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Liang L, Chuang SK. Trends in Soccer-Related Craniomaxillofacial Injuries, United States 2003-2022. J Oral Maxillofac Surg 2023; 81:1495-1503. [PMID: 37743045 DOI: 10.1016/j.joms.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/31/2023] [Accepted: 09/01/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Soccer is one of the most popular sports worldwide. However, it has risks of injury to craniomaxillofacial regions such as the head, neck, and mouth. PURPOSE The purpose of this study is to determine which demographic and injury characteristics among soccer players with craniomaxillofacial injuries are associated with increased hospitalizations. STUDY DESIGN, SETTING, AND SAMPLE This is a retrospective cohort study utilizing the National Electronic Injury Surveillance System. Subjects included in this study experienced an injury to a craniomaxillofacial area from soccer between January 1, 2003, and December 31, 2022. PREDICTOR VARIABLE The predictor variables included demographics (age, sex, race) and injury characteristics (craniomaxillofacial region, diagnosis). MAIN OUTCOME VARIABLE The primary outcome variable was injury severity defined as hospitalization outcome after injury (yes/no). The secondary outcome variable was the trends in the incidence of soccer craniomaxillofacial injuries over time (2003-2022). COVARIATES The covariates were the heterogenous set of predictor variables in this study. ANALYSES Descriptive statistics and univariate analyses were computed. Survey-weighted univariate and multivariate logistic regression were used to measure the association of demographic and injury variables with hospitalization outcome. Statistical significance was defined as P < .05. RESULTS The study sample included 26,642 subjects (national estimate, 799,393). The national incidence of craniomaxillofacial soccer injuries generally increased between 2003 and 2012 and decreased between 2016 and 2020. Subjects in the ≥30 age group had increased odds of hospitalization compared to those in the 10-19 age group (odds ratio [OR], 2.12; P < .001). Compared to females, males had significantly higher odds of hospitalization (OR, 1.53; P < .001). Head (OR, 8.42; P < .001) and neck (OR, 15.8; P < .001) injuries had increased odds of hospitalization compared to facial injuries. Relative to contusions/abrasions, subjects with fractures (OR, 94.7; P < .001), dental injuries (OR, 41.3; P < .001), and concussions (OR, 5.33; P = .017) were at significantly higher odds of hospitalization. CONCLUSION AND RELEVANCE Age, sex, craniomaxillofacial region, and diagnosis were significant predictors of hospitalization outcome after craniomaxillofacial soccer injury. Safer playing styles, use of mouthguards, and proper medical management may reduce future risks of craniomaxillofacial injury from soccer.
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Affiliation(s)
- Lang Liang
- Dental Student, Harvard School of Dental Medicine, Boston, MA.
| | - Sung-Kiang Chuang
- Clinical Professor, Department of Oral and Maxillofacial Surgery, University of Pennsylvania, School of Dental Medicine, Philadelphia, PA; Attending, Department of Oral and Maxillofacial Surgery, Good Samaritan Medical Center, Brockton, MA
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Adanty K, Bhagavathula KB, Tronchin O, Li DX, Rabey KN, Doschak MR, Adeeb S, Hogan J, Ouellet S, Plaisted TA, Satapathy SS, Romanyk DL, Dennison CR. The Mechanical Characterization and Comparions of Male and Female Calvaria Under Four-Point Bending Impacts. J Biomech Eng 2023; 145:1153590. [PMID: 36511109 DOI: 10.1115/1.4056459] [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: 07/02/2022] [Accepted: 12/02/2022] [Indexed: 12/15/2022]
Abstract
The circumstances in which we mechanically test and critically assess human calvarium tissue would find relevance under conditions encompassing real-world head impacts. These conditions include, among other variables, impact velocities, and strain rates. Compared to quasi-static loading on calvaria, there is less reporting on the impact loading of the calvaria and consequently, there are relatively fewer mechanical properties on calvaria at relevant impact loading rates available in the literature. The purpose of this work was to report on the mechanical response of 23 human calvarium specimens subjected to dynamic four-point bending impacts. Impacts were performed using a custom-built four-point impact apparatus at impact velocities of 0.86-0.89 m/s resulting in surface strain rates of 2-3/s-representative of strain rates observed in vehicle collisions and blunt impacts. The study revealed comparable effective bending moduli (11-15 GPa) to the limited work reported on the impact mechanics of calvaria in the literature, however, fracture bending stress (10-47 MPa) was relatively less. As expected, surface strains at fracture (0.21-0.25%) were less compared to studies that performed quasi-static bending. Moreover, the study revealed no significant differences in mechanical response between male and female calvaria. The findings presented in this work are relevant to many areas including validating surrogate skull fracture models in silico or laboratory during impact and optimizing protective devices used by civilians to reduce the risk of a serious head injury.
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Affiliation(s)
- Kevin Adanty
- Biomedical Instrumentation Laboratory, Donadeo Innovation Center for Engineering, Department of Mechanical Engineering, University of Alberta, 9211 116 Street NW, Edmonton, AB T6G 2E1, Canada
| | - Kapil B Bhagavathula
- Donadeo Innovation Center for Engineering, Department of Mechanical Engineering, University of Alberta, 9211 116 Street NW, Edmonton, AB T6G 2E1, Canada
| | - Olivia Tronchin
- Biomedical Instrumentation Laboratory, Donadeo Innovation Center for Engineering, Department of Mechanical Engineering, University of Alberta, 9211 116 Street NW, Edmonton, AB T6G 2E1, Canada
| | - David X Li
- Biomedical Instrumentation Laboratory, Donadeo Innovation Center for Engineering, Department of Mechanical Engineering, University of Alberta, 9211 116 Street NW, Edmonton, AB T6G 2E1, Canada
| | - Karyne N Rabey
- Department of Surgery, Division of Anatomy, University of Alberta, 2J2.00 WC Mackenzie Health Sciences Centre, 8440-112 Street NW, Edmonton, AB T6G 2R7, Canada; Department of Anthropology, Faculty of Arts, University of Alberta, 13-15 Tory Building, Edmonton, AB T6G 2H4, Canada
| | - Michael R Doschak
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Medical Sciences Building, 8613 114 Street NW, Edmonton, AB T6G 2H7, Canada
| | - Samer Adeeb
- Donadeo Innovation Centre for Engineering, Department of Civil and Environmental Engineering, University of Alberta, 9211 116 Street NW, Edmonton, AB T6G 1H9, Canada
| | - James Hogan
- Donadeo Innovation Center for Engineering, Department of Mechanical Engineering, University of Alberta, 9211 116 Street NW, Edmonton, AB T6G 2E1, Canada
| | - Simon Ouellet
- Defense Research and Development Canada, Valcartier Research Centre, 2459, de la, Route de la Bravoure, Quebec City, QC G3J 1X5, Canada
| | - Thomas A Plaisted
- U.S. Army Combat Capabilities Development Command, Army Research Laboratory, Aberdeen Proving Ground, MD 21005
| | - Sikhanda S Satapathy
- U.S. Army Combat Capabilities Development Command, Army Research Laboratory, Aberdeen Proving Ground, MD 21005
| | - Dan L Romanyk
- Donadeo Innovation Center for Engineering, Department of Mechanical Engineering, University of Alberta, 9211 116 Street NW, Edmonton, AB T6G 2E1, Canada; School of Dentistry, University of Alberta, 7-020 H Katz Group Centre for Pharmacy and Health Research, 87 Ave 114 Street, Edmonton, AB T6G 2E1, Canada
| | - Christopher R Dennison
- Biomedical Instrumentation Laboratory, Donadeo Innovation Center for Engineering, Department of Mechanical Engineering, University of Alberta, 9211 116 Street NW, Edmonton, AB T6G 2E1, Canada; Department of Mechanical Engineering, University of Victoria, Engineering Office Wing, Room 548 3800 Finnerty Road, Victoria, BC V8P 5C2, Canada
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A New In-Skates Balance Error Scoring System for Ice Hockey Players. Clin J Sport Med 2021; 31:e447-e452. [PMID: 31842050 DOI: 10.1097/jsm.0000000000000816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 11/15/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Evaluate a new in-skates balance error scoring system (SBESS) for ice hockey players wearing their equipment. DESIGN Prospective, randomized, single blinded study. SETTING Sport Medicine Clinic. PARTICIPANTS Eighty university hockey players. INTERVENTION A control group performed the SBESS assessment at rest on 2 separate occasions and an experimental group performed the assessment at rest and after exertion. The SBESS consists of maintaining different stances on ice skates for 20 seconds each, while wearing full equipment (no stick, gloves and helmet) and standing on a hard rubber surface. Three independent reviewers scored the video recorded assessments. MAIN OUTCOMES MEASURES Primary outcome was the number of balance errors and the secondary outcome was the number of falls. RESULTS The control group's median SBESS scores were 2 and 3 on the first and second attempts at rest, respectively. The experimental group's median SBESS scores were 2 at rest and 2 after exertion. There was no fatigue effect and no athletes fell while performing the test. Of the 4 stances tested, the tandem stance had the highest variability in error scores between athletes and when repeated by the same athlete. The intraclass correlation coefficient (ICC) for interrater reliability was above 0.82, and the intrarater reliability ICC was above 0.86 for all SBESS scores. There was no concordance between the SBESS and the modified BESS. CONCLUSIONS The SBESS, omitting the tandem stance, is a safe and reproducible sideline balance assessment of ice hockey players wearing full equipment.
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Soccer-related injuries utilization of U.S. emergency departments for concussions, intracranial injuries, and other-injuries in a national representative probability sample: Nationwide Emergency Department Sample, 2010 to 2013. PLoS One 2021; 16:e0258345. [PMID: 34637479 PMCID: PMC8509888 DOI: 10.1371/journal.pone.0258345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 09/26/2021] [Indexed: 11/19/2022] Open
Abstract
Soccer participation in the United States (U.S.) has increased over time, and injuries as well as interest to prevent injuries has become more common. This study described Emergency Department (ED) visits related to concussions, intracranial injuries (ICI), and all-other injuries attributed to soccer play; described healthcare cost and length of hospital stay of soccer-related injuries; and determined independent predictors of concussions, ICI, and all-other soccer injuries leading to ED visits. The study examined soccer-related weighted discharge data from the Nationwide Emergency Department Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. Weighted tabular analysis of univariate and bivariate analyses and weighted and adjusted logistic regression models were conducted. A total of 480,580 of U.S. ED visits related to soccer injuries were available for analysis between 2010 to 2013. Generally, 98% of soccer-related ED visits resulted in routine (treat-and-release) visits. However, the odds of transfer to a short-term hospital following ED evaluation and treatment was more than 37-fold higher for soccer-injured youth and adults diagnosed with ICI when compared to all-other soccer injuries; additionally, these patients showed 28-fold higher odds of being admitted for inpatient care at the ED-affiliated hospital. For concussion, soccer-injured patients with concussion showed nearly 1.5-fold higher odds of being transferred to a short-term hospital than did those with any other soccer injury. Soccer-related ED visits cost more than 700 million in U.S. dollars from 2010 to 2013. Notable differences were noted between concussions, ICI, and all-other soccer injuries presenting to U.S. ED. Albeit underestimated given that this study excludes other forms of health care and treatment for injuries, such as outpatient clinics, over the counter medications and treatment, and rehabilitation, healthcare cost associated with soccer-related injuries presenting to ED is high, and remarkably costly in those with an ICI diagnosis.
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Pueringer J, Cohn JE, Othman S, Shokri T, Ducic Y, Sokoya M. Tennis-related adult maxillofacial trauma injuries. PHYSICIAN SPORTSMED 2021; 49:64-67. [PMID: 32400246 DOI: 10.1080/00913847.2020.1768451] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objectives: Tennis participation continues to increase amongst adults across the United States. The purpose of this study was to analyze trends in adult tennis-related facial injury epidemiology, demographics, diagnoses, and locations of injury. Materials and methods: The National Electronic Injury Surveillance System was evaluated for tennis-related facial injuries in adults from 2009 through 2018. Number of injuries were extrapolated, and data were analyzed for age, sex, specific injury diagnoses, locations, and discharge disposition. Descriptive statistics were used to present and describe variables of interest. Chi-squared testing (χ2) was performed to compare categorical variables. Results: During the study period, 342 tennis-related facial trauma ED visits were analyzed. Lacerations were the most common injury (45%), followed by contusions or abrasions (33.3%), concussions (11.7%), and fractures (8.5%). The most common sites of injury were the face (47.4%) and head (27.2%) regions. Males accounted for 62.0% of injuries, while females accounted for the remaining 38.0%. Patients between 34-65 years-old accounted for 47.7% of all injuries, and athletes over 65 years-old had the highest rate of fractures (10.1%). Conclusions: Facial trauma incurred secondary to tennis may follow patient-specific patterns. The incidence of tennis-related facial trauma is smaller compared to other sports, but the severity of such injuries remain a danger. Facial protection and enforcement in tennis is virtually absent, and these findings strengthen the need to educate athletes, families, and physicians on injury awareness and prevention.
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Affiliation(s)
- John Pueringer
- Medical Student, Philadelphia College of Osteopathic Medicine , Philadelphia, PA, USA
| | - Jason E Cohn
- Department of Otolaryngology-Head and Neck Surgery, Philadelphia College of Osteopathic Medicine , Philadelphia, PA, USA
| | - Sammy Othman
- Medical Student, Drexel University College of Medicine , Philadelphia, PA, USA
| | - Tom Shokri
- Department of Otolaryngology-Head and Neck Surgery, Penn State Hershey Medical Center , Hershey, PA, USA
| | - Yadranko Ducic
- Department of Otolaryngology- Head & Neck Surgery, Otolaryngology and Facial Plastic Surgery Associates , Fort Worth, TX, USA
| | - Mofiyinfolu Sokoya
- Department of Otolaryngology-Head and Neck Surgery, University of Arizona College of Medicine , Tucson, AZ, USA
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Cassoudesalle H, Laborde B, Orhant E, Dehail P. Video analysis of concussion mechanisms and immediate management in French men's professional football (soccer) from 2015 to 2019. Scand J Med Sci Sports 2020; 31:465-472. [PMID: 33038045 DOI: 10.1111/sms.13852] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 09/20/2020] [Accepted: 09/30/2020] [Indexed: 12/01/2022]
Abstract
In this study, the concussion mechanisms were analyzed in male professional competition football, with the main objective to specify the frequency of head-to-head impact, and immediate management of the concussed players was described in order to check its compliance with the recommendations of football's governing bodies. Based on continuously recorded data from the French Football Federation (FFF), a retrospective database of all reported concussions during matches in the 1st and 2nd French Male leagues was generated comprising seasons 2015/16-2018/19. Injury mechanisms, playing action, immediate medical assessment and management of concussed players, and foul play-referee's decision, were analyzed from video recordings. In total, 41 concussions were reported (incidence rate of 0.44/1000 hours of match exposure [95% CI: 0.40 to 0.49]) of which 36 were identified and analyzed on video sequences. The commonest playing action leading to concussion was aerial challenge (61%), and the main mechanism was head-to-head impact (47%). Following the head impact, 28% of concussed players were not medically assessed on pitch and 53% returned to play the same match. Head-to-head impact was not associated with systematic medical assessment, nor with foul play. In conclusion, the main cause of concussions involved head-to-head impact occurring when two players challenge for heading the ball in the air. The detection of potential concussive head impacts and the immediate management of players possibly concussed during matches remain insufficient according to the international recommendations. Some rules changes, with particular vigilance in case of head-to-head impact, should be discussed.
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Affiliation(s)
- Hélène Cassoudesalle
- Neurorehabilitation Unit, University Hospital of Bordeaux, Bordeaux, France.,University of Bordeaux, INSERM, BPH, U1219, "Handicap, Activity, Cognition & Health" Team, Bordeaux, France
| | - Bertrand Laborde
- Neurorehabilitation Unit, University Hospital of Bordeaux, Bordeaux, France
| | - Emmanuel Orhant
- Medical Service Director, Federation Francaise de Football, Paris, France
| | - Patrick Dehail
- Neurorehabilitation Unit, University Hospital of Bordeaux, Bordeaux, France.,University of Bordeaux, INSERM, BPH, U1219, "Handicap, Activity, Cognition & Health" Team, Bordeaux, France
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Auger J, Markel J, Pecoski DD, Leiva-Molano N, Talavage TM, Leverenz L, Shen F, Nauman EA. Factors affecting peak impact force during soccer headers and implications for the mitigation of head injuries. PLoS One 2020; 15:e0240162. [PMID: 33064732 PMCID: PMC7567382 DOI: 10.1371/journal.pone.0240162] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 09/16/2020] [Indexed: 11/28/2022] Open
Abstract
It has been documented that up to 22% of all soccer injuries are concussions. This is in part due to players purposely using their head to direct the ball during play. To provide a more complete understanding of head trauma in soccer athletes, this study characterized the effects of four soccer ball characteristics (size, inflation pressure, mass, velocity) on the resulting peak impact force as it relates to the potential for incurring neurophysiological changes. A total of six hundred trials were performed on size 4 and 5 soccer balls as well as a novel lightweight soccer ball. Impact force was measured with a force plate and ball velocity was determined using motion capture. These data were used, in conjunction with dimensional analysis to relate impact force to ball size, mass, velocity, and pressure. Reasonable reductions in allowable ball parameters resulted in a 19.7% decrease in peak impact force. Adjustments to ball parameters could reduce a high cumulative peak translational acceleration soccer athlete down into a previously defined safer low loading range. In addition, it was noted that water absorption by soccer balls can result in masses that substantially increase impact force and quickly surpass the NCAA weight limit for game play. Additional research is required to determine whether varying soccer ball characteristics will enable soccer players to avoid persistent neurophysiological deficits or what additional interventions may be necessary and the legal implications of these data are discussed.
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Affiliation(s)
- Joshua Auger
- School of Mechanical Engineering, Purdue University, West Lafayette, Indiana, United States of America
| | - Justin Markel
- School of Mechanical Engineering, Purdue University, West Lafayette, Indiana, United States of America
| | - Dimitri D. Pecoski
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, United States of America
| | - Nicolas Leiva-Molano
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, United States of America
| | - Thomas M. Talavage
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, United States of America
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, Indiana, United States of America
| | - Larry Leverenz
- Department of Health and Kinesiology, Purdue University, West Lafayette, Indiana, United States of America
| | - Francis Shen
- University of Minnesota Law School, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Eric A. Nauman
- School of Mechanical Engineering, Purdue University, West Lafayette, Indiana, United States of America
- Department of Health and Kinesiology, Purdue University, West Lafayette, Indiana, United States of America
- Department of Basic Medical Sciences, Purdue University, West Lafayette, Indiana, United States of America
- * E-mail:
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Abstract
Background: Globally, soccer is the most popular team sport, unifying many fans all around the world. The epidemiological studies so far have confirmed that head playing and hitting the ball with head may cause minor head injuries, which exert their effects in a cumulative way. Methods: Literature search for this review was conducted and data about traumatic brain injury collected from various sources. Results: The consequences of head injury are evident as chronic changes in cognition, including disturbances in concentration and slowing of mental and physical agility. Conclusion: Various recommendations have been issued for the prevention of chronic negative cumulative effects of soccer ball head playing. In addition, the professional soccer players are also exposed to more intense craniocerebral trauma, such as concussions and contusions. These patients require treatment of skilled sports physicians, neurologists and neurosurgeons and some may need long to return to the sport scene again.
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Affiliation(s)
- Gorazd Bunc
- Clinical Department of Neurosurgery, University Medical Centre, Maribor, Slovenia
| | - Janez Ravnik
- Clinical Department of Neurosurgery, University Medical Centre, Maribor, Slovenia
| | - Tomaz Velnar
- Clinical Department of Neurosurgery, University Medical Centre, Maribor, Slovenia
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Why Professional Football Players Chose Not to Reveal Their Concussion Symptoms During a Practice or Game. Clin J Sport Med 2018; 28:1-12. [PMID: 29064867 DOI: 10.1097/jsm.0000000000000495] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine why professional football players in Canada decided not to seek medical attention during a game or practice when they believed they had suffered a concussion. DESIGN Retrospective survey. SETTING Preseason Canadian Football League training camps. PARTICIPANTS Four hundred fifty-four male professional football players. MAIN OUTCOME MEASURES Reasons athletes did not seek medical attention for a presumed concussion during the previous season, how often this occurred and how important these reasons were in the decision process. RESULTS One hundred six of the 454 respondents (23.4%) believed they had suffered a concussion during their previous football season and 87 of the 106 (82.1%) did not seek medical attention for a concussion at least once during that season. The response "Did not feel the concussion was serious/severe and felt you could still continue to play with little danger to yourself" was the most commonly listed reason (49/106) for not seeking medical attention for a presumed concussion. Many players answered that they did not seek medical attention because they did not want to be removed from a game (42/106) and/or they did not want to risk missing future games (41/106) by being diagnosed with a concussion. CONCLUSIONS Some professional football players who believed they had suffered a concussion chose not to seek medical attention at the time of injury. Players seemed educated about the concussion evaluation process and possible treatment guidelines, but this knowledge did not necessarily translate into safe and appropriate behavior at the time of injury.
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Collings LJ, Cook NE, Porter S, Kusch C, Sun J, Virji-Babul N, Iverson GL, Panenka WJ. Attention-deficit/hyperactivity disorder is associated with baseline child sport concussion assessment tool third edition scores in child hockey players. Brain Inj 2017; 31:1479-1485. [PMID: 28980829 DOI: 10.1080/02699052.2017.1377351] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The objectives of this study were to report baseline, preseason data for the Child-SCAT3, stratified by attention deficit hyperactivity disorder (ADHD) status, and examine group differences in Child-SCAT3 performance between children with and without ADHD. DESIGN Cross-sectional study. METHODS Young male hockey players (n = 304), aged 8-12 years, were administered the Child-SCAT3 during pre-season. Child-SCAT3 measures included a 20-item symptom scale, a Standardised Assessment of Concussion Child Version (SAC-C), a modified Balance Error Scoring System (m-BESS), a tandem gait task, and a coordination test. RESULTS Children with ADHD (n = 20) endorsed significantly more symptoms (d = 0.95) and greater symptom severity (d = 1.13) compared to children without ADHD. No statistically significant differences were found between groups on Child-SCAT3 measures of cognitive or physical functioning (e.g. balance and coordination). CONCLUSIONS ADHD should be considered when interpreting Child-SCAT3 scores, especially symptom reporting, in the context of concussion assessment. Better understanding of symptom reporting in uninjured child athletes with ADHD can inform the clinical interpretation of symptoms at baseline and following an actual or suspected concussion. Normative data for the Child-SCAT3 that is not stratified by or otherwise accounts for ADHD status should be used with caution when appraising performance of children with ADHD.
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Affiliation(s)
- Laurel J Collings
- a Department of Psychiatry , University of British Columbia , Vancouver , Canada.,b Child and Family Research Institute , Vancouver , Canada
| | - Nathan E Cook
- c Department of Psychiatry , Harvard Medical School , Boston , MA , USA.,d Learning and Emotional Assessment Program, Department of Psychiatry , Massachusetts General Hospital , Boston , MA , USA.,e MassGeneral Hospital for Children™ Sports Concussion Program, MassGeneral Hospital for Children™ , Boston , MA , USA
| | - Shaun Porter
- f Department of Physical Therapy , Djavad Mowafaghian Centre for Brain Health , Vancouver , Canada
| | - Cody Kusch
- g Seafair Minor Hockey Association , Richmond , Canada
| | - Jonathan Sun
- g Seafair Minor Hockey Association , Richmond , Canada
| | - Naznin Virji-Babul
- b Child and Family Research Institute , Vancouver , Canada.,f Department of Physical Therapy , Djavad Mowafaghian Centre for Brain Health , Vancouver , Canada.,h Dajavad Mowafaghian Centre for Brain Health , Vancouver , Canada
| | - Grant L Iverson
- a Department of Psychiatry , University of British Columbia , Vancouver , Canada.,e MassGeneral Hospital for Children™ Sports Concussion Program, MassGeneral Hospital for Children™ , Boston , MA , USA.,i Department of Physical Medicine and Rehabilitation , Harvard Medical School , Boston , MA , USA.,j Spaulding Rehabilitation Hospital , Charlestown , MA , USA.,k Home Base , A Red Sox Foundation and Massachusetts General Hospital Program , Boston , MA , USA
| | - William J Panenka
- a Department of Psychiatry , University of British Columbia , Vancouver , Canada.,b Child and Family Research Institute , Vancouver , Canada
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Clark JM, Hoshizaki TB, Gilchrist MD. Protective capacity of an ice hockey goaltender helmet for three events associated with concussion. Comput Methods Biomech Biomed Engin 2017; 20:1299-1311. [DOI: 10.1080/10255842.2017.1341977] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- J. Michio Clark
- School of Mechanical & Materials Engineering, University College Dublin, Dublin, Ireland
- School of Human Kinetics, University of Ottawa, Ottawa, Canada
| | | | - Michael D. Gilchrist
- School of Mechanical & Materials Engineering, University College Dublin, Dublin, Ireland
- School of Human Kinetics, University of Ottawa, Ottawa, Canada
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Abstract
OBJECTIVE To measure neurocognitive functioning in college and professional football players after game participation. STUDY DESIGN Retrospective, cross-sectional cohort design. PARTICIPANTS Ninety-four male university and professional football players. INTERVENTION All participants completed Immediate Postconcussion Assessment and Cognitive Testing (ImPACT) testing at baseline, and either at postconcussion (group 1) or postgame (group 2) participation. MAIN OUTCOME MEASURES Results from the 5 ImPACT composite scores (Verbal Memory, Visual Memory, Visual Motor Speed, Reaction Time and Impulse Control) and Total Symptom Score. RESULTS Repeated-measures analysis of variance demonstrated a significant main effect for time (improvements) in 3 of 5 domains for the postconcussion group, but no improvements in the postgame group. The postconcussion group presented with significantly improved results on 4 of 5 ImPACT domains compared with the postgame group at the follow-up time interval. CONCLUSIONS Participation in a football game with potential cumulative head contacts did not yield increased symptoms or cognitive impairment. However, the absence of improvement in cognitive functioning in noninjured football players, which was found in those players who were returned to play after an injury, may suggest that there is a measureable impact as a result of playing football.
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Tackling causes and costs of ED presentation for American football injuries: a population-level study. Am J Emerg Med 2016; 34:1198-204. [DOI: 10.1016/j.ajem.2016.02.057] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 02/19/2016] [Accepted: 02/21/2016] [Indexed: 11/18/2022] Open
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Hojjat H, Svider PF, Lin HS, Folbe AJ, Shkoukani MA, Eloy JA, Zuliani G. Adding Injury to Insult: A National Analysis of Combat Sport-Related Facial Injury. Ann Otol Rhinol Laryngol 2016; 125:652-9. [PMID: 27189152 DOI: 10.1177/0003489416644617] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES/HYPOTHESIS To estimate the incidence of patients presenting to emergency departments (EDs) for facial trauma sustained from participation in combat sports and evaluate injury patterns and patient demographics. METHODS The National Electronic Injury Surveillance System (NEISS) was evaluated for facial injuries from wrestling, boxing, and martial arts leading to ED visits from 2008 to 2013. Relevant entries were examined for injury mechanism, location, type, as well as other patient characteristics. RESULTS There were 1143 entries extrapolating to an estimated 42 395 ED visits from 2008 to 2013. Injury rates for boxing, marital arts, and wrestling were, respectively, 44, 56, and 120 injuries per 100 000 participants. Males comprised the majority (93.7%). A plurality of injuries involved lacerations (46.0%), followed by fractures (26.2%) and contusions/abrasions (19.3%). The proportion of fractures was highest among boxers (36.9%). Overall, the most common mechanisms of injury were punching, kicking, and head butting. CONCLUSIONS The significant number of ED visits resulted from combat sports facial trauma, reinforcing the importance of familiarity with injury patterns among practitioners managing facial trauma. As most injuries involve individuals younger than 19 despite guidelines suggesting children and adolescents avoid combat sports, these findings may be used for patient education and encouragement of the use of personal protective equipment. Furthermore, injury patterns reported in this analysis may serve as an adjunct for enhancing clinical history taking and physical examination.
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Affiliation(s)
- Houmehr Hojjat
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Peter F Svider
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Ho-Sheng Lin
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA Section of Otolaryngology, Department of Surgery, John D. Dingell VA Medical Center, Detroit, Michigan, USA
| | - Adam J Folbe
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Mahdi A Shkoukani
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA Section of Otolaryngology, Department of Surgery, John D. Dingell VA Medical Center, Detroit, Michigan, USA Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Newark, New Jersey, USA
| | - Giancarlo Zuliani
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA Section of Otolaryngology, Department of Surgery, John D. Dingell VA Medical Center, Detroit, Michigan, USA Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
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Kennedy J, Green RS, Henteleff H. Penetrating chest trauma secondary to a composite hockey stick injury. CAN J EMERG MED 2015; 8:437-40. [PMID: 17209495 DOI: 10.1017/s1481803500014263] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
ABSTRACTHockey is enjoyed by millions of people around the world and is a sport in which aggression is encouraged and injuries are common. Although body-checking is the most common cause of injury in hockey today, hockey sticks are associated with up to 14% of injuries. We report a case of chest trauma requiring surgical intervention secondary to the penetration of a composite hockey stick into a player's thoracic cavity.
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Semple BD, Lee S, Sadjadi R, Fritz N, Carlson J, Griep C, Ho V, Jang P, Lamb A, Popolizio B, Saini S, Bazarian JJ, Prins ML, Ferriero DM, Basso DM, Noble-Haeusslein LJ. Repetitive concussions in adolescent athletes - translating clinical and experimental research into perspectives on rehabilitation strategies. Front Neurol 2015; 6:69. [PMID: 25883586 PMCID: PMC4382966 DOI: 10.3389/fneur.2015.00069] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 03/13/2015] [Indexed: 12/23/2022] Open
Abstract
Sports-related concussions are particularly common during adolescence, a time when even mild brain injuries may disrupt ongoing brain maturation and result in long-term complications. A recent focus on the consequences of repetitive concussions among professional athletes has prompted the development of several new experimental models in rodents, as well as the revision of guidelines for best management of sports concussions. Here, we consider the utility of rodent models to understand the functional consequences and pathobiology of concussions in the developing brain, identifying the unique behavioral and pathological signatures of concussive brain injuries. The impact of repetitive concussions on behavioral consequences and injury progression is also addressed. In particular, we focus on the epidemiological, clinical, and experimental evidence underlying current recommendations for physical and cognitive rest after concussion, and highlight key areas in which further research is needed. Lastly, we consider how best to promote recovery after injury, recognizing that optimally timed, activity-based rehabilitative strategies may hold promise for the adolescent athlete who has sustained single or repetitive concussions. The purpose of this review is to inform the clinical research community as it strives to develop and optimize evidence-based guidelines for the concussed adolescent, in terms of both acute and long-term management.
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Affiliation(s)
- Bridgette D. Semple
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Sangmi Lee
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Raha Sadjadi
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Nora Fritz
- Kennedy Krieger Institute, John Hopkins University, Baltimore, MD, USA
| | - Jaclyn Carlson
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Carrie Griep
- San Francisco State University Graduate Program in Physical Therapy, University of California San Francisco, San Francisco, CA, USA
| | - Vanessa Ho
- San Francisco State University Graduate Program in Physical Therapy, University of California San Francisco, San Francisco, CA, USA
| | - Patrice Jang
- San Francisco State University Graduate Program in Physical Therapy, University of California San Francisco, San Francisco, CA, USA
| | - Annick Lamb
- San Francisco State University Graduate Program in Physical Therapy, University of California San Francisco, San Francisco, CA, USA
| | - Beth Popolizio
- San Francisco State University Graduate Program in Physical Therapy, University of California San Francisco, San Francisco, CA, USA
| | - Sonia Saini
- San Francisco State University Graduate Program in Physical Therapy, University of California San Francisco, San Francisco, CA, USA
| | - Jeffrey J. Bazarian
- School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY, USA
| | - Mayumi L. Prins
- Department of Neurosurgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
| | - Donna M. Ferriero
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - D. Michele Basso
- School of Health and Rehabilitation Sciences, Ohio State University, Columbus, OH, USA
| | - Linda J. Noble-Haeusslein
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
- Department of Physical Therapy and Rehabilitation Sciences, University of California San Francisco, San Francisco, CA, USA
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17
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Abstract
OBJECTIVE To determine why athletes decide not to seek medical attention during a game or practice when they believe they have suffered a concussion. DESIGN A retrospective survey. SETTING University Sport Medicine Clinic. PARTICIPANTS A total of 469 male and female university athletes from several varsity team sports were participated in the study. MAIN OUTCOME MEASURES Athletes were surveyed about the previous 12 months to identify specific reasons why those athletes who believed they had suffered a concussion during a game or practice decided not to seek attention at that time, how often these reasons occurred, and how important these reasons were in the decision process. RESULTS Ninety-two of the 469 athletes (19.6%) believed they had suffered a concussion within the previous 12 months while playing their respective sport, and 72 of these 92 athletes (78.3%) did not seek medical attention during the game or practice at least once during that time. Sports in which athletes were more likely to not reveal their concussion symptoms were football and ice hockey. The reason "Did not feel the concussion was serious/severe and felt you could still continue to play with little danger to yourself," was listed most commonly (55/92) as a cause for not seeking medical attention for a presumed concussion. CONCLUSIONS A significant percentage of university athletes who believed they had suffered a concussion chose not to seek medical attention at the time of injury. Improved education of players, parents, and coaches about the dangers of continuing to play with concussion symptoms may help improve reporting. CLINICAL RELEVANCE Medical staff should be aware that university athletes who believe they have suffered a concussion may choose not to volunteer their symptoms during a game or practice for a variety of personal and athletic reasons.
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Hashimoto T, Ishii T, Okada N, Itoh M. Impulsive force on the head during performance of typical ukemi techniques following different judo throws. J Sports Sci 2015; 33:1356-65. [PMID: 25562389 DOI: 10.1080/02640414.2014.990482] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In this study, eight judo athletes who are major candidates for the Japan national team were recruited as participants. Kinematic analysis of exemplary ukemi techniques was carried out using two throws, o-soto-gari, a throw linked to frequent injury, and o-uchi-gari. The aim of this study was to kinematically quantify the timing patterns of exemplary ukemi techniques and to obtain kinematic information of the head, in a sequence of ukemi from the onset of the throw to the completion of ukemi. The results indicated that the vertical velocity with which the uke's head decelerated was reduced by increasing the body surface exposed to the collision with the tatami and by increasing the elapsed time. In particular, overall upper limb contact with the tatami is greatly associated with deceleration. In o-soto-gari, the impulsive force on the faller's head as the head reached the lowest point was 204.82 ± 19.95 kg m · s(-2) while in o-uchi-gari it was 118.46 ± 63.62 kg m · s(-2), z = -1.75, P = 0.08, and it did present a large-sized effect with r = 0.78. These findings indicate that the exemplary o-soto-gari as compared to o-uchi-gari is the technique that causes more significant damage to the uke's head.
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Lawrence LA, Svider PF, Raza SN, Zuliani G, Carron MA, Folbe AJ. Hockey-related facial injuries: a population-based analysis. Laryngoscope 2014; 125:589-93. [PMID: 25169755 DOI: 10.1002/lary.24893] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 07/26/2014] [Accepted: 07/29/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS Recognition of the potentially severe sequelae arising from inadequate facial protection has facilitated sustained efforts to increase the use of protective visors in recent decades. Our objective was to characterize nationwide trends among patients presenting to emergency departments (ED) for facial injuries sustained while playing ice hockey. METHODS The National Electronic Injury Surveillance System was searched for hockey-related facial injuries, with analysis for incidence; age and gender; and specific injury diagnoses, mechanisms, and facial locations. RESULTS There were an estimated 93,444 ED visits for hockey-related facial injuries from 2003 to 2012. The number of annual ED visits declined by 43.8% from 2003 to 2012. A total of 90.6% of patients were male; and the peak age of injury was 17 years. Lacerations were the most common form of facial injury (81.5% of patients) across all age groups. Contusions/abrasions and fractures followed in frequency, with fractures increasing with advancing age. CONCLUSIONS The overall incidence of ED visits due to facial injuries from ice hockey has significantly decreased over the last decade, concurrent with increased societal use of facial protective equipment. Nonetheless, facial hockey injuries facilitate a significant number of ED visits among both adults and children; thus, the knowledge of demographic-specific trends described in this analysis is relevant for physicians involved in the management of facial trauma. These findings reinforce the need to educate individuals who play hockey about the importance of appropriate facial protection.
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Affiliation(s)
- Lauren A Lawrence
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, U.S.A
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20
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Gardner A, Iverson GL, Levi CR, Schofield PW, Kay-Lambkin F, Kohler RMN, Stanwell P. A systematic review of concussion in rugby league. Br J Sports Med 2014; 49:495-8. [PMID: 24723636 DOI: 10.1136/bjsports-2013-093102] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Concussion remains one of the inherent risks of participation in rugby league. While other injuries incurred by rugby league players have been well studied, less focus and attention has been directed towards concussion. REVIEW METHOD The current review examined all articles published in English from 1900 up to June 2013 pertaining to concussion in rugby league players. DATA SOURCES Publications were retrieved via six databases using the key search terms: rugby league, league, football; in combination with injury terms: athletic injuries, concussion, sports concussion, sports-related concussion, brain concussion, brain injury, brain injuries, mild traumatic brain injury, mTBI, traumatic brain injury, TBI, craniocerebral trauma, head injury and brain damage. Observational, cohort, correlational, cross-sectional and longitudinal studies were all included. RESULTS 199 rugby league injury publications were identified. 39 (20%) were related in some way to concussion. Of the 39 identified articles, 6 (15%) had the main aim of evaluating concussion, while the other 33 reported on concussion incidence as part of overall injury data analyses. Rugby league concussion incidence rates vary widely from 0.0 to 40.0/1000 playing hours, depending on the definition of injury (time loss vs no time loss). The incidence rates vary across match play versus training session, seasons (winter vs summer) and playing position (forwards vs backs). The ball carrier has been found to be at greater risk for injury than tacklers. Concussion accounts for 29% of all injuries associated with illegal play, but only 9% of injuries sustained in legal play. CONCLUSIONS In comparison with other collision sports, research evaluating concussion in rugby league is limited. With such limited published rugby league data, there are many aspects of concussion that require attention, and future research may be directed towards these unanswered questions.
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Affiliation(s)
- Andrew Gardner
- Centre for Translational Neuroscience and Mental Health, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, Massachusetts, USA
| | - Christopher R Levi
- Centre for Translational Neuroscience and Mental Health, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Peter W Schofield
- Centre for Translational Neuroscience and Mental Health, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Frances Kay-Lambkin
- Centre for Translational Neuroscience and Mental Health, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Ryan M N Kohler
- Australian Sports Commission, Australian Capital Territory, Canberra, Australia
| | - Peter Stanwell
- Faculty of Health & Medicine, School of Health Sciences, University of Newcastle, Callaghan, New South Wales, Australia
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21
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Mannix R, O'Brien MJ, Meehan WP. The epidemiology of outpatient visits for minor head injury: 2005 to 2009. Neurosurgery 2014; 73:129-34; discussion 134. [PMID: 23615100 DOI: 10.1227/01.neu.0000429846.14579.41] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Centers for Disease Control and Prevention have called for studies detailing the prevalence and burden of mild traumatic brain injury (mTBI) in the outpatient clinical setting. OBJECTIVE The aim of this study was to describe the prevalence of outpatient visits for minor head injury and compare the number of outpatient visits for minor head injury with the number of emergency department (ED) visits. METHODS This was a cross-sectional study of outpatient visits for minor head injuries from the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS). We examined outpatient visits for minor head injury between 2005 and 2009 and compared them with visits in the ED for the same diagnoses using simple survey-weighted descriptive statistics. RESULTS In the 5-year study period, there were 4 146 777 outpatient visits for minor head injury and 6 077 147 ED visits for minor head injury. In the outpatient setting, 14% of office-based visits and 21% of hospital-based visits referred patients for advanced imaging, whereas 63% of minor head injury patients in the ED underwent imaging. A return visit was arranged for 54% of minor head injury patients in office-based practices and 29% of patients in hospital-based clinics, while 67% of minor head injury patients were given instructions to follow-up after an ED visit. CONCLUSION More than 800 000 outpatient visits for minor head injury occur each year. The diagnostics and management associated with these visits differ from those seen in the ED setting.
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Affiliation(s)
- Rebekah Mannix
- Division of Emergency Medicine, Children's Hospital Boston, Boston, Massachusetts, USA.
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22
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Johnson CD, Green BN, Nelson RC, Moreau B, Nabhan D. Chiropractic and concussion in sport: a narrative review of the literature. J Chiropr Med 2014; 12:216-29. [PMID: 24396325 DOI: 10.1016/j.jcm.2013.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Concussion is a common sporting injury that may be seen by doctors of chiropractic and should be managed following current practice guidelines. The purpose of this abstract is to present a literature review on chiropractic management of concussion in sport and to discuss current guidelines. METHODS A review of the literature was performed using the PubMed search engine. MeSH terms included chiropractic and concussion. Search dates were the beginning of the record through July 30, 2013. All languages and article types were included in the search. Articles found were retrieved and evaluated for the relevance of chiropractic management of concussion in sport. RESULTS Five articles were found (1 prospective study, 1 survey, 3 literature reviews) ranging in publication years from 1993 to 2012. No articles reported a position statement, and none provided a review of current concussion management practices related to chiropractic practice. No articles reported adverse outcomes of chiropractic management of an athlete with concussion. CONCLUSION Research related to the chiropractic management of concussion in sport is a nascent area of investigation. Although there are few published articles, the articles in this review showed that doctors of chiropractic encounter concussed athletes at events and in clinical practice. It is essential for doctors of chiropractic to understand the importance of using standardized concussion assessment tools and current concussion guidelines.
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Affiliation(s)
- Claire D Johnson
- Professor and Editor, National University of Health Sciences, Lombard, IL
| | - Bart N Green
- Associate Editor, National University of Health Sciences, Lombard, IL
| | - Robert C Nelson
- President, American Chiropractic Board of Sports Physicians, Private Practice, Lakewood, CO
| | - Bill Moreau
- Managing Director, Sports Medicine, United States Olympic Committee, Colorado Springs, CO
| | - Dustin Nabhan
- Associate Director, United States Olympic Committee, Clinical Research and Multidisciplinary Clinical Care, Colorado Springs, CO
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Cusimano MD, Cho N, Amin K, Shirazi M, McFaull SR, Do MT, Wong MC, Russell K. Mechanisms of team-sport-related brain injuries in children 5 to 19 years old: opportunities for prevention. PLoS One 2013; 8:e58868. [PMID: 23555602 PMCID: PMC3610710 DOI: 10.1371/journal.pone.0058868] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 02/11/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is a gap in knowledge about the mechanisms of sports-related brain injuries. The objective of this study was to determine the mechanisms of brain injuries among children and youth participating in team sports. METHODS We conducted a retrospective case series of brain injuries suffered by children participating in team sports. The Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) database was searched for brain injury cases among 5-19 year-olds playing ice hockey, soccer, American football (football), basketball, baseball, or rugby between 1990 and 2009. Mechanisms of injury were classified as "struck by player," "struck by object," "struck by sport implement," "struck surface," and "other." A descriptive analysis was performed. RESULTS There were 12,799 brain injuries related to six team sports (16.2% of all brain injuries registered in CHIRPP). Males represented 81% of injuries and the mean age was 13.2 years. Ice hockey accounted for the greatest number of brain injuries (44.3%), followed by soccer (19.0%) and football (12.9%). In ice hockey, rugby, and basketball, striking another player was the most common injury mechanism. Football, basketball, and soccer also demonstrated high proportions of injuries due to contact with an object (e.g., post) among younger players. In baseball, a common mechanism in the 5-9 year-old group was being hit with a bat as a result of standing too close to the batter (26.1% males, 28.3% females). INTERPRETATION Many sports-related brain injury mechanisms are preventable. The results suggest that further efforts aimed at universal rule changes, safer playing environments, and the education of coaches, players, and parents should be targeted in maximizing prevention of sport-related brain injury using a multifaceted approach.
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Affiliation(s)
- Michael D Cusimano
- Injury Prevention Research Office, St. Michael's Hospital, University of Toronto, Toronto, Canada.
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24
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Levy ML, Kasasbeh AS, Baird LC, Amene C, Skeen J, Marshall L. Concussions in soccer: a current understanding. World Neurosurg 2011; 78:535-44. [PMID: 22120567 DOI: 10.1016/j.wneu.2011.10.032] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 09/14/2011] [Accepted: 10/20/2011] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Traumatic brain injury (TBI) is a significant public health problem in the United States, with approximately 1.5-2 million TBIs occurring each year. However, it is believed that these figures underestimate the true toll of TBI. Soccer is the most popular sport in the world and has a following of millions in the United States. Soccer is a sport not traditionally identified as high-risk for concussions, yet several studies have shown that concussion rates in soccer are comparable to, and often exceed those of, other contact sports. As many as 22% of all soccer injuries are concussions. METHODS Soccer is a sport not traditionally identified as high risk for concussions, yet several studies have shown that concussion rates in soccer are comparable to, and often exceed those of, other contact sports. As many as 22% of all soccer injuries are concussions. Head injury during soccer is usually the result of either "direct contact" or contact with the ball while "heading" the ball. Relationships between the number of headers sustained in a single season and the degree of cognitive impairment (attention and visual/verbal memory) have been demonstrated. It is also likely that multiple concussions may cause cumulative neuropsychologic impairment in soccer players. RESULTS Although our understanding of risk factors for sports-related concussions is far from complete, there is great potential for prevention in sports-related concussions. Several measures must be taken to avert the development of concussions in soccer and, when they take place, reduce their effects. These include the development and testing of effective equipment during play, the maintenance of regulatory standards for all such equipment, educating young athletes on the safe and appropriate techniques used during play, and strict adherence to the rules of competition. CONCLUSIONS In spite of such preventive measures, concussions in soccer will continue to occur. Considering the frequency of concussions in soccer, the serious sequelae of these concussions, and because almost half of concussed soccer players were noncompliant with recommended American Academy of Neurology return-to-play guidelines, further measures must be taken to protect players, in addition to understanding those criteria that result in removing an injured player from competition and the steps by which to safely return an athlete to competition after injury.
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Affiliation(s)
- Michael L Levy
- Division of Pediatric Neurosurgery Rady Children's Hospital of San Diego, San Diego, CA, USA.
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25
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Deits J, Yard EE, Collins CL, Fields SK, Comstock RD. Patients with ice hockey injuries presenting to US emergency departments, 1990-2006. J Athl Train 2011; 45:467-74. [PMID: 20831391 DOI: 10.4085/1062-6050-45.5.467] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Although the number of US ice hockey participants doubled from 1990 to 2006, no nationally representative studies have examined US ice hockey injuries among participants of all ages during this period. OBJECTIVE To describe patients with ice hockey injuries presenting to a representative sample of US emergency departments (EDs) from 1990 through 2006. DESIGN Prospective injury surveillance study. SETTING The US Consumer Product Safety Commission collects data from 100 nationally representative EDs via the National Electronic Injury Surveillance System (NEISS). PATIENTS OR OTHER PARTICIPANTS Individuals injured while playing ice hockey and presenting to a NEISS-affiliated ED from 1990 through 2006. MAIN OUTCOME MEASURE(S) Incidence and patterns of ice hockey-related injuries. RESULTS From 1990 through 2006, 8228 patients with ice hockey-related injuries presented to NEISS-affiliated EDs, representing an estimated 302 368 ice hockey-related injuries sustained nationally during this time. Injuries occurred predominantly among males (93.5%). More than half of the injured were aged 9 to 14 years (28.9%) or 15 to 18 years (30.1%), and injury incidence in these age groups increased over the study period (P = .009 and P < .001, respectively). The most commonly injured body sites were the face (19.1%), wrist/hand/finger (14.1%), shoulder/upper arm (13.8%), and lower leg/ankle/foot (11.1%). Lacerations (27.0%), contusions/abrasions (23.6%), fractures (17.3%), and sprains/strains (16.9%) were the most common injuries. Falls (16.5%), contact with boards (13.6%), and contact with stick (13.0%) were the most common injury mechanisms. Compared with those aged 9 to 18 years, those aged 2 to 8 years and those older than 18 years sustained larger proportions of face (injury proportion ratio [IPR] = 2.66; 95% confidence interval [CI] = 2.29, 3.08) and mouth (IPR = 4.34; 95% CI = 2.87, 6.56) injuries. Concussions were more common among those aged 2 to 18 years (9.0%) than in those who were older than 18 years (3.7%) (IPR = 2.47; 95% CI = 1.75, 3.49). CONCLUSIONS Ice hockey injury patterns vary by age and sex. Our findings indicate that many trips to the ED might be prevented by using protective equipment appropriately.
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Affiliation(s)
- Jeff Deits
- The Ohio State University, School of Physical Activity and Educational Services, Columbus, USA
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Meehan WP, Mannix R. Pediatric concussions in United States emergency departments in the years 2002 to 2006. J Pediatr 2010; 157:889-93. [PMID: 20708747 PMCID: PMC2988879 DOI: 10.1016/j.jpeds.2010.06.040] [Citation(s) in RCA: 153] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Revised: 05/19/2010] [Accepted: 06/18/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To estimate the incidence and demographics of concussions in children coming to emergency departments (EDs) in the United States and describe the rates of neuroimaging and follow-up instructions in these patients. STUDY DESIGN This is a cross-sectional study of children 0 to 19 years old diagnosed with concussion from the National Hospital Ambulatory Medical Care Survey. National Hospital Ambulatory Medical Care Survey collects data on approximately 25,000 visits annually to 600 randomly selected hospital emergency and outpatient departments. We examined visits to United States emergency departments between 2002 and 2006. Simple descriptive statistics were used. RESULTS Of the 50,835 pediatric visits in the 5-year sample, 230 observations, representing 144,000 visits annually, were for concussions. Sixty-nine percent of concussion visits were by males. Thirty percent were sports-related. Sixty-nine percent of patients diagnosed with a concussion had head imaging. Twenty-eight percent of patients were discharged without specific instructions to follow-up with an outpatient provider for further treatment. CONCLUSIONS Approximately 144,000 pediatric patients present to emergency departments each year with a concussion. Most of these patients undergo computed tomography of the head, and nearly one-third are discharged without specific instructions to follow-up with an outpatient provider for further treatment.
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Affiliation(s)
- William P Meehan
- Division of Emergency Medicine, Department of Medicine, Children's Hospital Boston, Boston, MA, USA.
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Chaze B, McDonald P. Head injuries in winter sports: downhill skiing, snowboarding, sledding, snowmobiling, ice skating and ice hockey. Phys Med Rehabil Clin N Am 2008; 20:287-93, xii. [PMID: 19084778 DOI: 10.1016/j.pmr.2008.10.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Winter sports are often associated with high speed, which carries with it the potential for collision. As such, head injuries are among the more commonly encountered injuries in winter-related sporting activities. This article focuses on popular winter sports such as downhill skiing and snowboarding, sledding, snowmobiling, ice skating, and hockey. In virtually all of these activities, the incidence and severity of head injuries can be reduced by the use of appropriate protective headgear.
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Affiliation(s)
- Brian Chaze
- Section of Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada
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Head Injuries in Winter Sports: Downhill Skiing, Snowboarding, Sledding, Snowmobiling, Ice Skating and Ice Hockey. Neurol Clin 2008; 26:325-32; xii-xiii. [DOI: 10.1016/j.ncl.2007.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Mihalik JP, McCaffrey MA, Rivera EM, Pardini JE, Guskiewicz KM, Collins MW, Lovell MR. Effectiveness of mouthguards in reducing neurocognitive deficits following sports-related cerebral concussion. Dent Traumatol 2007; 23:14-20. [PMID: 17227375 DOI: 10.1111/j.1600-9657.2006.00488.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although it is widely accepted that mouthguards decrease the incidence of dental injuries, there is a controversy among sports medicine professionals as to the effectiveness of mouthguards in decreasing the incidence or severity of sports-related cerebral concussion (SRCC). While some experimental data suggest that this may be the case, there exist a number of reports suggesting that mouthguards do not serve this purpose. These conclusions have been drawn, however, without actually measuring the extent of neurocognitive dysfunction in athletes following sports-related concussion. The purpose of this study was to determine whether mouthguard use reduces the neurocognitive and symptomatic impairments that follow an injurious episode of SRCC. Preseason baseline data were collected as part of an ongoing clinical program that uses a computerized neurocognitive test to assess various faculties of brain function and symptoms reported at the time of testing. Follow-up testing from 180 student-athletes who had sustained an SRCC was analyzed for the purpose of this study. These athletes were separated into one of two groups: those who reported using mouthguards and those who did not. Neurocognitive testing was accomplished using the Immediate Post-Concussion and Assessment Test (ImPACT). Results suggest that neurocognitive deficits at the time of the athletes' first follow-up assessment did not differ between mouthguard users and non-users, suggesting that mouthguard use does little to reduce the severity of neurocognitive dysfunction and onset of symptoms following sports-related head trauma. However, an interesting finding in this study was that athletes experienced significantly lower neurocognitive test scores and reported higher symptom scores following SRCC regardless of mouthguard use. This emphasizes a thorough clinical evaluation of athletes that have sustained an SRCC. Although it was found in this study that mouthguard use does not decrease the severity of concussion, it is important to note that the use of mouthguards is paramount in reducing maxillofacial and dental trauma and their use should continue to be mandated by athletic associations and supported by all dental and sports medicine professionals.
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Affiliation(s)
- Jason P Mihalik
- Sports Medicine Research Laboratory, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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Abstract
The purpose of this study was to investigate the rate of craniofacial injuries in amateur soccer and help us better understand the nature of these injuries. Retrospective study was carried out using records from the patients with craniofacial injuries associated with soccer activities. All data were collected on the basis of sex, age, type and anatomic site of the injury. In the one-year period of this study, 11/53 cases with craniofacial injuries associated with soccer activities have been treated in our clinic. The highest incidence was in the 18 to 24 year age group (mean age 20.7) with male propensity. The majority of the patients suffered from dento-alveolar fractures (36%), followed by temporomandibular joint disorders (27%), mandibular fractures (27%), and nasal fractures (9%). The most common cause of the fractures was impact against another player (63.6%), followed by impact against equipment (18.2%) and impact against the ground (18.2%). These results show that there is a high risk of potential oral and craniofacial injury during soccer activities.
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Affiliation(s)
- Sinan Tozoglu
- Department of Oral and Maxillofacial Surgery, Ataturk University, Faculty of Dentistry, Erzurum, Turkey.
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Collie A, Makdissi M, Maruff P, Bennell K, McCrory P. Cognition in the days following concussion: comparison of symptomatic versus asymptomatic athletes. J Neurol Neurosurg Psychiatry 2006; 77:241-5. [PMID: 16421129 PMCID: PMC2077582 DOI: 10.1136/jnnp.2005.073155] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Concussion is a common neurological injury occurring during contact sport. Current guidelines recommend that no athlete should return to play while symptomatic or displaying cognitive dysfunction. This study compared post-concussion cognitive function in recently concussed athletes who were symptomatic/asymptomatic at the time of assessment with that of non-injured (control) athletes. METHODS Prospective study of 615 male Australian Rules footballers. Before the season, all participants (while healthy) completed a battery of baseline computerised (CogSport) and paper and pencil cognitive tasks. Sixty one injured athletes (symptomatic = 25 and asymptomatic = 36) were reassessed within 11 days of being concussed; 84 controls were also reassessed. The serial cognitive function of the three groups was compared using analysis of variance. RESULTS The performance of the symptomatic group declined at the post-concussion assessment on computerised tests of simple, choice, and complex reaction times compared with the asymptomatic and control groups. The magnitude of changes was large according to conventional statistical criteria. On paper and pencil tests, the symptomatic group displayed no change at reassessment, whereas large improvements were seen in the other two groups. CONCLUSION Injured athletes experiencing symptoms of concussion displayed impaired motor function and attention, although their learning and memory were preserved. These athletes displayed no change in performance on paper and pencil tests in contrast with the improvement observed in asymptomatic and non-injured athletes. Athletes experiencing symptoms of concussion should be withheld from training and competition until both symptoms and cognitive dysfunction have resolved.
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Affiliation(s)
- A Collie
- Centre for Health, Exercise and Sports Medicine, University of Melbourne, Parkville, Victoria, Australia.
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Iverson GL, Brooks BL, Lovell MR, Collins MW. No cumulative effects for one or two previous concussions. Br J Sports Med 2006; 40:72-5. [PMID: 16371496 PMCID: PMC2491929 DOI: 10.1136/bjsm.2005.020651] [Citation(s) in RCA: 166] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2005] [Indexed: 11/04/2022]
Abstract
BACKGROUND Sports medicine clinicians and the general public are interested in the possible cumulative effects of concussion. OBJECTIVE To examine whether athletes with a history of one or two previous concussions differed in their preseason neuropsychological test performances or symptom reporting. METHOD Participants were 867 male high school and university amateur athletes who completed preseason testing with ImPACT version 2.0. They were sorted into three groups on the basis of number of previous concussions. There were 664 athletes with no previous concussions, 149 with one previous concussion, and 54 with two previous concussions. Multivariate analysis of variance was conducted using the verbal memory, visual memory, reaction time, processing speed, and postconcussion symptom composite scores as dependent variables and group membership as the independent variable. RESULTS There was no significant multivariate effect, nor were there any significant main effects for individual scores. There was no measurable effect of one or two previous concussions on athletes' preseason neuropsychological test performance or symptom reporting. CONCLUSION If there is a cumulative effect of one or two previous concussions, it is very small and undetectable using this methodology.
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Affiliation(s)
- G L Iverson
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
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Affiliation(s)
- J Scott Delaney
- Department of Emergency Medicine, McGill University Health Centre, McGill Sport Medicine Clinic, McGill University, Montreal, Quebec, Canada.
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Neck injuries presenting to emergency departments in the United States from 1990 to 1999 for ice hockey, soccer, and American football. Br J Sports Med 2005; 39:e21. [PMID: 15793079 DOI: 10.1136/bjsm.2004.015735] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine the number and rate of neck injuries in the community as a whole for ice hockey, soccer, and American football by analysing data from patients presenting to emergency departments in the United States from 1990 to 1999. METHODS Data compiled for the US Consumer Product Safety Commission were used to generate estimates for the total number of neck injuries and the more specific diagnoses of neck fractures, dislocations, contusions, sprains, strains, and lacerations occurring nationally from 1990 to 1999. These data were combined with yearly participation figures to generate rates of injury presenting to emergency departments for each sport. RESULTS There were an estimated 5038 neck injuries from ice hockey, 19,341 from soccer, and 114 706 from American football. These could be broken down as follows: 4964 contusions, sprains, or strains from ice hockey, 17,927 from soccer, and 104 483 from football; 105 neck fractures or dislocations from ice hockey, 214 from soccer, and 1588 from football; 199 neck lacerations for ice hockey, 0 for soccer, and 621 for football. The rates for total neck injuries and combined neck contusions, sprains, or strains were higher for football than for ice hockey or soccer in all years for which data were available. CONCLUSION The rate of neck injury in the United States was higher in football than in ice hockey or soccer in the time period studied.
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Hostetler SG, Xiang H, Smith GA. Characteristics of ice hockey-related injuries treated in US emergency departments, 2001-2002. Pediatrics 2004; 114:e661-6. [PMID: 15574599 DOI: 10.1542/peds.2004-1565] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Ice hockey, a popular sport in some regions, has potential for injury due to the velocities of players, pucks, and sticks. Previous studies conducted worldwide have shown that the rate of injury increases as the size and the speed of players increase, as well as when checking is allowed. However, national data about the annual number and types of injuries among ice hockey players are lacking. Data from previous studies were collected from regional tournaments, collegiate teams, local emergency departments (EDs), and different countries. The purpose of this article is to examine ice hockey injuries using a national US database to determine the age distribution of total injuries, injury types, and body regions injured, with a particular focus on ice hockey players <18 years old. METHODS Data regarding ice hockey-related injuries treated in US EDs between January 1, 2001, and December 31, 2002, were extracted from the National Electronic Injury Surveillance System (NEISS). Data considered included age, gender, race, injury diagnosis, and body region injured. Ice hockey-related injury cases were identified using the consumer product code for ice hockey and the narrative description of the incident in NEISS. RESULTS An estimated 32,750 individuals with ice hockey-related injuries were treated in US EDs in 2001-2002, including >18,000 youths <18 years old. The number of injuries peak through adolescence (ages 12-17; 47% of all injuries). Males experienced 90% of all injuries. A very small percentage of individuals were hospitalized after injury (1.2% of individuals <18 years old; 0.5% of individuals > or =18 years old). The incidence of head injuries increased as age decreased, although the trend was not statistically significant. The upper extremity (44%) accounted for the highest total percentages of body regions injured for youths <18 years old, and trunk (14%) and facial injuries (10%) represented the smallest total percentages. Players > or =18 years old had significantly more lacerations than younger players (38% of injuries for 18- to 24-year-olds; 25% for 25- to 34-year-olds; 50% for 35- to 44-year-olds compared with 19% for 6- to 11-year-olds and 14% for 12- to 17-year-olds). CONCLUSIONS Adolescents had the greatest number of ice hockey-related injuries treated in NEISS hospital EDs in 2001-2002; thus, ongoing efforts to develop injury prevention strategies should focus on this age group. Players < or =17 years old had a lower percentage of lacerations compared with all older players and a higher percentage of upper extremity injuries. The percentage of individuals hospitalized after injury was very low, yet youths <18 years old had twice the percentage of hospitalization after injury compared with individuals > or =18 years old. Males experienced the vast majority of all ice hockey-related injuries, with females representing a higher percentage of injuries among youths than among adults. Children and adults alike can reap the physical fitness and social benefits from ice hockey, when they are able to avoid predictable and preventable injuries.
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Affiliation(s)
- Sarah Grim Hostetler
- Center for Injury Research and Policy, Columbus Children's Research Institute, Children's Hospital, Ohio State University, Columbus, Ohio 43205, USA
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