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Dulle JF, Moore ML, Brinkman JC, Pollock JR, Dulle DL, Jenkins AS, Chhabra A. The Most Cited and Influential Publications Relating to Ice Hockey Since 2000 Focus Primarily on Concussion and Traumatic Brain Injuries. Arthrosc Sports Med Rehabil 2023; 5:e613-e622. [PMID: 37388886 PMCID: PMC10300535 DOI: 10.1016/j.asmr.2023.02.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 02/26/2023] [Indexed: 07/01/2023] Open
Abstract
Purpose To determine the most frequently cited articles relating to ice hockey since 2000 and conduct a bibliometric analysis of these publications. Methods The Clarivate Web of Knowledge database was used to gather data and generate a list of publications relating to "ice hockey" on June 20, 2022. Articles were filtered by the total number of citations accrued and were included or excluded on the basis of relevance to ice hockey; no date of publication, language, or journal restrictions. After the 50 most highly cited articles were identified, articles published before the year 2000 were excluded to avoid bias. The information analyzed from each article included author name (first and last), publication year, country of origin, institutional affiliation (of the first and last author), journal name, research design, main research topic, competition level, and the level of evidence. Results Ultimately, 46 studies were included in this analysis. The total number of citations was 8,267 times with an average of 179.7 citations per article. The most cited article was cited 926 times. The articles came from 5 different countries, with the United States and Canada comprising 27 and 13 articles, respectively. All articles were published in English. The American Journal of Sports Medicine published the greatest number of articles. The most studied topic was concussion/traumatic brain injury (n = 26). Professional hockey was the most studied level of competition (n = 15), while college followed (n = 13). Three institutions, University of Calgary, Dartmouth School of Medicine, and University of North Carolina at Chapel Hill were responsible for 32.6% of the top articles (n = 15). Conclusions The majority of the most cited articles relating to ice hockey are cohort studies, review articles, and epidemiological studies originating from the United States or Canada. The majority of publications included in the analysis focused on concussion and traumatic brain injury prevalence, identification, diagnosis, outcomes, and prevention, as well as the most studied level of competition was professional, but the greatest number of participants arose from the youth and high school level. Level of Evidence Level IV, cross-sectional study.
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Affiliation(s)
- Jamie F. Dulle
- University of Redlands, Biology Department, Redlands, California
| | - M. Lane Moore
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, Arizona, U.S.A
| | | | - Jordan R. Pollock
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, Arizona, U.S.A
| | - Donald L. Dulle
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, U.S.A
| | - Anna S. Jenkins
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, Arizona, U.S.A
| | - Anikar Chhabra
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, U.S.A
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Sifuentes-Cervantes JS, Muzzi D, Castro-Núñez J, Guerrero LM, Cunningham LL. Maxillofacial Trauma Patterns in Bare-Knuckle Fighting. J Oral Maxillofac Surg 2022; 80:1663-1669. [DOI: 10.1016/j.joms.2022.07.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/21/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022]
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Fares MY, Salhab HA, Fares J, Khachfe HH, Fares Y, Baydoun H, Abboud JA, Alaaeddine N. Craniofacial and traumatic brain injuries in mixed martial arts. PHYSICIAN SPORTSMED 2021; 49:420-428. [PMID: 33151104 DOI: 10.1080/00913847.2020.1847623] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Objective: Mixed-Martial-Arts (MMA) has witnessed a rapid growth over the recent years. This study aims to explore the patterns and trends of head injuries in MMA.Design: Descriptive epidemiological study.Setting: Ringside physician reports of the Ultimate Fighting Championship (UFC) fights between 2016 and 2019 (inclusive) were screened. Data were extracted from the Nevada State Athletic Commission (NSAC) database. Play-by-play video analysis was also conducted.Participants: UFC fighters involved in fights sanctioned by the NSAC, between 2016 and the end of 2019 (N = 816).Independent variables: Sex, location of head injury, type of head injury, injury mechanism, number of significant head strikes, type of finish, and weight division.Main outcome measures: Head injury rates were calculated. A one-way analysis of variance (ANOVA) was used to explore any statistically significant differences between injury rates of different locations, types, and types of finishes. An independent t-test was used to determine whether any significant differences existed between the two sexes, and a Joinpoint regression analysis was used to determine the statistical significance of the trends of head injury rates across different weight divisions. P-values <0.05 were considered significant (95% CI).Results: A total of 288 head injuries in 408 fights were recorded during our study period. Head injury rate constituted 35 injuries per 100 athletic-exposures (AE) in sanctioned fights. Traumatic brain injuries (TBI) were the most common type of injury, with a rate of 16 per 100AE, significantly greater than that of fractures (p = 0.003). Males had a head injury rate of 37 per 100AE, higher than that of females which was 23 per 100AE. Technical Knockout (TKO)/ Knockout(KO) was the type of finish with the highest rate of head injuries, significantly greater than that of decision or submission (p < 0.001). In general, head injury rates were higher as weight divisions increased.Conclusion: Head injuries are prevalent in MMA. Preventive measures need to be implemented to ensure fighter safety and limit injury risk.
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Affiliation(s)
- Mohamad Y Fares
- Neuroscience Research Center, Faculty of Medicine, Lebanese University, Beirut, Lebanon.,Faculty of Medicine, American University of Beirut, Beirut, Lebanon.,College of Medical, Veterinary, and Life Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Hamza A Salhab
- Neuroscience Research Center, Faculty of Medicine, Lebanese University, Beirut, Lebanon.,Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Jawad Fares
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Youssef Fares
- Neuroscience Research Center, Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | - Hasan Baydoun
- Department of Orthopedics, American University of Beirut Medical Center, Beirut, Lebanon
| | - Joseph A Abboud
- The Rothman Institute, Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Nada Alaaeddine
- Neuroscience Research Center, Faculty of Medicine, Lebanese University, Beirut, Lebanon
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Sifuentes-Cervantes JS, Yamamoto-Valenzuela K, Autran-Martínez J, Castro-Núñez J, Guerrero LM. Maxillofacial Trauma in the Ultimate Fighting Championship. J Oral Maxillofac Surg 2021; 79:1921.e1-1921.e7. [PMID: 34153246 DOI: 10.1016/j.joms.2021.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE The Ultimate Fighting Championship (UFC) is an American mixed martial art (MMA) company. This study aims to characterize patterns and trends of maxillofacial injuries in MMA. MATERIALS AND METHODS The study design is a retrospective cohort study. Study sample consisted of fighters that suffered injuries during the matches from January 2015 to December 2019 (N = 259). The Athletic Commissions and corresponding fighting regulatory departments from 16 states and 24 countries were screened for medical reports released by UFC ringside physicians. Predictor variables were sex, weight division, injury location, injury type, and fight outcome (i.e., Technical Knockout/Knockout, Submission, Decision). Primary outcome variables were need for medical suspension and duration of medical suspension, secondary outcome variable was frequency of injury. Chi-square test was used to determine any statistical significance between predictor variables. One-way analysis of variance was used to determine any statistically significant differences between medical suspension times, sex, injury location, type of injury, weight divisions and fight outcome throughout the years. P value less than .05 (95% confidence interval [CI]) was considered statistically significant. RESULTS A total of 259 fighters suffered injuries. Of the 319 total injuries, 291 (91.2%) occurred in male fighters, and 28 (8.8%) in females. Middle facial third injuries were the most common for both males and females; lower facial third injuries were proportionally similar. The male weight division with the longest medical suspensions were the light heavyweight (110.68 days) and welterweight (108.25 days) (P < .10166); the female weight division with the longest medical suspension was strawweight (88.92 days) and shortest was bantamweight (81.75 days) (P < .921123). CONCLUSIONS Upper and midface trauma was predominant with fractures concentrated in the light heavyweight and welterweight divisions. Medical suspensions duration were longer in the light heavyweight and welterweight divisions.
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Affiliation(s)
- Jose S Sifuentes-Cervantes
- PGY 1, Oral and Maxillofacial Surgery Residency Program, School of Dental Medicine, University of Puerto Rico, San Juan, Puerto Rico.
| | | | - Jorge Autran-Martínez
- PGY 2, Oral and Maxillofacial Surgery Residency Program, School of Dental Medicine, University of Puerto Rico, San Juan, Puerto Rico
| | - Jaime Castro-Núñez
- PGY 3, Oral and Maxillofacial Surgery Residency Program, School of Dental Medicine, University of Puerto Rico, San Juan, Puerto Rico; Research Department, Institución Universitaria Colegios de Colombia, Bogota, Colombia
| | - Lidia M Guerrero
- Professor and Program Director, Oral and Maxillofacial Surgery Residency Program, School of Dental Medicine, University of Puerto Rico, San Juan, Puerto Rico
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Kerr ZY, Pierpoint LA, Rosene JM. Epidemiology of Concussions in High School Boys' Ice Hockey, 2008/09 to 2016/17 School Years. Clin J Sport Med 2021; 31:e21-e28. [PMID: 30451700 DOI: 10.1097/jsm.0000000000000697] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study examined the epidemiology of concussions in high school boys' ice hockey during the 2008/09 to 2016/17 school years. DESIGN Prospective cohort study. Athletic trainers from an average 33 high schools annually reported boys' ice hockey concussion and athlete-exposure (AE) data for the High School Reporting Information Online system. SETTING Convenience sample of high school boys' ice hockey programs during the 2008/09 to 2016/17 school years. PATIENTS OR OTHER PARTICIPANTS High school boys' ice hockey players (aged ∼14-18 years). INDEPENDENT VARIABLES Concussion data on event type, injury mechanism, symptom resolution time, and time loss were obtained. MAIN OUTCOME MEASURES Concussion rates with 95% confidence intervals (CIs) and distributions were calculated. RESULTS Overall, 348 concussions were reported in boys' ice hockey during the 2008/09 to 2016/17 academic years, leading to a concussion rate of 0.68/1000 AEs (95% CI, 0.61-0.75). Most occurred in competitions (85.6%), particularly after the first period (72.1% of all competition concussions). Among practice concussions, most occurred after the first hour of practice (60.0%). Most concussions were due to player contact (47.7%) and boards/glass contact (31.9%). Although 69.0% of concussed athletes had symptoms resolve in less than 7 days, only 14.1% returned to activity within a week. CONCLUSIONS Most concussions occurred within the second and third periods. Preventive strategies that counter an increased risk of concussion due to a greater intensity of gameplay coupled with increased fatigue may be warranted. Moreover, athletes may further benefit from prevention efforts that focus on anticipating impacts during gameplay.
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Affiliation(s)
- Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina
| | - Lauren A Pierpoint
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz, Aurora, Colorado; and
| | - John M Rosene
- Department of Exercise and Sport Performance, University of New England, Biddeford, Maine
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Mason SJ, Davidson BS, Lehto M, Ledreux A, Granholm AC, Gorgens KA. A Cohort Study of the Temporal Stability of ImPACT Scores Among NCAA Division I Collegiate Athletes: Clinical Implications of Test-Retest Reliability for Enhancing Student Athlete Safety. Arch Clin Neuropsychol 2020; 35:1131–1144. [PMID: 32853329 DOI: 10.1093/arclin/acaa047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2020] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVE In this study we examined the temporal stability of the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) within NCAA Division I athletes across various timepoints using an exhaustive series of statistical models. METHODS Within a cohort design, 48 athletes completed repeated baseline ImPACT assessments at various timepoints. Intraclass correlation coefficients (ICC) were calculated using a two-way mixed effects model with absolute agreement. RESULTS Four ImPACT composite scores (Verbal Memory, Visual Memory, Visual Motor Speed, and Reaction Time) demonstrated moderate reliability (ICC = 0.51-0.66) across the span of a typical Division I athlete's career, which is below previous reliability recommendations (0.90) for measures used in individual decision-making. No evidence of fixed bias was detected within Verbal Memory, Visual Motor Speed, or Reaction Time composite scores, and minimal detectable change values exceeded the limits of agreement. CONCLUSIONS The demonstrated temporal stability of the ImPACT falls below the published recommendations, and as such, fails to provide robust support for the NCAA's recommendation to obtain a single preparticipation cognitive baseline for use in sports-related concussion management throughout an athlete's career. Clinical interpretation guidelines are provided for clinicians who utilize baseline ImPACT scores for later performance comparisons.
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Affiliation(s)
- Sara J Mason
- Graduate School of Professional Psychology, University of Denver, Denver 80208, CO, USA
| | - Bradley S Davidson
- Mechanical and Materials Engineering, University of Denver, Denver 80208, CO, USA
| | - Marybeth Lehto
- Graduate School of Professional Psychology, University of Denver, Denver 80208, CO, USA
| | - Aurélie Ledreux
- Knoebel Institute for Healthy Aging, University of Denver, Denver 80208, CO, USA
| | | | - Kim A Gorgens
- Graduate School of Professional Psychology, University of Denver, Denver 80208, CO, USA
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Lempke LB, Weber Rawlins ML, Lynall RC, Schmidt JD. The Influence of Concussion Knowledge on Reporting Intentions in Collegiate Student-Athletes. ACTA ACUST UNITED AC 2020. [DOI: 10.3928/19425864-20190618-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Waterworth V, Procyk A, Canetti E, Hing W, Gough S. The influence of education in decision making concerning athlete’s return to sport following a concussion injury: A systematic review. JOURNAL OF CONCUSSION 2020. [DOI: 10.1177/2059700220941985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives Concussions have emerged as one of the most prevalent and controversial injuries sustained within the sporting context. The objective of this review was to determine the influence that education has on decision making concerning athlete’s return to sport following a concussion injury and if the risk is worth it in the eyes of the athletes. Study design Systematic review. Methods A rapid literature review was performed in PubMed, CINAHL, SPORTDiscus, Embase and Web of Science looking for articles that discussed concussions and any three of the four following search terms: (a) decision making, (b) education/knowledge, (c) sport/return to sport and (d) risk. Results Sixteen of 1243 articles were included in this review based on eligibility criteria. Ten were cohort studies, four were cross-sectional studies and two were qualitative research. There was a good agreement between the authors for all studies when determining risk of bias, presenting a Cohen’s κ of 0.901 (95% CI, 0.834, 0.968), p < 0.001. Conclusion Education can make a difference in athlete’s decision making process to return to sport; however, their awareness of the health risks that they put themselves in by returning to sport too soon is clouded by other external and internal factors. What is not fully understood is why do they put themselves at this risk? Further studies should explore athletes’ risk aversion behaviour and how it impacts their decision to return to sport following a concussion.
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Affiliation(s)
- Victoria Waterworth
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Alexander Procyk
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Elisa Canetti
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Wayne Hing
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Suzanne Gough
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
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Engström Å, Jumisko E, Shahim P, Lehto N, Blennow K, Zetterberg H, Tegner Y. Losing the identity of a hockey player: the long-term effects of concussions. Concussion 2020; 5:CNC74. [PMID: 32509326 PMCID: PMC7270839 DOI: 10.2217/cnc-2019-0014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 03/27/2020] [Indexed: 11/21/2022] Open
Abstract
AIM To describe what suffering multiple concussions meant for former semi-professional or professional hockey players who were forced to end their career. RESULTS Nine former Swedish hockey players, who once played on national or professional teams were interviewed. The interviews were analyzed with reference to hermeneutic phenomenology to interpret and explain their experiences. The theme of losing one's identity as a hockey player was constructed from five subthemes: being limited in everyday life, returning to the hockey stadium as soon as possible, forming a post career identity, lacking understanding and support, and preventing injuries by respecting other players. CONCLUSION The former hockey players struggled with developing their off-the-ice identities and with finding other sources of meaning for their lives.
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Affiliation(s)
- Åsa Engström
- Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden
| | - Eija Jumisko
- Development Manager, Lapland University of Applied Sciences, Rovaniemi, Finland
| | - Pashtun Shahim
- Clinical Neurochemistry Laboratory, Institute of Neuroscience & Physiology, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Niklas Lehto
- Division of Medical Sciences, Department of Health Science, Luleå University of Technology, Luleå, Sweden
| | - Kaj Blennow
- Department of Psychiatry & Neurochemistry, Institute of Neuroscience & Physiology, the Sahlgrenska Academy at the University of Gothenburg & Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry & Neurochemistry, Institute of Neuroscience & Physiology, the Sahlgrenska Academy at the University of Gothenburg & Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, Queen Square & UK Dementia Research Institute at UCL, London, UK
| | - Yelverton Tegner
- Division of Medical Sciences, Department of Health Science, Luleå University of Technology, Luleå, Sweden
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Abstract
Nowadays, the number of people practising contact sports has increased. In many of them, using head protective equipment is not mandatory, even if the use of headbands could increase the level of safety regarding several types of traumatic brain injuries. Many commercial solutions are currently available, based on plastic-based foams providing a decent level of protection and comfort to the user. This work introduces the use of agglomerated cork as an eco-friendly alternative to synthetic foams but at least keeping safety levels. Cork is a natural cellular material that has been showing excellent crashworthiness properties. In this study, cork agglomerate density is carefully chosen to be incorporated into a protective headband. Results are compared against three other commercial headbands. For each one, the risk of brain injury was analysed for different injury thresholds and impact energies. The results clearly demonstrate that the cork-based apparel may provide comparable, and in some cases, better performances, outlasting the commercial ones.
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Kontos AP, Eagle SR, Putukian M, Kirkendall D, Chiampas G, Kaminski T. Concussions in U.S. youth soccer players: results from the U.S. soccer online concussion survey. SCI MED FOOTBALL 2020. [DOI: 10.1080/24733938.2020.1736327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Anthony P. Kontos
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shawn R. Eagle
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Donald Kirkendall
- Duke Sport Science Institute, Duke University Medical Center, Durham, NC, USA
| | | | - Thomas Kaminski
- Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
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Fueger C, Sergio LE, Heuer S, Petrovska L, Huddleston WE. Remote concussion history does not affect visually-guided reaching in young adult females. Concussion 2019; 4:CNC64. [PMID: 31827882 PMCID: PMC6902312 DOI: 10.2217/cnc-2019-0007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: We examined the long-term effects of concussions in young adult females on visuomotor behavior during a visually-guided reaching task of various complexities. Materials & methods: 20 females with a history of longer than 6 months since a concussion and 20 healthy females quickly and accurately performed a delayed reach to a previously cued target. Results: As both cognitive and motor load increased, task performance decreased for both groups (p < 0.05). However, contrary to our primary hypothesis, no differences in task performance were found between the two experimental groups (p > 0.05). Conclusion: The young adult females with a remote history of concussion demonstrated no deficits in visuomotor behavior on an attention-mediated reaching task as compared with control participants. Current literature is inconclusive regarding the long-term effects of concussion. Some have argued that the differing results are due to many uncontrolled factors in study design. In this study, 20 females with a history of concussion more than 6 months ago and 20 healthy females performed a reaching task under different levels of difficulty. As the reaching task got harder, both groups had greater difficulty doing the task quickly and accurately (p < 0.05). Surprisingly, however, no differences in reaching performance existed between the two groups (p > 0.05). Young adult females with a remote history of concussion demonstrated no greater problems with complicated reaching tasks when compared with control participants when experimental conditions are tightly controlled.
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Affiliation(s)
- Christopher Fueger
- Department of Kinesiology: Integrative Health Care & Performance, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA
| | - Lauren E Sergio
- School of Kinesiology & Health Science, York University, Toronto M3J 3M4, Canada
| | - Sabine Heuer
- Department of Communication Sciences & Disorders, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA
| | - Labina Petrovska
- Department of Kinesiology: Integrative Health Care & Performance, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA
| | - Wendy E Huddleston
- Department of Kinesiology: Integrative Health Care & Performance, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA
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Fares MY, Fares J, Fares Y, Abboud JA. Musculoskeletal and head injuries in the Ultimate Fighting Championship (UFC). PHYSICIAN SPORTSMED 2019; 47:205-211. [PMID: 30408429 DOI: 10.1080/00913847.2018.1546108] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Mixed martial arts (MMA) has witnessed a surge in popularity worldwide. This study explores the musculoskeletal and head injuries sustained in the professional fights of the Ultimate Fighting Championship (UFC), and establishes associations between injury profiles and impactful contributory factors. METHODS The Nevada State Athletic Commission database was screened for ringside physician reports of UFC fights between January 2016 and July 2018. Information on the fighter's gender, weight, injury, way of finish, and match result were collected. Injury rates were calculated and statistical analyses were conducted to determine significant associations among variables. P-values <0.05 were considered significant (95% CI). RESULTS A total of 291 injuries were recorded in 285 fights from nine weight divisions. The overall injury rate was 51 per 100 athletic exposures (AE). Males predominantly partook in 249 matches (87%) and had higher injury rates (54 injuries per 100 AE) than females (30 injuries per 100 AE). Decision was the most common way a match ended. Knockouts (KOs) were significantly higher in males (36%) than in females (14%, P = 0.0007). Submissions were significantly higher in females (36%) than in males (16%, P = 0.001). Head injuries (67%) were the most common injuries reported with a rate of 34 per 100 AE. Upper limb injuries were significantly higher in females (40%) than in males (14%, P = 0.0003). Lower limb injuries were significantly higher in males (19%) than in females (5%, P = 0.01). Head injuries were significantly associated with KOs (P < 0.0001). Upper limb injuries (P = 0.032) and lower limb injuries (P = 0.034) were significantly associated with matches that ended with Decision. Trend-line analyses showed that as weight division increases, overall injury rates, head injuries, lower limb injuries, and KOs' frequency increase, whereas upper limb injuries, Submission frequency, and Decision frequency decrease. CONCLUSION MMA has a high injury rate. Gender, way of finish, and weight play an important role in predicting fight outcomes and injury profiles. Injury prevention policies must be entertained to limit injury risk in MMA.
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Affiliation(s)
- Mohamad Y Fares
- a The Rothman Institute, Department of Orthopaedic Surgery , Thomas Jefferson University Hospital , Philadelphia , PA , USA.,b Faculty of Medicine , American University of Beirut , Beirut , Lebanon.,c Neuroscience Research Center, Faculty of Medicine , Lebanese University , Beirut , Lebanon
| | - Jawad Fares
- d Department of Neurological Surgery , Feinberg School of Medicine, Northwestern University , Chicago , IL , USA
| | - Youssef Fares
- c Neuroscience Research Center, Faculty of Medicine , Lebanese University , Beirut , Lebanon
| | - Joseph A Abboud
- a The Rothman Institute, Department of Orthopaedic Surgery , Thomas Jefferson University Hospital , Philadelphia , PA , USA
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Abstract
OBJECTIVE Evaluate postconcussive symptom reporting and recovery. SETTING Public high school. PARTICIPANTS Unmatched controls (n = 760); students who sustained a sports-related concussion (n = 77); matched controls (gender, grade, sport) (n = 77). DESIGN Prospective longitudinal cohort study. OUTCOME MEASURE Immediate Postconcussion Assessment and Cognitive Testing. RESULTS At baseline, athletes who went on to sustain concussions were more likely than unmatched controls to be younger (P = .02), male (P = .001), and participate in different sports (P < .0001) such as football (concussed = 52%, unmatched controls = 20%). Differences were also noted regarding a previous history of concussion (P = .045; concussed athletes = 26%; unmatched control athletes = 16%) and lifetime number of concussions (P = .05). At baseline, those whose sustained concussions during the study period were more likely than matched controls to report numbness (P = .01) and concentration problems (P = .01) and more likely than unmatched controls to report dizziness (P = .02), sensitivity to light (P = .01), sensitivity to noise (P = .002), and numbness (P = .02). However, when data were reanalyzed and those with a previous history of concussion were removed, differences between those who sustained concussions during the study period and matched controls were no longer significant; when compared to unmatched controls, sensitivity to light (P = .01) and vision problems (P = .04) remained significant. Among those who sustained concussions, median time to recovery was 6 days (95% confidence interval: 4-9), and 71 out of 77 (92%) recovered by the fourth postinjury evaluation (median: 20 days postinjury). CONCLUSIONS Course and time frame of recovery were variable. Data also suggest that a previous history of concussion may be contributing to baseline symptom reporting and highlight the potential enduring impact of history of concussion on sensorimotor function. However, further research as to whether preinjury measures of sensorimotor function may increase understanding regarding concussion risk is warranted.
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Abstract
Sport-related concussion (SRC) is a common injury in recreational and organized sport. Over the past 30 years, there has been significant progress in our scientific understanding of SRC, which in turn has driven the development of clinical guidelines for diagnosis, assessment, and management of SRC. In addition to a growing need for knowledgeable health care professionals to provide evidence-based care for athletes with SRC, media attention and legislation have created awareness and, in some cases, fear about many issues and unknowns surrounding SRC. The American Medical Society for Sports Medicine formed a writing group to review the existing literature on SRC, update its previous position statement, and address current evidence and knowledge gaps regarding SRC. The absence of definitive outcomes-based data is challenging and requires relying on the best available evidence integrated with clinical experience and patient values. This statement reviews the definition, pathophysiology, and epidemiology of SRC, the diagnosis and management of both acute and persistent concussion symptoms, the short- and long-term risks of SRC and repetitive head impact exposure, SRC prevention strategies, and potential future directions for SRC research. The American Medical Society for Sports Medicine is committed to best clinical practices, evidence-based research, and educational initiatives that positively impact the health and safety of athletes.
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Harmon KG, Clugston JR, Dec K, Hainline B, Herring S, Kane SF, Kontos AP, Leddy JJ, McCrea M, Poddar SK, Putukian M, Wilson JC, Roberts WO. American Medical Society for Sports Medicine position statement on concussion in sport. Br J Sports Med 2019; 53:213-225. [DOI: 10.1136/bjsports-2018-100338] [Citation(s) in RCA: 217] [Impact Index Per Article: 43.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2018] [Indexed: 12/14/2022]
Abstract
Sport-related concussion (SRC) is a common injury in recreational and organised sport. Over the past 30 years, there has been significant progress in our scientific understanding of SRC, which in turn has driven the development of clinical guidelines for diagnosis, assessment and management of SRC. In addition to a growing need for knowledgeable healthcare professionals to provide evidence-based care for athletes with SRC, media attention and legislation have created awareness and, in some cases, fear about many issues and unknowns surrounding SRC. The American Medical Society for Sports Medicine (AMSSM) formed a writing group to review the existing literature on SRC, update its previous position statement, and to address current evidence and knowledge gaps regarding SRC. The absence of definitive outcomes-based data is challenging and requires relying on the best available evidence integrated with clinical experience and patient values. This statement reviews the definition, pathophysiology and epidemiology of SRC, the diagnosis and management of both acute and persistent concussion symptoms, the short-term and long-term risks of SRC and repetitive head impact exposure, SRC prevention strategies, and potential future directions for SRC research. The AMSSM is committed to best clinical practices, evidence-based research and educational initiatives that positively impact the health and safety of athletes.
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17
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Spotlight on Neurotrauma Research in Canada's Leading Academic Centers. J Neurotrauma 2018; 35:1986-2004. [PMID: 30074875 DOI: 10.1089/neu.2018.29017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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18
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Curran-Sills G, Abedin T. Risk factors associated with injury and concussion in sanctioned amateur and professional mixed martial arts bouts in Calgary, Alberta. BMJ Open Sport Exerc Med 2018; 4:e000348. [PMID: 30018788 PMCID: PMC6045699 DOI: 10.1136/bmjsem-2018-000348] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2018] [Indexed: 11/28/2022] Open
Abstract
Background There is limited literature that examines risk factors for injury and mild traumatic brain injury (mTBI) in mixed martial arts (MMA). An examination of previously unstudied bout and athlete characteristics that may pose health risks while partaking in this sport is warranted. Hypothesis/purpose To determine the incidence of injury and concussion, along with the identification of risk factors that contribute to injury and mTBI in amateur and professional MMA bouts in Calgary, Alberta. Study design A retrospective cohort study with case–control design. Methods Calgary amateur and professional MMA records were examined from 1 January 2010 to 31 December 2015. Descriptive statistics were used to describe the incidence of injury and concussion, along with univariate and multivariable logistic regression to identify risk factors for injury and mTBI. Results The injury rate per 100 athlete exposure (AE), the injury rate per 100 min of exposure and the concussion rate per 100 AE were 23.6 (95% CI 20.5 to 27.0), 4.1 (95% CI 3.48 to 4.70) and 14.7 (95% CI 11.8 to 17.2), respectively. The most common location of injury was the head and mTBI was the most common type of injury. Athletes whose bout was finished by a knockout/technical knockout, corner stoppage, draw, no contest or physician, and those whose country of origin was non-Canadian, were more likely to sustain an injury. No risk factors for concussion were shown to be significant. Conclusion Engaging in MMA exposes athletes to inherent risk and several recommendations are proposed to reduce these risks. Future prospective investigations are necessary to better delineate the findings in this study.
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Affiliation(s)
- Gwynn Curran-Sills
- Family Medicine and Primary Care Research Office, University of Calgary, Calgary, Alberta, Canada
| | - Tasnima Abedin
- Family Medicine and Primary Care Research Office, University of Calgary, Calgary, Alberta, Canada
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Donaldson S, Donaldson M, Shivji S. Utilizing the Quantitative Electroencephalograph (qEEG) to Objectively Document the Nature and Severity of Concussions in Junior Hockey Players: A Pilot Investigation. Appl Psychophysiol Biofeedback 2018; 43:211-216. [DOI: 10.1007/s10484-018-9400-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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20
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Todd R, Bhalerao S, Vu MT, Soklaridis S, Cusimano MD. Understanding the psychiatric effects of concussion on constructed identity in hockey players: Implications for health professionals. PLoS One 2018; 13:e0192125. [PMID: 29466377 PMCID: PMC5821444 DOI: 10.1371/journal.pone.0192125] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 01/18/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The following study was undertaken to investigate the effect of concussion and psychiatric illness on athletes and their caregivers. METHODS Semi-structured interviews with 20 ice hockey stakeholders (17 men and 3 women) including minor and professional players, coaches, parents, and physicians were conducted over two years (2012-2014). These interviews were analyzed using grounded theory. RESULTS From this analysis, a common biographical theme emerged whereby the subject's identity as a hockey player, constructed early in life over many years, was disrupted by concussion. Furthermore, some players underwent a biographical deconstruction when they experienced post-concussive mental illness, which was amplified by isolation, stigma from peers, and lack of a clear life trajectory. Many players obtained support from family and peers and were able to recover, as evidenced by the biographical reconstruction of their identity post-hockey concussion. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Understanding the process of biographical deconstruction and reconstruction has significant psychosocial treatment implications for both healthcare professionals and caregivers of this population. Specifically, the authors suggest that interpersonal psychotherapy (IPT) that focuses on role transitions may create opportunities to facilitate the process of biographical reconstruction and life transition.
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Affiliation(s)
- Ryan Todd
- Department of Psychiatry, University of Calgary, Alberta, Canada
| | - Shree Bhalerao
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Medical Psychiatry, St. Michaels Hospital, Toronto, Ontario, Canada
| | | | - Sophie Soklaridis
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Michael D. Cusimano
- Surgery, Education and Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery. St. Michaels Hospital, Toronto, Ontario, Canada
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Sollmann N, Echlin PS, Schultz V, Viher PV, Lyall AE, Tripodis Y, Kaufmann D, Hartl E, Kinzel P, Forwell LA, Johnson AM, Skopelja EN, Lepage C, Bouix S, Pasternak O, Lin AP, Shenton ME, Koerte IK. Sex differences in white matter alterations following repetitive subconcussive head impacts in collegiate ice hockey players. NEUROIMAGE-CLINICAL 2017; 17:642-649. [PMID: 29204342 PMCID: PMC5709295 DOI: 10.1016/j.nicl.2017.11.020] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 11/08/2017] [Accepted: 11/18/2017] [Indexed: 12/31/2022]
Abstract
Objective Repetitive subconcussive head impacts (RSHI) may lead to structural, functional, and metabolic alterations of the brain. While differences between males and females have already been suggested following a concussion, whether there are sex differences following exposure to RSHI remains unknown. The aim of this study was to identify and to characterize sex differences following exposure to RSHI. Methods Twenty-five collegiate ice hockey players (14 males and 11 females, 20.6 ± 2.0 years), all part of the Hockey Concussion Education Project (HCEP), underwent diffusion-weighted magnetic resonance imaging (dMRI) before and after the Canadian Interuniversity Sports (CIS) ice hockey season 2011-2012 and did not experience a concussion during the season. Whole-brain tract-based spatial statistics (TBSS) were used to compare pre- and postseason imaging in both sexes for fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD). Pre- and postseason neurocognitive performance were assessed by the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT). Results Significant differences between the sexes were primarily located within the superior longitudinal fasciculus (SLF), the internal capsule (IC), and the corona radiata (CR) of the right hemisphere (RH). In significant voxel clusters (p < 0.05), decreases in FA (absolute difference pre- vs. postseason: 0.0268) and increases in MD (0.0002), AD (0.00008), and RD (0.00005) were observed in females whereas males showed no significant changes. There was no significant correlation between the change in diffusion scalar measures over the course of the season and neurocognitive performance as evidenced from postseason ImPACT scores. Conclusions The results of this study suggest sex differences in structural alterations following exposure to RSHI. Future studies need to investigate further the underlying mechanisms and association with exposure and clinical outcomes.
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Key Words
- AD, axial diffusivity
- CIS, Canadian Interuniversity Sports
- CR, corona radiata
- Diffusion tensor imaging
- EC, external capsule
- FA, fractional anisotropy
- HCEP, Hockey Concussion Education Project
- IC, internal capsule
- Ice hockey
- ImPACT, Immediate Post-Concussion Assessment and Cognitive Test
- LH, left hemisphere
- MD, mean diffusivity
- MRI, magnetic resonance imaging
- NCAA, National Collegiate Athletic Association
- RD, radial diffusivity
- RH, right hemisphere
- RSHI, repetitive subconcussive head impacts
- Repetitive subconcussive head impacts
- SD, standard deviation
- SLF, superior longitudinal fasciculus
- Sex difference
- TBI, traumatic brain injury
- TBSS, tract-based spatial statistics
- Traumatic brain injury
- WM, white matter
- White matter
- dMRI, diffusion magnetic resonance imaging
- rs, Spearman's rank correlation coefficient
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Affiliation(s)
- Nico Sollmann
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
| | - Paul S Echlin
- Elliott Sports Medicine Clinic, Burlington, ON, Canada.
| | - Vivian Schultz
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany.
| | - Petra V Viher
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Translational Research Center, University Hospital of Psychiatry, Bern, Switzerland.
| | - Amanda E Lyall
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Yorghos Tripodis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA; Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, USA.
| | - David Kaufmann
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany; Department of Radiology, Charité Universitätsmedizin, Berlin, Germany.
| | - Elisabeth Hartl
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Neurology, Epilepsy Center, Ludwig-Maximilians-Universität, Munich, Germany.
| | - Philipp Kinzel
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany.
| | - Lorie A Forwell
- 3M Centre, The University of Western Ontario, London, ON, Canada.
| | - Andrew M Johnson
- School of Health Studies, The University of Western Ontario, London, ON, Canada.
| | - Elaine N Skopelja
- Ruth Lilly Medical Library, Indiana University, Indianapolis, IN, USA.
| | - Christian Lepage
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; School of Psychology, University of Ottawa, Ottawa, ON, Canada.
| | - Sylvain Bouix
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Ofer Pasternak
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Alexander P Lin
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; VA Boston Healthcare System, Brockton Division, Brockton, MA, USA.
| | - Inga K Koerte
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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22
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Alsalaheen B, Stockdale K, Pechumer D, Broglio SP. Validity of the Immediate Post Concussion Assessment and Cognitive Testing (ImPACT). Sports Med 2017; 46:1487-501. [PMID: 27071989 DOI: 10.1007/s40279-016-0532-y] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The immediate post concussion assessment and cognitive testing (ImPACT) is the most widely used concussion assessment tool. Despite its popularity, it is unclear if validation studies for the ImPACT test covered all aspects of validity to support its widespread use in research and clinical practice. OBJECTIVE The purpose of this report is to review literature surrounding the validity and the utility of the ImPACT test. DATA SOURCES AND APPRAISAL A systematic review of relevant studies in PubMed, CINAHL, and PsycINFO was carried out. Studies were evaluated using the STROBE (strengthening the reporting of observational studies in epidemiology) or the STARD (standards for reporting of diagnostic accuracy) criteria. RESULTS The literature search yielded 5968 studies. Sixty-nine studies met the inclusion criteria and were included in the qualitative review. Although the convergent validity of ImPACT was supported, evidence of discriminant and predictive validity, diagnostic accuracy and responsiveness was inconclusive. The utility of the ImPACT test after acute symptom resolution was sparse. The review found many factors influenced the validity and utility of ImPACT scores. CONCLUSION Clinicians must consider the benefit of ImPACT testing for their patients on a case-by-case scenario and must take the psychometric properties of the test into account when interpreting results.
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Affiliation(s)
- Bara Alsalaheen
- Physical Therapy Department, University of Michigan-Flint, 2157 William S. White Building, 303 E. Kearsley Street, Flint, MI, 48502-1950, USA.
| | - Kayla Stockdale
- Physical Therapy Department, University of Michigan-Flint, 2157 William S. White Building, 303 E. Kearsley Street, Flint, MI, 48502-1950, USA
| | - Dana Pechumer
- Physical Therapy Department, University of Michigan-Flint, 2157 William S. White Building, 303 E. Kearsley Street, Flint, MI, 48502-1950, USA
| | - Steven P Broglio
- Neurotrauma Research Laboratory, University of Michigan, Ann Arbor, MI, USA
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Petrelli T, Farrokhyar F, McGrath P, Sulowski C, Sobhi G, DeMatteo C, Giglia L, Singh SK. The use of ibuprofen and acetaminophen for acute headache in the postconcussive youth: A pilot study. Paediatr Child Health 2017; 22:2-6. [PMID: 29483787 DOI: 10.1093/pch/pxw011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Objective Acute postconcussive headaches are problematic for children after mild traumatic brain injury. There are no evidence-based guidelines for their management. This pilot study aims to assess the feasibility and efficacy of routine analgesia administration. Methods A four-arm open-label randomized controlled trial pilot/feasibility study was conducted: (i) acetaminophen, (ii) ibuprofen, (iii) alternating acetaminophen and ibuprofen and (iv) a control group. Children and youth 8 to 18 years of age presenting to emergency department with headache within 48 hours of their first concussion were recruited consecutively and sequentially randomized. Children with abnormal neuroimaging, history of previous concussions and bleeding disorder were excluded. A headache survey was administered at recruitment. All participants were provided with standard concussion management education and were also instructed on how to use the headache diary for the 1-week study follow-up period. The diary captures (i) headache days, (ii) number of headaches, (iii) headache intensity and (iv) return-to-school information. Feasibility was assessed based on study recruitment and compliance. Results There were no feasibility concerns with the recruitment and no major compliance issues. Patients on acetaminophen, ibuprofen or both had significantly less headache days, episodes of headache and lower headache intensity than did the standard care group. Patients on both ibuprofen and acetaminophen (79.0%) and on ibuprofen alone (61.0%) were more likely to be back at school 1 week postinjury as compared with the acetaminophen group (33.3%) and the standard care group (21.1%). Conclusion Results showed routine analgesia administration was feasible and effective for postconcussive headache management. A larger full-scale randomized controlled trial is required to further assess the efficacy with longer follow-up, a wider variety of patients and more concussion related outcomes.
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Affiliation(s)
- Tina Petrelli
- Department of Surgery, McMaster University, Hamilton, Ontario.,McMaster Children's Hospital, Hamilton, Ontario
| | - Forough Farrokhyar
- Department of Surgery, McMaster University, Hamilton, Ontario.,Department of Clinical Epidemiology Biostatistics and Surgical Research Methodology, McMaster University, Hamilton, Ontario
| | | | - Chris Sulowski
- McMaster Children's Hospital, Hamilton, Ontario.,Department of Pediatrics, McMaster University, Hamilton, Ontario
| | - Gita Sobhi
- McMaster Children's Hospital, Hamilton, Ontario
| | - Carol DeMatteo
- School of Rehabilitation Science and CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario
| | | | - Sheila K Singh
- Department of Surgery, McMaster University, Hamilton, Ontario.,McMaster Children's Hospital, Hamilton, Ontario.,Stem Cell and Cancer Research Institute, Michael DeGroote Centre for Learning and Discovery, McMaster University, Hamilton, Ontario
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Krolikowski MP, Black AM, Palacios-Derflingher L, Blake TA, Schneider KJ, Emery CA. The Effect of the "Zero Tolerance for Head Contact" Rule Change on the Risk of Concussions in Youth Ice Hockey Players. Am J Sports Med 2017; 45:468-473. [PMID: 27789471 DOI: 10.1177/0363546516669701] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Ice hockey is a popular winter sport in Canada. Concussions account for the greatest proportion of all injuries in youth ice hockey. In 2011, a policy change enforcing "zero tolerance for head contact" was implemented in all leagues in Canada. PURPOSE To determine if the risk of game-related concussions and more severe concussions (ie, resulting in >10 days of time loss) and the mechanisms of a concussion differed for Pee Wee class (ages 11-12 years) and Bantam class (ages 13-14 years) players after the 2011 "zero tolerance for head contact" policy change compared with players in similar divisions before the policy change. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS The retrospective cohort included Pee Wee (most elite 70%, 2007-2008; n = 891) and Bantam (most elite 30%, 2008-2009; n = 378) players before the rule change and Pee Wee (2011-2012; n = 588) and Bantam (2011-2012; n = 242) players in the same levels of play after the policy change. Suspected concussions were identified by a team designate and referred to a sport medicine physician for diagnosis. Incidence rate ratios (IRRs) were estimated based on multiple Poisson regression analysis, controlling for clustering by team and other important covariates and offset by game-exposure hours. Incidence rates based on the mechanisms of a concussion were estimated based on univariate Poisson regression analysis. RESULTS The risk of game-related concussions increased after the head contact rule in Pee Wee (IRR, 1.85; 95% CI, 1.20-2.86) and Bantam (IRR, 2.48; 95% CI, 1.17-5.24) players. The risk of more severe concussions increased after the head contact rule in Pee Wee (IRR, 4.12; 95% CI, 2.00-8.50) and Bantam (IRR, 7.91; 95% CI, 3.13-19.94) players. The rates of concussions due to body checking and direct head contact increased after the rule change. CONCLUSION The "zero tolerance for head contact" policy change did not reduce the risk of game-related concussions in Pee Wee or Bantam class ice hockey players. Increased concussion awareness and education after the policy change may have contributed to the increased risk of concussions found after the policy change.
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Affiliation(s)
- Maciej P Krolikowski
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Amanda M Black
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Luz Palacios-Derflingher
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tracy A Blake
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada
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The Epidemiology of Concussions: Number and Nature of Concussions and Time to Recovery Among Female and Male Canadian Varsity Athletes 2008 to 2011. Clin J Sport Med 2017; 27:52-56. [PMID: 26862834 DOI: 10.1097/jsm.0000000000000308] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To provide incidence rates and days to symptom resolution and cognitive recovery stratified by sex and sport at a Canadian institution. STUDY DESIGN A retrospective chart analysis. SUBJECTS Seven hundred fifty-nine varsity level athletes competing in men's football, men's and women's soccer, men's and women's volleyball, men's and women's basketball, men's and women's ice hockey, women's field hockey, women's rugby, men's and women's tennis, men's and women's water polo, men's and women's swimming, badminton, cross-country, and track and field in the 2008 to 2009 season through the 2010 to 2011 season. MAIN OUTCOME MEASURES Incidence of concussion, days to symptom recovery, and days to cognitive recovery as measured by clinical interpretation using the sports concussion assessment tool (SCAT)/SCAT2 and Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) with baseline and follow-up data. RESULTS A total of 81 concussions were reported and diagnosed among 759 athletes. Significantly, more female athletes were concussed than male athletes (13.08%-7.53%, respectively; P = 0.014) with the highest rates in women's rugby [incidence density (ID) = 20.00 concussions per athlete-season], women's ice hockey (ID = 18.67 per athlete-season), and men's basketball (ID = 20.00 per athlete-season). Sex differences in symptom recovery and cognitive recovery were not significant. CONCLUSIONS The incidence of concussion across multiple sports in a Canadian varsity athlete population is of concern. There are inconsistencies found between the time an athlete claims to have no symptoms and the time of neurocognitive recovery as measured by computerized neurocognitive testing. Therefore, objective computerized testing is recommended to ensure that athletes are functionally recovered before return to play.
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Building Statewide Infrastructure for the Academic Support of Students With Mild Traumatic Brain Injury. J Head Trauma Rehabil 2016; 31:397-406. [DOI: 10.1097/htr.0000000000000205] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Thomas RE, Alves J, Vaska MM, Magalhães R. SCAT2 and SCAT3 scores at baseline and after sports-related mild brain injury/concussion: qualitative synthesis with weighted means. BMJ Open Sport Exerc Med 2016; 2:e000095. [PMID: 27900167 PMCID: PMC5125422 DOI: 10.1136/bmjsem-2015-000095] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2016] [Indexed: 11/06/2022] Open
Abstract
Objective Identify all Sport Concussion Assessment Tool (SCAT2/3) studies, compare baseline and postconcussion results. Design Systematic review (qualitative synthesis, weighted means). Data sources 18 databases, 9 grey literature resources searched for SCAT2/3 data; 9150 articles identified, titles/abstracts assessed/data-entry independently by two reviewers. Eligibility criteria for selecting studies Any studies reporting partial/complete SCAT2/3 data. Results 21 studies with data (partial/complete data 16 SCAT2 (4087 athletes); 5 SCAT3 (891). Newcastle-Ottawa risk-of-bias scale: studies with maximum possible score of 4, 85% scored 3 or 4; studies with maximum possible score of 6, 75% scored 5 or 6. SCAT2 high schoolers: weighted mean score for symptoms 18.46 (22=no symptoms), Balance Error Scoring System (BESS) 26.14, Standardised Assessment of Concussion (SAC) 26.00 and SCAT2 total 88.63. Collegiate/adults weighted means: symptoms 20.09, BESS 25.54, SAC 27.51 and total SCAT2 91.20. Between-study and within-study variability similar to those of the high schoolers. Limited variability between genders. Only 2 studies report baseline and postconcussion scores and 9 partial scores, but data are too limited to provide weighted average scores. Conclusions Group mean baseline SCAT scores for high school and collegiate athletes are similar, with minimal gender differences; baseline symptoms show more variability than other components. There are minimal data for elementary students and professionals, no data for adult non-collegiate athletes. Two studies provide preconcussion and postconcussion scores. No data on minimal significant clinical differences to guide players/coaches in withdrawing from a game in progress and deciding when recovery is complete and play can be resumed. The SCAT needs supplementing with clinical and neuropsychological return-to-play assessments.
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Affiliation(s)
- Roger E Thomas
- Department of Family Medicine, Faculty of Medicine , Health Sciences Centre, University of Calgary , Calgary, Alberta , Canada
| | - Jorge Alves
- CEREBRO-Brain Health Center , Braga , Portugal
| | - Marcus M Vaska
- Knowledge Resource Service, Alberta Health Services , Holy Cross Centre , Calgary, Alberta , Canada
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Hänninen T, Tuominen M, Parkkari J, Vartiainen M, Öhman J, Iverson GL, Luoto TM. Sport concussion assessment tool – 3rd edition – normative reference values for professional ice hockey players. J Sci Med Sport 2016; 19:636-41. [DOI: 10.1016/j.jsams.2015.08.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 07/02/2015] [Accepted: 08/25/2015] [Indexed: 10/23/2022]
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The Impact of a Concussion-U Educational Program on Knowledge of and Attitudes about Concussion. Can J Neurol Sci 2016; 43:659-64. [DOI: 10.1017/cjn.2016.263] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackground: The diagnosis of a sports-related concussion is often dependent on the athlete self-reporting their symptoms. It has been suggested that improving youth athlete knowledge and attitudes toward concussion may increase self-reporting behaviour. The objective of this study was to determine if a novel Concussion-U educational program improves knowledge of and attitudes about concussion among a cohort of elite male Bantam and Midget AAA hockey players. Methods: Fifty-seven male Bantam and Midget AAA-level hockey players (mean age=14.52±1.13 years) were recruited from the local community. Each participant completed a modified version of the Rosenbaum Concussion Knowledge and Attitudes Survey–Student Version immediately before and after a Concussion-U educational presentation. Follow-up sessions were arranged 4 to 6 months after the presentation, and assessed retention of knowledge and attitude changes. Results: Forty-three players completed all three surveys. Concussion knowledge and attitude scores significantly (p<0.01) increased from pre- to post-presentation by 12.79 and 8.41%, respectively. At long-term follow-up, knowledge levels remained significantly (p<0.01) higher than baseline by 8.49%. Mean attitude scores were also increased at follow-up; however, this increase was not statistically significant. Conclusions: A Concussion-U educational program led to an immediate improvement in concussion knowledge and attitudes among elite male Bantam and Midget AAA hockey players. Increased knowledge was maintained at long-term follow-up, but improved attitude was not. Future studies should investigate whether similar educational programs influence symptom reporting and concussion incidence. In addition, they should focus on how to maintain improved concussion attitudes.
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Cusimano MD, Ilie G, Mullen SJ, Pauley CR, Stulberg JR, Topolovec-Vranic J, Zhang S. Aggression, Violence and Injury in Minor League Ice Hockey: Avenues for Prevention of Injury. PLoS One 2016; 11:e0156683. [PMID: 27258426 PMCID: PMC4892613 DOI: 10.1371/journal.pone.0156683] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 05/18/2016] [Indexed: 11/18/2022] Open
Abstract
Background In North America, more than 800,000 youth are registered in organized ice hockey leagues. Despite the many benefits of involvement, young players are at significant risk for injury. Body-checking and aggressive play are associated with high frequency of game-related injury including concussion. We conducted a qualitative study to understand why youth ice hockey players engage in aggressive, injury-prone behaviours on the ice. Methods Semi-structured interviews were conducted with 61 minor ice hockey participants, including male and female players, parents, coaches, trainers, managers and a game official. Players were aged 13–15 playing on competitive body checking teams or on non-body checking teams. Interviews were manually transcribed, coded and analyzed for themes relating to aggressive play in minor ice hockey. Results Parents, coaches, teammates and the media exert a large influence on player behavior. Aggressive behavior is often reinforced by the player’s social environment and justified by players to demonstrate loyalty to teammates and especially injured teammates by seeking revenge particularly in competitive, body-checking leagues. Among female and male players in non-body checking organizations, aggressive play is not reinforced by the social environment. These findings are discussed within the framework of social identity theory and social learning theory, in order to understand players’ need to seek revenge and how the social environment reinforces aggressive behaviors. Conclusion This study provides a better understanding of the players’ motivations and environmental influences around aggressive and violent play which may be conducive to injury. The findings can be used to help design interventions aimed at reducing aggression and related injuries sustained during ice hockey and sports with similar cultures and rules.
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Affiliation(s)
- Michael D. Cusimano
- Division of Neurosurgery, Department of Surgery, Injury Prevention Research Office, Saint Michael’s Hospital, Toronto, Ontario, Canada
- * E-mail:
| | - Gabriela Ilie
- Dalhousie University Faculty of Medicine, Department of Community Health and Epidemiology, Halifax, Nova Scotia, Canada
| | - Sarah J. Mullen
- Division of Neurosurgery, Department of Surgery, Injury Prevention Research Office, Saint Michael’s Hospital, Toronto, Ontario, Canada
| | - Christopher R. Pauley
- Division of Neurosurgery, Department of Surgery, Injury Prevention Research Office, Saint Michael’s Hospital, Toronto, Ontario, Canada
| | | | - Jane Topolovec-Vranic
- Faculty of Medicine (Occupational Science and Occupational Therapy), University of Toronto, Toronto, Canada
| | - Stanley Zhang
- Division of Neurosurgery, Department of Surgery, Injury Prevention Research Office, Saint Michael’s Hospital, Toronto, Ontario, Canada
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Yengo-Kahn AM, Hale AT, Zalneraitis BH, Zuckerman SL, Sills AK, Solomon GS. The Sport Concussion Assessment Tool: a systematic review. Neurosurg Focus 2016; 40:E6. [DOI: 10.3171/2016.1.focus15611] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Over the last 2 decades, sport-related concussion (SRC) has garnered significant attention. Even with increased awareness and athlete education, sideline recognition and real-time diagnosis remain crucial. The need for an objective and standardized assessment of concussion led to the eventual development of the Sport Concussion Assessment Tool (SCAT) during the Second International Conference on Concussion in Sport in 2004, which is now in its third iteration (SCAT3). In an effort to update our understanding of the most well-known sideline concussion assessment, the authors conducted a systematic review of the SCAT and the evidence supporting its use to date.
METHODS
English-language titles and abstracts published between 1995 and October 2015 were searched systematically across 4 electronic databases and a review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines adapted for the review of a heterogeneous collection of study designs. Peer-reviewed journal articles were included if they reported quantitative data on any iteration of the SCAT, Standardized Assessment of Concussion (SAC), or modified Balance Error Scoring System (mBESS) data at baseline or following concussion in an exclusively athlete population with any portion older than 13 years of age. Studies that included nonathletes, only children less than 13 years old, exclusively BESS data, exclusively symptom scale data, or a non–SCAT-related assessment were excluded.
RESULTS
The database search process yielded 549 abstracts, and 105 full-text articles were reviewed with 36 meeting criteria for inclusion. Nineteen studies were associated with the SAC, 1 was associated with the mBESS exclusively, and 16 studies were associated with a full iteration of the SCAT. The majority of these studies (56%) were prospective cohort studies. Male football players were the most common athletes studied. An analysis of the studies focused on baseline differences associated with age, sex, concussion history, and the ability to detect an SRC.
CONCLUSIONS
Looking toward the upcoming Concussion in Sport Group meeting in fall 2016, one may expect further revision to the SCAT3. However, based on this systematic review, the authors propose further, in-depth study of an already comprehensive concussion test, with acute, diagnostic, as well as long-term use.
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Affiliation(s)
| | | | | | - Scott L. Zuckerman
- 1Vanderbilt Sports Concussion Center, and
- 2Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Allen K. Sills
- 1Vanderbilt Sports Concussion Center, and
- 2Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Gary S. Solomon
- 1Vanderbilt Sports Concussion Center, and
- 2Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
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Wright AD, Jarrett M, Vavasour I, Shahinfard E, Kolind S, van Donkelaar P, Taunton J, Li D, Rauscher A. Myelin Water Fraction Is Transiently Reduced after a Single Mild Traumatic Brain Injury--A Prospective Cohort Study in Collegiate Hockey Players. PLoS One 2016; 11:e0150215. [PMID: 26913900 PMCID: PMC4767387 DOI: 10.1371/journal.pone.0150215] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 02/10/2016] [Indexed: 12/12/2022] Open
Abstract
Impact-related mild traumatic brain injuries (mTBI) are a major public health concern, and remain as one of the most poorly understood injuries in the field of neuroscience. Currently, the diagnosis and management of such injuries are based largely on patient-reported symptoms. An improved understanding of the underlying pathophysiology of mTBI is urgently needed in order to develop better diagnostic and management protocols. Specifically, dynamic post-injury changes to the myelin sheath in the human brain have not been examined, despite ‘compromised white matter integrity’ often being described as a consequence of mTBI. In this preliminary cohort study, myelin water imaging was used to prospectively evaluate changes in myelin water fraction, derived from the T2 decay signal, in two varsity hockey teams (45 players) over one season of athletic competition. 11 players sustained a concussion during competition, and were scanned at 72 hours, 2 weeks, and 2 months post-injury. Results demonstrated a reduction in myelin water fraction at 2 weeks post-injury in several brain areas relative to preseason scans, including the splenium of the corpus callosum, right posterior thalamic radiation, left superior corona radiata, left superior longitudinal fasciculus, and left posterior limb of the internal capsule. Myelin water fraction recovered to pre-season values by 2 months post-injury. These results may indicate transient myelin disruption following a single mTBI, with subsequent remyelination of affected neurons. Myelin disruption was not apparent in the athletes who did not experience a concussion, despite exposure to repetitive subconcussive trauma over a season of collegiate hockey. These findings may help to explain many of the metabolic and neurological deficits observed clinically following mTBI.
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Affiliation(s)
- Alexander D. Wright
- MD/PhD Program, University of British Columbia, Vancouver, Canada
- Southern Medical Program, University of British Columbia Okanagan, Kelowna, Canada
- Department of Experimental Medicine, University of British Columbia, Vancouver, Canada
| | - Michael Jarrett
- UBC MRI Research Centre, University of British Columbia, Vancouver, Canada
| | - Irene Vavasour
- UBC MRI Research Centre, University of British Columbia, Vancouver, Canada
| | - Elham Shahinfard
- UBC MRI Research Centre, University of British Columbia, Vancouver, Canada
| | - Shannon Kolind
- Faculty of Medicine, Division of Neurology, University of British Columbia, Vancouver, Canada
| | - Paul van Donkelaar
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, Canada
| | - Jack Taunton
- Faculty of Medicine, Division of Sports Medicine, University of British Columbia, Vancouver, Canada
| | - David Li
- Faculty of Medicine, Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Alexander Rauscher
- UBC MRI Research Centre, University of British Columbia, Vancouver, Canada
- Department of Pediatrics, Division of Neurology, University of British Columbia, Vancouver, Canada
- * E-mail:
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Kontos AP, Elbin R, Sufrinko A, Dakan S, Bookwalter K, Price A, Meehan WP, Collins MW. Incidence of Concussion in Youth Ice Hockey Players. Pediatrics 2016; 137:e20151633. [PMID: 26746405 PMCID: PMC4732355 DOI: 10.1542/peds.2015-1633] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Ice hockey is a fast-paced collision sport that entails both intentional (ie, body checking) and incidental contact that may involve the head. The objective of this study was to determine the incidence of concussions in relation to games/practices and age among competition-level youth ice hockey players (ages 12-18 years). METHODS Participants included 397 youth ice hockey players from Western Pennsylvania; Boston, Massachusetts; and Birmingham, Alabama, during the 2012-2013 and 2013-2014 youth ice hockey seasons. Incidence rates (IRs) and incidence rate ratios (IRRs) of concussion were calculated for games/practices and age groups. RESULTS A total of 23 369 (12 784 practice/10 585 game) athletic exposures (AEs) involving 37 medically diagnosed concussions occurred. More than 40% of concussions involved illegal contact. The combined IR for games and practices was 1.58 concussions per 1000 AEs. The IRR was 2.86 times (95% confidence interval 0.68-4.42) higher during games (2.49 per 1000 AEs) than practices (1.04 per 1000 AEs). CONCLUSIONS The overall IR for concussion in youth ice hockey was comparable to those reported in other youth collision sports. The game-to-practice IRR was lower than previously reported in ice hockey and other youth sports, although more concussions per exposure occurred in games compared with practices. Younger players had a higher rate of concussions than older players.
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Affiliation(s)
- Anthony P. Kontos
- Department of Orthopaedic Surgery/UPMC Sports Medicine Concussion Program- University of Pittsburgh, Pittsburgh, Pennsylvania
| | - R.J. Elbin
- Department of Health, Human Performance and Recreation/Office for Sport Concussion Research- University of Arkansas, Fayetteville, Arkansas
| | - Alicia Sufrinko
- Department of Orthopaedic Surgery/UPMC Sports Medicine Concussion Program- University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Scott Dakan
- Department of Orthopaedic Surgery/UPMC Sports Medicine Concussion Program- University of Pittsburgh, Pittsburgh, Pennsylvania;,College of Medicine- Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania; and
| | - Kylie Bookwalter
- Department of Orthopaedic Surgery/UPMC Sports Medicine Concussion Program- University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ali Price
- Department of Orthopaedic Surgery/UPMC Sports Medicine Concussion Program- University of Pittsburgh, Pittsburgh, Pennsylvania
| | - William P. Meehan
- Boston Children’s Hospital /Harvard Medical School, Boston, Massachusetts,Micheli Center for Sports Injury Prevention, Waltham, Massachusetts
| | - Michael W. Collins
- Department of Orthopaedic Surgery/UPMC Sports Medicine Concussion Program- University of Pittsburgh, Pittsburgh, Pennsylvania
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Abstract
OBJECTIVE To investigate concussion rates and reporting frequencies in high school and collegiate athletes in 2013, compare results to those obtained from 1999 to 2002, and examine to what extent the 2012 Wisconsin state concussion law affected reporting in 2013. DESIGN Retrospective 2013 survey compared with prior survey. SETTING High schools and colleges in the Milwaukee, Wisconsin, area. PARTICIPANTS Athletes (N = 784) from multiple sports were surveyed in 2013. Football players (N = 1532) from 1999 to 2002 completed the same measure. MAIN OUTCOME MEASURES Both surveys assessed concussion history, concussion incidence during the current season, whether incident concussions were reported, who concussions were reported to, and reasons for not reporting. The 2013 survey also assessed awareness of the Wisconsin state law and its effect on reporting. RESULTS Rates of concussion in the surveyed season were comparable to previous findings from 1999 to 2002 (16.6% vs 15.3%, P = 0.558). Notably, athletes were significantly more likely to report their concussions in 2013 (70.6% vs 47.3% previously, P = 0.011). Among high school athletes surveyed, 59.5% were aware of the Wisconsin state law, with 55.1% stating it would make them more likely to report a concussion. CONCLUSIONS Rates of concussion for 1 sport season have not changed significantly over the past 14 years. The percentage of concussions that are reported to someone has increased significantly. Awareness of the Wisconsin state law does not fully account for the increase in concussion reporting. CLINICAL RELEVANCE Given the finite amount of knowledge regarding the influence of concussion-related cultural and legal changes, these findings will help to inform clinicians of the current concussion milieu from the perspective of athletes. It will inform practitioners involved in concussion management to what extent athletes are aware of and report concussions.
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Kroshus E, Kubzansky LD, Goldman RE, Austin SB. Norms, athletic identity, and concussion symptom under-reporting among male collegiate ice hockey players: a prospective cohort study. Ann Behav Med 2015; 49:95-103. [PMID: 25236670 DOI: 10.1007/s12160-014-9636-5] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Many athletes fail to report concussion symptoms to coaches or medical personnel, putting them at risk for potentially catastrophic neurologic consequences if additional brain trauma is sustained prior to full recovery. PURPOSE The purpose of this study was to determine whether concussion reporting norms prior to the start of the athletic season predicted reporting symptoms of a possible concussion during the season, and whether this association was moderated by athletic identity. METHODS Members of six National Collegiate Athletic Association Division 1 men's ice hockey teams (n = 116) completed written surveys before and after the 2012-2013 collegiate ice hockey season. RESULTS Participants who at pre-season perceived that "most athletes" were likely to report symptoms of a concussion were themselves more likely to report symptoms during the season. Athletic identity weakly moderated this association. CONCLUSIONS Perceived reporting norms may be an important target of interventions aimed at reducing symptom under-reporting among athletes.
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Affiliation(s)
- Emily Kroshus
- Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA,
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36
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DEMATTEO CAROL, VOLTERMAN KIMBERLYA, BREITHAUPT PETERG, CLARIDGE EVERETTA, ADAMICH JOHN, TIMMONS BRIANW. Exertion Testing in Youth with Mild Traumatic Brain Injury/Concussion. Med Sci Sports Exerc 2015; 47:2283-90. [DOI: 10.1249/mss.0000000000000682] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Rowson B, Rowson S, Duma SM. Hockey STAR: A Methodology for Assessing the Biomechanical Performance of Hockey Helmets. Ann Biomed Eng 2015; 43:2429-43. [PMID: 25822907 PMCID: PMC4569651 DOI: 10.1007/s10439-015-1278-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 02/10/2015] [Indexed: 12/14/2022]
Abstract
Optimizing the protective capabilities of helmets is one of several methods of reducing brain injury risk in sports. This paper presents the experimental and analytical development of a hockey helmet evaluation methodology. The Summation of Tests for the Analysis of Risk (STAR) formula combines head impact exposure with brain injury probability over the broad range of 227 head impacts that a hockey player is likely to experience during one season. These impact exposure data are mapped to laboratory testing parameters using a series of 12 impact conditions comprised of three energy levels and four head impact locations, which include centric and non-centric directions of force. Injury risk is determined using a multivariate injury risk function that incorporates both linear and rotational head acceleration measurements. All testing parameters are presented along with exemplar helmet test data. The Hockey STAR methodology provides a scientific framework for manufacturers to optimize hockey helmet design for injury risk reduction, as well as providing consumers with a meaningful metric to assess the relative performance of hockey helmets.
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Affiliation(s)
- Bethany Rowson
- Department of Biomedical Engineering and Mechanics, Virginia Tech, 313 Kelly Hall, 325 Stanger Street, Blacksburg, VA, 24061, USA.
| | - Steven Rowson
- Department of Biomedical Engineering and Mechanics, Virginia Tech, 313 Kelly Hall, 325 Stanger Street, Blacksburg, VA, 24061, USA
| | - Stefan M Duma
- Department of Biomedical Engineering and Mechanics, Virginia Tech, 313 Kelly Hall, 325 Stanger Street, Blacksburg, VA, 24061, USA
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Schulte S, Podlog LW, Hamson-Utley JJ, Strathmann FG, Strüder HK. A systematic review of the biomarker S100B: implications for sport-related concussion management. J Athl Train 2015; 49:830-50. [PMID: 25299445 DOI: 10.4085/1062-6050-49.3.33] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Elevated levels of the astroglial protein S100B have been shown to predict sport-related concussion. However, S100B levels within an athlete can vary depending on the type of physical activity (PA) engaged in and the methodologic approach used to measure them. Thus, appropriate reference values in the diagnosis of concussed athletes remain undefined. The purpose of our systematic literature review was to provide an overview of the current literature examining S100B measurement in the context of PA. The overall goal is to improve the use of the biomarker S100B in the context of sport-related concussion management. DATA SOURCES PubMed, SciVerse Scopus, SPORTDiscus, CINAHL, and Cochrane. STUDY SELECTION We selected articles that contained (1) research studies focusing exclusively on humans in which (2) either PA was used as an intervention or the test participants or athletes were involved in PA and (3) S100B was measured as a dependent variable. DATA EXTRACTION We identified 24 articles. Study variations included the mode of PA used as an intervention, sample types, sample-processing procedures, and analytic techniques. DATA SYNTHESIS Given the nonuniformity of the analytical methods used and the data samples collected, as well as differences in the types of PA investigated, we were not able to determine a single consistent reference value of S100B in the context of PA. Thus, a clear distinction between a concussed athlete and a healthy athlete based solely on the existing S100B cutoff value of 0.1 μg/L remains unclear. However, because of its high sensitivity and excellent negative predictive value, S100B measurement seems to have the potential to be a diagnostic adjunct for concussion in sports settings. We recommend that the interpretation of S100B values be based on congruent study designs to ensure measurement reliability and validity.
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Affiliation(s)
- Stefanie Schulte
- Department of Exercise and Sport Science, University of Utah, Salt Lake City
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Koerte IK, Lin AP, Willems A, Muehlmann M, Hufschmidt J, Coleman MJ, Green I, Liao H, Tate DF, Wilde EA, Pasternak O, Bouix S, Rathi Y, Bigler ED, Stern RA, Shenton ME. A review of neuroimaging findings in repetitive brain trauma. Brain Pathol 2015; 25:318-49. [PMID: 25904047 PMCID: PMC5699448 DOI: 10.1111/bpa.12249] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 02/05/2015] [Indexed: 12/14/2022] Open
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease confirmed at postmortem. Those at highest risk are professional athletes who participate in contact sports and military personnel who are exposed to repetitive blast events. All neuropathologically confirmed CTE cases, to date, have had a history of repetitive head impacts. This suggests that repetitive head impacts may be necessary for the initiation of the pathogenetic cascade that, in some cases, leads to CTE. Importantly, while all CTE appears to result from repetitive brain trauma, not all repetitive brain trauma results in CTE. Magnetic resonance imaging has great potential for understanding better the underlying mechanisms of repetitive brain trauma. In this review, we provide an overview of advanced imaging techniques currently used to investigate brain anomalies. We also provide an overview of neuroimaging findings in those exposed to repetitive head impacts in the acute/subacute and chronic phase of injury and in more neurodegenerative phases of injury, as well as in military personnel exposed to repetitive head impacts. Finally, we discuss future directions for research that will likely lead to a better understanding of the underlying mechanisms separating those who recover from repetitive brain trauma vs. those who go on to develop CTE.
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Affiliation(s)
- Inga K. Koerte
- Psychiatry Neuroimaging LaboratoryDepartments of Psychiatry and RadiologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMA
- Department of Child and Adolescent PsychiatryPsychosomatic and PsychotherapyDr. von Hauner Children's HospitalLudwig‐Maximilian UniversityMunichGermany
| | - Alexander P. Lin
- Psychiatry Neuroimaging LaboratoryDepartments of Psychiatry and RadiologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMA
- Center for Clinical SpectroscopyDepartment of RadiologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMA
| | - Anna Willems
- Psychiatry Neuroimaging LaboratoryDepartments of Psychiatry and RadiologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMA
- Department of Child and Adolescent PsychiatryPsychosomatic and PsychotherapyDr. von Hauner Children's HospitalLudwig‐Maximilian UniversityMunichGermany
| | - Marc Muehlmann
- Psychiatry Neuroimaging LaboratoryDepartments of Psychiatry and RadiologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMA
- Department of Child and Adolescent PsychiatryPsychosomatic and PsychotherapyDr. von Hauner Children's HospitalLudwig‐Maximilian UniversityMunichGermany
| | - Jakob Hufschmidt
- Psychiatry Neuroimaging LaboratoryDepartments of Psychiatry and RadiologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMA
- Department of Pediatric NeurologyDr. von Hauner Children's HospitalLudwig‐Maximilian UniversityMunichGermany
| | - Michael J. Coleman
- Psychiatry Neuroimaging LaboratoryDepartments of Psychiatry and RadiologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMA
| | - Isobel Green
- Psychiatry Neuroimaging LaboratoryDepartments of Psychiatry and RadiologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMA
| | - Huijun Liao
- Center for Clinical SpectroscopyDepartment of RadiologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMA
| | - David F. Tate
- General Dynamic Information Technologies ContractorDefense and Veterans Brain Injury CentersSan Antonio Military Medical CenterSan AntonioTX
| | - Elisabeth A. Wilde
- Departments of Physical Medicine and RehabilitationNeurology and RadiologyBaylor College of MedicineSan AntonioTX
- Michael E. DeBakey VA Medical CenterSan AntonioTX
| | - Ofer Pasternak
- Psychiatry Neuroimaging LaboratoryDepartments of Psychiatry and RadiologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMA
| | - Sylvain Bouix
- Psychiatry Neuroimaging LaboratoryDepartments of Psychiatry and RadiologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMA
| | - Yogesh Rathi
- Psychiatry Neuroimaging LaboratoryDepartments of Psychiatry and RadiologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMA
| | - Erin D. Bigler
- Neuroscience Center and Department of PsychologyBrigham Young UniversityProvoUT
| | - Robert A. Stern
- Departments of Neurology, Neurosurgery, and Anatomy and Neurobiology, Boston University Alzheimer's Disease CenterBoston University School of MedicineBostonMA
| | - Martha E. Shenton
- Psychiatry Neuroimaging LaboratoryDepartments of Psychiatry and RadiologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMA
- VA Boston Healthcare SystemBostonMA
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Rousseau P, Hoshizaki TB. Defining the effective impact mass of elbow and shoulder strikes in ice hockey. Sports Biomech 2015; 14:57-67. [DOI: 10.1080/14763141.2015.1025236] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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41
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Rowson B, Rowson S, Duma SM. Hockey STAR: A Methodology for Assessing the Biomechanical Performance of Hockey Helmets. Ann Biomed Eng 2015. [PMID: 25822907 DOI: 10.1007/s10439-015-1278-7.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Optimizing the protective capabilities of helmets is one of several methods of reducing brain injury risk in sports. This paper presents the experimental and analytical development of a hockey helmet evaluation methodology. The Summation of Tests for the Analysis of Risk (STAR) formula combines head impact exposure with brain injury probability over the broad range of 227 head impacts that a hockey player is likely to experience during one season. These impact exposure data are mapped to laboratory testing parameters using a series of 12 impact conditions comprised of three energy levels and four head impact locations, which include centric and non-centric directions of force. Injury risk is determined using a multivariate injury risk function that incorporates both linear and rotational head acceleration measurements. All testing parameters are presented along with exemplar helmet test data. The Hockey STAR methodology provides a scientific framework for manufacturers to optimize hockey helmet design for injury risk reduction, as well as providing consumers with a meaningful metric to assess the relative performance of hockey helmets.
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Affiliation(s)
- Bethany Rowson
- Department of Biomedical Engineering and Mechanics, Virginia Tech, 313 Kelly Hall, 325 Stanger Street, Blacksburg, VA, 24061, USA.
| | - Steven Rowson
- Department of Biomedical Engineering and Mechanics, Virginia Tech, 313 Kelly Hall, 325 Stanger Street, Blacksburg, VA, 24061, USA
| | - Stefan M Duma
- Department of Biomedical Engineering and Mechanics, Virginia Tech, 313 Kelly Hall, 325 Stanger Street, Blacksburg, VA, 24061, USA
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Echlin PS, Johnson AM, Holmes JD, Tichenoff A, Gray S, Gatavackas H, Walsh J, Middlebro T, Blignaut A, MacIntyre M, Anderson C, Fredman E, Mayinger M, Skopelja EN, Sasaki T, Bouix S, Pasternak O, Helmer KG, Koerte IK, Shenton ME, Forwell LA. The Sport Concussion Education Project. A brief report on an educational initiative: from concept to curriculum. J Neurosurg 2014; 121:1331-6. [PMID: 25280091 DOI: 10.3171/2014.8.jns132804] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Current research on concussion is primarily focused on injury identification and treatment. Prevention initiatives are, however, important for reducing the incidence of brain injury. This report examines the development and implementation of an interactive electronic teaching program (an e-module) that is designed specifically for concussion education within an adolescent population. This learning tool and the accompanying consolidation rubric demonstrate that significant engagement occurs in addition to the knowledge gained among participants when it is used in a school curriculum setting.
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Kroshus E, Baugh CM, Hawrilenko M, Daneshvar DH. Pilot Randomized Evaluation of Publically Available Concussion Education Materials. HEALTH EDUCATION & BEHAVIOR 2014; 42:153-62. [DOI: 10.1177/1090198114543011] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Many states and sports leagues are instituting concussion policies aimed at reducing risk of morbidity and mortality; many include mandates about the provision of concussion education to youth athletes. However, there is limited evidence if educational materials provided under these typically vague mandates are in fact effective in changing concussion risk-related behavior or any cognition predictive of risk-related behavior. The purpose of this pilot randomized controlled study was to conduct a theory-driven evaluation of three publically available concussion education materials: two videos and one informational handout. Participants were 256 late adolescent males from 12 teams in a single league of ice hockey competition in the United States. Randomization of educational condition occurred at the team level. Written surveys assessing postimpact symptom reporting behavior, concussion knowledge, and concussion reporting cognitions were completed by participants immediately before receiving their educational intervention, 1 day after, and 1 month after. Results indicated no change in any measure over any time interval, with the exception of perceived underreporting norms. In one of the video conditions, perceived underreporting norms increased significantly 1 day after viewing the video. Possible content and viewing environment-related reasons for this increase are discussed. Across all conditions, perceived underreporting norms increased 1 month after intervention receipt, raising the possibility that late in the competitive season underreporting may be perceived as normative. The need for the development of theory-driven concussion education materials, drawing on best practices from health behavior scholars, is discussed.
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Abstract
BACKGROUND Mixed martial arts (MMA) is a full combative sport with a recent global increase in popularity despite significant scrutiny from medical associations. To date, the empirical research of the risk of head injuries associated with this sport is limited. Youth and amateur participation is growing, warranting investigation into the burden and mechanism of injuries associated with this sport. PURPOSE (1) To determine the incidence, risk factors, and characteristics of knockouts (KOs) and technical knockouts (TKOs) from repetitive strikes in professional MMA; and (2) to identify the mechanisms of head trauma and the situational factors that lead to KOs and TKOs secondary to repetitive strikes through video analysis. STUDY DESIGN Descriptive epidemiology study. METHODS Competition data and video records for all KOs and TKOs from numbered Ultimate Fighting Championship MMA events (n = 844) between 2006 to 2012. Analyses included (1) multivariate logistic regression to investigate factors associated with an increased risk of sustaining a KO or TKO secondary to repetitive strikes and (2) video analysis of all KOs and TKOs secondary to repetitive strikes with descriptive statistics. RESULTS During the study period, the KO rate was 6.4 per 100 athlete-exposures (AEs) (12.7% of matches), and the rate of TKOs secondary to repetitive strikes was 9.5 per 100 AEs (19.1% of matches), for a combined incidence of match-ending head trauma of 15.9 per 100 AEs (31.9% of matches). Logistic regression identified that weight class, earlier time in a round, earlier round in a match, and older age were risk factors for both KOs and TKOs secondary to repetitive strikes. Match significance and previously sustained KOs or TKOs were also risk factors for KOs. Video analysis identified that all KOs were the result of direct impact to the head, most frequently a strike to the mandibular region (53.9%). The average time between the KO-strike and match stoppage was 3.5 seconds (range, 0-20 seconds), with losers sustaining an average of 2.6 additional strikes (range, 0-20 strikes) to the head. For TKOs secondary to strikes, in the 30-second interval immediately preceding match stoppage, losers sustained, on average, 18.5 strikes (range, 5-46 strikes), with 92.3% of these being strikes to the head. CONCLUSION Rates of KOs and TKOs in MMA are higher than previously reported rates in other combative and contact sports. Public health authorities and physicians should be cognizant of the rates and mechanisms of head trauma. Preventive measures to lessen the risks of head trauma for those who elect to participate in MMA are described.
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Affiliation(s)
- Michael G Hutchison
- David L. MacIntosh Sport Medicine Clinic, Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - David W Lawrence
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michael D Cusimano
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada Division of Neurosurgery, Injury Prevention Research Office, St Michael's Hospital, Toronto, Ontario, Canada
| | - Tom A Schweizer
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada Keenan Research Centre for Biomedical Science of St Michael's Hospital, Toronto, Ontario, Canada
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Sasaki T, Pasternak O, Mayinger M, Muehlmann M, Savadjiev P, Bouix S, Kubicki M, Fredman E, Dahlben B, Helmer KG, Johnson AM, Holmes JD, Forwell LA, Skopelja EN, Shenton ME, Echlin PS, Koerte IK. Hockey Concussion Education Project, Part 3. White matter microstructure in ice hockey players with a history of concussion: a diffusion tensor imaging study. J Neurosurg 2014; 120:882-90. [PMID: 24471841 DOI: 10.3171/2013.12.jns132092] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECT The aim of this study was to examine the brain's white matter microstructure by using MR diffusion tensor imaging (DTI) in ice hockey players with a history of clinically symptomatic concussion compared with players without a history of concussion. METHODS Sixteen players with a history of concussion (concussed group; mean age 21.7 ± 1.5 years; 6 female) and 18 players without a history of concussion (nonconcussed group; mean age 21.3 ± 1.8 years, 10 female) underwent 3-T DTI at the end of the 2011-2012 Canadian Interuniversity Sports ice hockey season. Tract-based spatial statistics (TBSS) was used to test for group differences in fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD), and the measure "trace," or mean diffusivity. Cognitive evaluation was performed using the Immediate Postconcussion Assessment and Cognitive Test (ImPACT) and the Sport Concussion Assessment Tool-2 (SCAT2). RESULTS TBSS revealed a significant increase in FA and AD, and a significant decrease in RD and trace in several brain regions in the concussed group, compared with the nonconcussed group (p < 0.05). The regions with increased FA and decreased RD and trace included the right posterior limb of the internal capsule, the right corona radiata, and the right temporal lobe. Increased AD was observed in a small area in the left corona radiata. The DTI measures correlated with neither the ImPACT nor the SCAT2 scores. CONCLUSIONS The results of the current study indicate that a history of concussion may result in alterations of the brain's white matter microstructure in ice hockey players. Increased FA based on decreased RD may reflect neuroinflammatory or neuroplastic processes of the brain responding to brain trauma. Future studies are needed that include a longitudinal analysis of the brain's structure and function following a concussion to elucidate further the complex time course of DTI changes and their clinical meaning.
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Affiliation(s)
- Takeshi Sasaki
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts
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Epidemiology of concussion in sport: a literature review. J Chiropr Med 2014; 12:230-51. [PMID: 24396326 DOI: 10.1016/j.jcm.2012.11.005] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 11/19/2012] [Accepted: 11/30/2012] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The purpose of this study was to summarize sport concussion incidence data, identify sports that present higher injury frequency, reveal the degree of risk in some lesser-known sports, and outline specific details within the sports literature that raise additional concerns, such as helmet-to-helmet contact and player positions that experience frequent impact. METHODS A systematic literature review of Pub Med using keyword search on injury, concussion, and sports was performed through May 2012. Abstracts were identified, selections were made based upon inclusion criteria, and full-length articles were obtained. Additional articles were considered following review of reference sections. Articles were reviewed and tabulated according to sport. RESULTS Two hundred eighty-nine articles were screened, and 62 articles were reviewed. The overall incidence of concussion in sport ranged from 0.1 to 21.5 per 1000 athletic exposures. The lowest incidence was reported in swimming and diving. Concussion incidence was highest in Canadian junior ice hockey, but elevated incidence in American football remains a concern because of the large number of participants. CONCLUSIONS The literature reviewed included incidence of concussion on the field of play under real-world conditions and influenced by the current culture of sport. The studies examined in this article show that there is risk of concussion in nearly every sport. Some sports have higher concussion frequency than others, which may depend upon the forces and roles of the positions played in these sports. Younger athletes have a higher incidence of concussion, and female incidence is greater than male in many comparable sports. Headgear may reduce concussion in some sports but may also give athletes a false sense of protection.
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Abrahams S, Fie SM, Patricios J, Posthumus M, September AV. Risk factors for sports concussion: an evidence-based systematic review. Br J Sports Med 2013; 48:91-7. [DOI: 10.1136/bjsports-2013-092734] [Citation(s) in RCA: 142] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Tator CH. Concussions and their consequences: current diagnosis, management and prevention. CMAJ 2013; 185:975-9. [PMID: 23877672 DOI: 10.1503/cmaj.120039] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Charles H Tator
- The Division of Neurosurgery, University of Toronto, Toronto, Ont.
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Register-Mihalik JK, Guskiewicz KM, McLeod TCV, Linnan LA, Mueller FO, Marshall SW. Knowledge, attitude, and concussion-reporting behaviors among high school athletes: a preliminary study. J Athl Train 2013; 48:645-53. [PMID: 23848520 DOI: 10.4085/1062-6050-48.3.20] [Citation(s) in RCA: 317] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Many athletes continue to participate in practices and games while experiencing concussion-related symptoms, potentially predisposing them to subsequent and more complicated brain injuries. Limited evidence exists about factors that may influence concussion-reporting behaviors. OBJECTIVE To examine the influence of knowledge and attitude on concussion-reporting behaviors in a sample of high school athletes. DESIGN Cross-sectional study. SETTING Participants completed a validated survey instrument via mail. PATIENTS OR OTHER PARTICIPANTS A total of 167 high school athletes (97 males, 55 females, 5 sex not indicated; age = 15.7 ± 1.4 years) participating in football, soccer, lacrosse, or cheerleading. INTERVENTION(S) Athlete knowledge and attitude scores served as separate predictor variables. MAIN OUTCOME MEASURE(S) We examined the proportion of athletes who reported continuing to participate in games and practices while symptomatic from possible concussion and the self-reported proportion of recalled concussion and bell-ringer events disclosed after possible concussive injury. RESULTS Only 40% of concussion events and 13% of bell-ringer recalled events in the sample were disclosed after possible concussive injury. Increased athlete knowledge of concussion topics (increase of 1 standard deviation = 2.8 points) was associated with increased reporting prevalence of concussion and bell-ringer events occurring in practice (prevalence ratio [PR] = 2.27, 95% confidence interval [CI] = 1.60, 3.21) and the reporting prevalence of bell-ringer-only events overall (PR = 1.87, 95% CI = 1.38, 2.54). Athlete attitude scores (increase of 1 standard deviation = 11.5 points) were associated with decreases in the proportion of athletes stating they participated in games (PR = 0.74, 95% CI = 0.66, 0.82) and practices (PR = 0.67, 95% CI = 0.59, 0.77) while symptomatic from concussions. CONCLUSIONS Most recalled concussion events in our study were not reported to a supervising adult. Clinicians should be aware that knowledge and attitude influence concussion reporting. Clinicians and administrators should make concussion education a priority and encourage an optimal reporting environment to better manage and prevent concussive injuries in young athletes.
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