Concussion Burden, Recovery, and Risk Factors in Elite Youth Ice Hockey Players

Schneider, Kathryn; Nettel-Aguirre, Alberto; Palacios-Derflingher, Luz; Mrázik, Martin; Brooks, Brian L.; Woollings, Kaikanani; Blake, Tracy; McKay, Carly; Lebrun, Constance M.; Barlow, Karen M.; Taylor, Kerry; Lemke, Nicole; Meeuwisse, Willem; Emery, Carolyn A.

doi:10.1097/jsm.0000000000000673

Cited by 31 publications

(25 citation statements)

References 22 publications

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“…Consistent with this, 20% of elite youth ice hockey players were not cleared at 30 days after injury. 22 Zemek et al 23 reported that 30% of children and adolescents (age range, 5-17 years) reporting to the emergency department had persistent symptoms for >28 days. Kontos et al 14 reported that 61% of patients (age range, 12-22 years) assessed at a sports medicine clinic had not yet recovered at 30 days.…”

Section: Discussionmentioning

confidence: 99%

“… 10 In youth, 60% of concussions are sustained in sports, and >30% of concussions are expected to be recurrent. 2 , 20 , 22 In youth ice hockey (age range, 11-17 years), concussion rates are high, ranging from 2.8 to 4.2 concussions per 1000 game-hours in leagues allowing body checking and 1.1 to 2.31 concussions per 1000 game-hours in leagues not allowing body checking. 4 , 8 , 9 , 11 Studies evaluating time to clinical recovery in children and adolescents have reported that 15% to 30% remain symptomatic >1 month and 11% remain symptomatic for >3 months.…”

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confidence: 99%

“…Ice hockey may be unique given the high rates of concussion in youth players and the mechanisms of concussion in youth ice hockey associated with body checking and higher player speeds compared with other high concussion risk youth collision sports such as football and rugby. 4 , 8 , 9 , 11 , 22 …”

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confidence: 99%

“…4,8,9,11 Studies evaluating time to clinical recovery in children and adolescents have reported that 15% to 30% remain symptomatic >1 month and 11% remain symptomatic for >3 months. [1][2][3][22][23][24] The long-term effects of concussion in youth are largely unknown. The 5th International Conference on Concussion in Sport reported a standard definition for persistent postconcussive symptoms to ensure consistency in clinical management and research outcomes.…”

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confidence: 99%

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Factors Associated With Clinical Recovery After Concussion in Youth Ice Hockey Players

Emery

Black

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: The identification of factors associated with clinical recovery in youth after sports-related concussion could improve prognostication regarding return to play (RTP). Purpose: To assess factors associated with clinical recovery after concussion in youth ice hockey players. Study Design: Cohort study; Level of evidence, 2. Methods: Participants were part of a larger longitudinal cohort study (the Safe to Play study; N = 3353). Included were 376 ice hockey players (age range, 11-17 years) from teams in Calgary and Edmonton, Canada, with 425 physician-diagnosed ice hockey–related concussions over 5 seasons (2013-2018). Any player with a suspected concussion was referred to a sports medicine physician for diagnosis, and a Sport Concussion Assessment Tool (SCAT) form was completed. Time to clinical recovery was based on time between concussion and physician clearance to RTP. Two accelerated failure time models were used to estimate days to RTP clearance: model 1 considered symptom severity according to the SCAT3/SCAT5 symptom evaluation score (range, 0-132 points), and model 2 considered responses to individual symptom evaluation items (eg, headache, neck pain, dizziness) of none/mild (0-2 points) versus moderate/severe (3-6 points). Other covariates were time to physician first visit (≤7 and >7 days), age group (11-12, 13-14, and 15-17 years), sex, league type (body checking and no body checking), tandem stance (modified Balance Error Scoring System result ≥4 errors out of 10), and number of previous concussions (0, 1, 2, and ≥3). Results: The complete case analysis (including players without missing covariates) included 329 players (366 diagnosed concussions). The median time to clinical recovery was 18 days. In model 1, longer time to first physician visit (>7 days) (time ratio [TR], 1.637 [95% confidence interval (CI), 1.331-1.996]) and greater symptom severity (TR, 1.016 [95% CI, 1.012-1.020]) were significant predictors of longer clinical recovery. In model 2, longer time to first physician visit (TR, 1.698 [95% CI, 1.399-2.062]), headache (moderate/severe) (TR, 1.319 [95% CI, 1.110-1.568]), and poorer tandem stance (TR, 1.249 [95% CI, 1.052-1.484]) were significant predictors of longer clinical recovery. Conclusion: Medical clearance to RTP was longer for players with >7 days to physician assessment, poorer tandem stance, greater symptom severity, and moderate/severe headache at first visit.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Factors Associated With Clinical Recovery After Concussion in Youth Ice Hockey Players

Emery

Black

et al. 2021

Orthopaedic Journal of Sports Medicine

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“…The primary research objectives for both original cohort studies were different from that of the current study on mouthguard use and concussion risk27–29 However, the data from both cohorts provided an opportunity to examine the issue of concussion and mouthguard use as the data on mouthguard use were available, consistently collected and the timing was fortuitous in light of the policy climate. As such, there was no a priori sample size calculation.…”

Section: Methodsmentioning

confidence: 98%

Mouthguard use in youth ice hockey and the risk of concussion: nested case–control study of 315 cases

et al. 2020

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BackgroundConcussion is the most common injury in youth ice hockey. Whether mouthguard use lowers the odds of concussion remains an unanswered question.ObjectiveTo determine the association between concussion and mouthguard use in youth ice hockey.MethodsNested case–control design. Cases and controls were identified from two prospective cohort studies using valid injury surveillance methods. Cases were players concussed during a game or practice; controls were players who sustained a non-concussion injury during a game or practice. The primary exposure was mouthguard use at time of injury; mouthguard type (dental custom fit or off the shelf) was a secondary exposure. Physician-diagnosed or therapist-suspected concussion was the primary outcome. Dental injury was a secondary outcome. Multilevel logistic regression with random effect at a team level was used to obtain ORs for the mouthguard effect, adjusted for level of play, age group, position, concussion history, mechanism of injury, cohort, session type and body checking policy.ResultsAmong cases, 236/315 (75%) were wearing a mouthguard at time of injury, while 224/270 (83%) controls were wearing a mouthguard at time of injury. Any mouthguard use was associated with an adjusted OR for concussion of 0.36 (95% CI 0.17 to 0.73). Off-the-shelf mouthguards were associated with a 69% lower odds of concussion (adjusted OR: 0.31; 95% CI 0.14 to 0.65). Dental custom-fit mouthguards were associated with a non-significant 49% lower odds of concussion (adjusted OR: 0.51; 95% CI 0.22 to 1.10). No dental injuries were identified in either cohort.ConclusionMouthguard use was associated with lower odds of concussion. Players should be required to wear mouthguards in youth ice hockey.

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Data-Driven Risk Classification of Concussion Rates: A Systematic Review and Meta-Analysis

Pelt

Puetz²,

Swallow

et al. 2021

Sports Med

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Concussion Burden, Recovery, and Risk Factors in Elite Youth Ice Hockey Players

Cited by 31 publications

References 22 publications

Factors Associated With Clinical Recovery After Concussion in Youth Ice Hockey Players

Factors Associated With Clinical Recovery After Concussion in Youth Ice Hockey Players

Mouthguard use in youth ice hockey and the risk of concussion: nested case–control study of 315 cases

Data-Driven Risk Classification of Concussion Rates: A Systematic Review and Meta-Analysis

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