a direct hit to the lateral side of the head (ie, Rule 48-Illegal Check to the Head) was introduced in the National Hockey League (NHL) in the 2010-2011 season and refined in the 2011-2012 season to widen the application to include direct contact to all areas of the head. Objective To compare the incidence and proportion of concussions that occurred following hits to the head before and after the implementation of Rule 48. Design, Setting, and Participants This retrospective cohort study used a before and after design to evaluate concussions among NHL players in regular season games. Data from the 4 seasons preceding the implementation of Rule 48 (2006-2007 to 2009-2010) were compared with data from 5 seasons following its implementation (2014-2015 to 2018-2019). Data were analyzed from October 31, 2021, to November 30, 2022. Main Outcomes and Measures The incidence and relative proportion of concussion characteristics and mechanisms before and after the introduction of Rule 48. Results In the analysis of 688 concussions for NHL seasons spanning 2006 to 2010 (n = 231) and 2014 to 2019 (n = 457), there was an overall increase in the incidence of concussion between the 2 time frames, although the incidence of concussions due to hits to the lateral aspect of the head decreased from 1.6/100 games to 1.0/100 games (estimated difference, 0.6/100 games [90% credible interval (CrI), 0.30/100 games to 0.90/100 games). There was also a reduction of 18.8 (90% CrI, 13.0-23.7) percentage points in the proportion of concussions due to hits to the lateral aspect of the head from 80 of 231 concussions (34.6%) to 61 of 457 concussions (13.3%). The incidence of concussions following hits to the head from body checks using the shoulder, arm, and glove was similar before and following the implementation of Rule 48. However, the proportion was reduced 14.7 percentage points from 113 of 231 concussions (48.9%) before to 149 of 457 concussions (32.6%) after implementation of Rule 48 (90% CrI of the difference, 8.9-20.7 percentage points). Conclusions and Relevance The findings of this cohort study of NHL players suggest that after the introduction of Rule 48, the incidence rate and proportion of concussions from contact to the lateral aspect of the head decreased, as did the proportion of concussions following direct hits to the head.
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Affiliation(s)
- Michael G Hutchison
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
- David L. MacIntosh Sport Medicine Clinic, Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Alex P Di Battista
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | | | - Jared M Bruce
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine
- Department of Neurology, University of Missouri-Kansas City School of Medicine
- Department of Psychiatry, University of Missouri-Kansas City School of Medicine
| | - Ruben J Echemendia
- Concussion Care Clinic, University Orthopedic Center, University of Missouri-Kansas City
| | - J Scott Delaney
- Department of Emergency Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Paul Comper
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Eliason PH, Galarneau JM, Kolstad AT, Pankow MP, West SW, Bailey S, Miutz L, Black AM, Broglio SP, Davis GA, Hagel BE, Smirl JD, Stokes KA, Takagi M, Tucker R, Webborn N, Zemek R, Hayden A, Schneider KJ, Emery CA. Prevention strategies and modifiable risk factors for sport-related concussions and head impacts: a systematic review and meta-analysis. Br J Sports Med 2023; 57:749-761. [PMID: 37316182 DOI: 10.1136/bjsports-2022-106656] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To evaluate prevention strategies, their unintended consequences and modifiable risk factors for sport-related concussion (SRC) and/or head impact risk. DESIGN This systematic review and meta-analysis was registered on PROSPERO (CRD42019152982) and conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES Eight databases (MEDLINE, CINAHL, APA PsycINFO, Cochrane (Systematic Review and Controlled Trails Registry), SPORTDiscus, EMBASE, ERIC0 were searched in October 2019 and updated in March 2022, and references searched from any identified systematic review. ELIGIBILITY CRITERIA Study inclusion criteria were as follows: (1) original data human research studies, (2) investigated SRC or head impacts, (3) evaluated an SRC prevention intervention, unintended consequence or modifiable risk factor, (4) participants competing in any sport, (5) analytic study design, (6) systematic reviews and meta-analyses were included to identify original data manuscripts in reference search and (7) peer-reviewed. Exclusion criteria were as follows: (1) review articles, pre-experimental, ecological, case series or case studies and (2) not written in English. RESULTS In total, 220 studies were eligible for inclusion and 192 studies were included in the results based on methodological criteria as assessed through the Scottish Intercollegiate Guidelines Network high ('++') or acceptable ('+') quality. Evidence was available examining protective gear (eg, helmets, headgear, mouthguards) (n=39), policy and rule changes (n=38), training strategies (n=34), SRC management strategies (n=12), unintended consequences (n=5) and modifiable risk factors (n=64). Meta-analyses demonstrated a protective effect of mouthguards in collision sports (incidence rate ratio, IRR 0.74; 95% CI 0.64 to 0.89). Policy disallowing bodychecking in child and adolescent ice hockey was associated with a 58% lower concussion rate compared with bodychecking leagues (IRR 0.42; 95% CI 0.33 to 0.53), and evidence supports no unintended injury consequences of policy disallowing bodychecking. In American football, strategies limiting contact in practices were associated with a 64% lower practice-related concussion rate (IRR 0.36; 95% CI 0.16 to 0.80). Some evidence also supports up to 60% lower concussion rates with implementation of a neuromuscular training warm-up programme in rugby. More research examining potentially modifiable risk factors (eg, neck strength, optimal tackle technique) are needed to inform concussion prevention strategies. CONCLUSIONS Policy and rule modifications, personal protective equipment, and neuromuscular training strategies may help to prevent SRC. PROSPERO REGISTRATION NUMBER CRD42019152982.
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Affiliation(s)
- Paul H Eliason
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Jean-Michel Galarneau
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Ash T Kolstad
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - M Patrick Pankow
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | | | - Stuart Bailey
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
| | - Lauren Miutz
- Health and Sport Science, University of Dayton, Dayton, Ohio, USA
| | - Amanda Marie Black
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | | | - Gavin A Davis
- Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia
| | - Brent E Hagel
- Departments of Paediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jonathan D Smirl
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Keith A Stokes
- Centre for Health and Injury and Illness Prevention in Sport, University of Bath, Bath, UK
| | - Michael Takagi
- Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia
| | - Ross Tucker
- School of Management Studies, University of Cape Town, Rondebosch, South Africa
| | - Nick Webborn
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Roger Zemek
- Pediatrics and Emergency Medicine, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Alix Hayden
- Libraries and Cultural Resources, University of Calgary, Calgary, Alberta, Canada
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Departments of Paediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Prisco L, Salesi LA, McElheny KD, Weiss D, Diamond L, Brennan T. Primary Care Considerations for the Baseball Athlete. Curr Rev Musculoskelet Med 2022; 15:570-580. [PMID: 36342649 PMCID: PMC9640801 DOI: 10.1007/s12178-022-09798-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE OF REVIEW To summarize current guidance and best practices surrounding non-orthopedic medical concerns in baseball. RECENT FINDINGS Discussion of COVID19-related practice changes pertaining to the prevention and screening of communicable respiratory illness, concussion protocol updates, the enhanced role of a multi-disciplinary team of mental health professionals. Prevention, appropriate screening, and early identification remain cornerstones of effective primary care both within the general population as well as for the baseball athlete.
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Affiliation(s)
- Lauren Prisco
- grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Lauren A. Salesi
- grid.239915.50000 0001 2285 8823Primary Sports Medicine, Hospital for Special Surgery, 535 E 70th. St, New York, NY 10021 USA
| | - Kathryn D. McElheny
- grid.239915.50000 0001 2285 8823Primary Sports Medicine, Hospital for Special Surgery, 535 E 70th. St, New York, NY 10021 USA
| | - Doria Weiss
- grid.260917.b0000 0001 0728 151XNew York Medical College School of Medicine, Valhalla, NY USA
| | - Laura Diamond
- grid.416167.30000 0004 0442 1996The Addiction Institute of Mount Sinai West Hospital, Department of Psychiatry, New York, NY USA
| | - Tim Brennan
- grid.59734.3c0000 0001 0670 2351Addiction Institute of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY USA
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Tarzi G, Tarzi C, Mirsu D, Patel J, Dadashi E, El-Sabbagh J, Gerhart A, Cusimano MD. Effect of a new concussion substitute rule on medical assessment of head collision events in Premier League football. Inj Prev 2022; 28:521-525. [PMID: 35790348 DOI: 10.1136/ip-2022-044580] [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: 03/13/2022] [Accepted: 06/10/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To investigate the utilisation of additional permanent concussion substitutes (APCSs) and its efficacy with regards to rate and duration of medical assessment of head collision events (HCEs) in the 2020-2021 Premier League season. The present APCS rule allows players with a suspected concussion to be removed from a match without counting towards a team's allocated substitutions. METHODS Eighty Premier League matches, 40 prior to additional permanent concussion substitutes implementation (Pre-APCS) and 40 after (Post-APCS), were randomly selected and analysed by a team of trained reviewers for HCEs. Data on HCE incidence, rates of medical assessment, duration of medical assessment and return to play were collected for each match. Data for the Pre-APCS and Post-APCS groups were compared to analyse differences in assessment of HCEs. RESULTS During the 2020-2021 Premier League season, three APCSs were used. There were 38 HCEs identified in the Pre-APCS group (0.95 per match, 28.79 per 1000 athlete-hours of exposure) and 42 in the Post-APCS group (1.05 per match, 31.82 per 1000 athlete-hours of exposure). Incidence of HCEs (p=0.657), rates of medical assessment (23.7% Pre-APCS vs 21.4% Post-APCS; p=0.545) and duration of medical assessment (median 81 s Pre-APCS vs 102 s Post-APCS; p=0.466) did not significantly differ between the two groups. CONCLUSIONS The implementation of APCSs in the Premier League did not impact the rate or duration of medical assessement of HCEs. Despite the introduction of APCSs, the consensus protocols for HCE assessment were rarely followed. We recommend changes to APCS and its implementation that would be aimed at protecting player health.
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Affiliation(s)
- Gabriel Tarzi
- Injury Prevention Research Office, Division of Neurosurgery, St Michael's Hospital, Toronto, Ontario, Canada
| | - Christopher Tarzi
- Injury Prevention Research Office, Division of Neurosurgery, St Michael's Hospital, Toronto, Ontario, Canada
| | - Diana Mirsu
- Injury Prevention Research Office, Division of Neurosurgery, St Michael's Hospital, Toronto, Ontario, Canada
| | - Jay Patel
- Injury Prevention Research Office, Division of Neurosurgery, St Michael's Hospital, Toronto, Ontario, Canada
| | - Eileen Dadashi
- Injury Prevention Research Office, Division of Neurosurgery, St Michael's Hospital, Toronto, Ontario, Canada
| | - Jana El-Sabbagh
- Injury Prevention Research Office, Division of Neurosurgery, St Michael's Hospital, Toronto, Ontario, Canada
| | - Austin Gerhart
- Injury Prevention Research Office, Division of Neurosurgery, St Michael's Hospital, Toronto, Ontario, Canada
| | - Michael D Cusimano
- Injury Prevention Research Office, Division of Neurosurgery, St Michael's Hospital, Toronto, Ontario, Canada .,Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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