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Purcell L, Ahmed OH, Blauwet C, Meeuwisse W, Schneider KJ. Jamie Kissick: a champion for concussion education and Para sport. Br J Sports Med 2024; 58:235-236. [PMID: 38286572 DOI: 10.1136/bjsports-2024-108083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 01/31/2024]
Affiliation(s)
- Laura Purcell
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Osman Hassan Ahmed
- Physiotherapy Department, University Hospitals Dorset NHS Foundation Trust, Poole, UK
- The FA Centre for Para Football Research, The Football Association, Burton upon Trent, UK
| | - Cheri Blauwet
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
| | - Willem Meeuwisse
- 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
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Hutchison MG, Di Battista AP, Meeuwisse W, Bruce JM, Echemendia RJ, Delaney JS, Comper P. Concussion Characteristics in the National Hockey League Before and After the Introduction of Rule 48. JAMA Netw Open 2023; 6:e2344399. [PMID: 37991764 PMCID: PMC10665971 DOI: 10.1001/jamanetworkopen.2023.44399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/12/2023] [Indexed: 11/23/2023] Open
Abstract
Importance A rule prohibiting a direct hit to the lateral side of the head (ie, Rule 48-Illegal Check to the Head) was introduced in the National Hockey League (NHL) in the 2010-2011 season and refined in the 2011-2012 season to widen the application to include direct contact to all areas of the head. Objective To compare the incidence and proportion of concussions that occurred following hits to the head before and after the implementation of Rule 48. Design, Setting, and Participants This retrospective cohort study used a before and after design to evaluate concussions among NHL players in regular season games. Data from the 4 seasons preceding the implementation of Rule 48 (2006-2007 to 2009-2010) were compared with data from 5 seasons following its implementation (2014-2015 to 2018-2019). Data were analyzed from October 31, 2021, to November 30, 2022. Main Outcomes and Measures The incidence and relative proportion of concussion characteristics and mechanisms before and after the introduction of Rule 48. Results In the analysis of 688 concussions for NHL seasons spanning 2006 to 2010 (n = 231) and 2014 to 2019 (n = 457), there was an overall increase in the incidence of concussion between the 2 time frames, although the incidence of concussions due to hits to the lateral aspect of the head decreased from 1.6/100 games to 1.0/100 games (estimated difference, 0.6/100 games [90% credible interval (CrI), 0.30/100 games to 0.90/100 games). There was also a reduction of 18.8 (90% CrI, 13.0-23.7) percentage points in the proportion of concussions due to hits to the lateral aspect of the head from 80 of 231 concussions (34.6%) to 61 of 457 concussions (13.3%). The incidence of concussions following hits to the head from body checks using the shoulder, arm, and glove was similar before and following the implementation of Rule 48. However, the proportion was reduced 14.7 percentage points from 113 of 231 concussions (48.9%) before to 149 of 457 concussions (32.6%) after implementation of Rule 48 (90% CrI of the difference, 8.9-20.7 percentage points). Conclusions and Relevance The findings of this cohort study of NHL players suggest that after the introduction of Rule 48, the incidence rate and proportion of concussions from contact to the lateral aspect of the head decreased, as did the proportion of concussions following direct hits to the head.
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Affiliation(s)
- Michael G Hutchison
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
- David L. MacIntosh Sport Medicine Clinic, Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Alex P Di Battista
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | | | - Jared M Bruce
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine
- Department of Neurology, University of Missouri-Kansas City School of Medicine
- Department of Psychiatry, University of Missouri-Kansas City School of Medicine
| | - Ruben J Echemendia
- Concussion Care Clinic, University Orthopedic Center, University of Missouri-Kansas City
| | - J Scott Delaney
- Department of Emergency Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Paul Comper
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Schneider KJ, Patricios JS, Meeuwisse W, Schneider GM, Hayden KA, Premji Z, Ahmed OH, Blauwet C, Broglio S, Cantu RC, Davis GA, Dvorak J, Echemendia RJ, Emery CA, Iverson GL, Leddy JJ, Makdissi M, McCrea M, McNamee M, Putukian M, Yeates KO, Black AM, Burma JS, Critchley M, Eliason PH, Räisänen AM, Tabor JB, Toomey C, Ronksley PE, Cassidy JD. Amsterdam 2022 process: A summary of the methodology for the Amsterdam International Consensus on Concussion in Sport. Br J Sports Med 2023; 57:712-721. [PMID: 37316208 DOI: 10.1136/bjsports-2022-106663] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 06/16/2023]
Abstract
The purpose of this paper is to summarise the consensus methodology that was used to inform the International Consensus Statement on Concussion in Sport (Amsterdam 2022). Building on a Delphi process to inform the questions and outcomes from the 5th International Conference on Concussion in Sport, the Scientific Committee identified key questions, the answers to which would help encapsulate the current science in sport-related concussion and help guide clinical practice. Over 3½ years, delayed by 2 years due to the pandemic, author groups conducted systematic reviews on each selected topic. The 6th International Conference on Concussion in Sport was held in Amsterdam (27-30 October 2022) and consisted of 2 days of systematic review presentations, panel discussions, question and answer engagement with the 600 attendees, and abstract presentations. This was followed by a closed third day of consensus deliberations by an expert panel of 29 with observers in attendance. The fourth day, also closed, was dedicated to a workshop to discuss and refine the sports concussion tools (Concussion Recognition Tool 6 (CRT6), Sport Concussion Assessment Tool 6 (SCAT6), Child SCAT6, Sport Concussion Office Assessment Tool 6 (SCOAT6) and Child SCOAT6). We include a summary of recommendations for methodological improvements for future research that grew out of the systematic reviews.
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Affiliation(s)
- Kathryn J Schneider
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Jon S Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Geoff M Schneider
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - K Alix Hayden
- Libraries and Cultural Resources, University of Calgary, Calgary, Alberta, Canada
| | - Zahra Premji
- Libraries, University of Victoria, Victoria, British Columbia, Canada
| | - Osman Hassan Ahmed
- Physiotherapy Department, University Hospitals Dorset NHS Foundation Trust, Poole, UK
- The FA Centre for Para Football Research, The Football Association, Burton-Upon-Trent, UK
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Cheri Blauwet
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation, Spaulding Hospital/Brigham and Women's Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
- Kelley Adaptive Sports Research Institute, Boston, Massachusetts, USA
| | - Steven Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Robert C Cantu
- Centre for the Study of Traumatic Encephalopathy, Boston University School of Medicine, Boston, Massachusetts, USA
- Neurosurgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Gavin A Davis
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Cabrini Health, Malvern, Victoria, Australia
| | - Jiri Dvorak
- Spine Unit, Schulthess Clinic Human Performance Lab, Zurich, Switzerland
| | - Ruben J Echemendia
- Psychology, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Carolyn A Emery
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Grant L Iverson
- Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- Sports Concussion Program, MassGeneral Hospital for Children, Boston, Massachusetts, USA
| | - John J Leddy
- UBMD Orthopaedics and Sports Medicine, SUNY Buffalo, Buffalo, New York, USA
| | - Michael Makdissi
- Florey Institute of Neuroscience and Mental Health - Austin Campus, Heidelberg, Victoria, Australia
- La Trobe Sport and Exercise Medicine Research Centre, Melbourne, Victoria, Australia
| | - Michael McCrea
- Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Michael McNamee
- Department of Movement Sciences, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
- Swansea University, Swansea, UK
| | - Margot Putukian
- Major League Soccer, Major League Soccer, New York, New York, USA
| | - Keith Owen Yeates
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Amanda M Black
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Joel S Burma
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | | | | | - Anu M Räisänen
- Department of Physical Therapy Education - Oregon, Western University of Health Sciences College of Health Sciences - Northwest, Lebanon, Oregon, USA
| | | | - Clodagh Toomey
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- School of Allied Health, University of Limerick, Limerick, Ireland
| | - Paul E Ronksley
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - J David Cassidy
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Patricios JS, Schneider KJ, Dvorak J, Ahmed OH, Blauwet C, Cantu RC, Davis GA, Echemendia RJ, Makdissi M, McNamee M, Broglio S, Emery CA, Feddermann-Demont N, Fuller GW, Giza CC, Guskiewicz KM, Hainline B, Iverson GL, Kutcher JS, Leddy JJ, Maddocks D, Manley G, McCrea M, Purcell LK, Putukian M, Sato H, Tuominen MP, Turner M, Yeates KO, Herring SA, Meeuwisse W. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport-Amsterdam, October 2022. Br J Sports Med 2023; 57:695-711. [PMID: 37316210 DOI: 10.1136/bjsports-2023-106898] [Citation(s) in RCA: 98] [Impact Index Per Article: 98.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2023] [Indexed: 06/16/2023]
Abstract
For over two decades, the Concussion in Sport Group has held meetings and developed five international statements on concussion in sport. This 6th statement summarises the processes and outcomes of the 6th International Conference on Concussion in Sport held in Amsterdam on 27-30 October 2022 and should be read in conjunction with the (1) methodology paper that outlines the consensus process in detail and (2) 10 systematic reviews that informed the conference outcomes. Over 3½ years, author groups conducted systematic reviews of predetermined priority topics relevant to concussion in sport. The format of the conference, expert panel meetings and workshops to revise or develop new clinical assessment tools, as described in the methodology paper, evolved from previous consensus meetings with several new components. Apart from this consensus statement, the conference process yielded revised tools including the Concussion Recognition Tool-6 (CRT6) and Sport Concussion Assessment Tool-6 (SCAT6, Child SCAT6), as well as a new tool, the Sport Concussion Office Assessment Tool-6 (SCOAT6, Child SCOAT6). This consensus process also integrated new features including a focus on the para athlete, the athlete's perspective, concussion-specific medical ethics and matters related to both athlete retirement and the potential long-term effects of SRC, including neurodegenerative disease. This statement summarises evidence-informed principles of concussion prevention, assessment and management, and emphasises those areas requiring more research.
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Affiliation(s)
- Jon S Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Jiri Dvorak
- Spine Unit, Schulthess Clinic Human Performance Lab, Zurich, Switzerland
| | - Osman Hassan Ahmed
- Physiotherapy Department, University Hospitals Dorset NHS Foundation Trust, Poole, UK
- The FA Centre for Para Football Research, The Football Association, Burton-Upon-Trent, Staffordshire, UK
| | - Cheri Blauwet
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation/Harvard Medical School, Boston, Massachusetts, USA
- Kelley Adaptive Sports Research Institute, Spaulding Rehabilitation, Boston, Massachusetts, USA
| | - Robert C Cantu
- CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Gavin A Davis
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Cabrini Health, Malvern, Victoria, Australia
| | - Ruben J Echemendia
- Psychology, University of Missouri Kansas City, Kansas City, Missouri, USA
- Psychological and Neurobehavioral Associates, Inc, Miami, Florida, USA
| | - Michael Makdissi
- Florey Institute of Neuroscience and Mental Health-Austin Campus, Heidelberg, Victoria, Australia
- La Trobe Sport and Exercise Medicine Research Centre, Melbourne, Victoria, Australia
| | - Michael McNamee
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
- School of Sport and Exercise Medicine, Swansea University, Swansea, UK
| | - Steven Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Nina Feddermann-Demont
- University Hospital Zurich, Zurich, Switzerland
- Sports Neuroscience, University of Zurich, Zurich, Switzerland
| | - Gordon Ward Fuller
- School of Health and Related Research, University of Sheffield, Sheffield, South Yorkshire, UK
| | - Christopher C Giza
- Neurosurgery, UCLA Steve Tisch BrainSPORT Program, Los Angeles, California, USA
- Pediatrics/Pediatric Neurology, Mattel Children's Hospital UCLA, Los Angeles, California, USA
| | - Kevin M Guskiewicz
- Matthew Gfeller Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brian Hainline
- National Collegiate Athletic Association (NCAA), Indianapolis, Indiana, USA
| | - Grant L Iverson
- Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- Sports Concussion Program, MassGeneral Hospital for Children, Boston, Massachusetts, USA
| | | | - John J Leddy
- UBMD Orthopaedics and Sports Medicne, SUNY Buffalo, Buffalo, New York, USA
| | - David Maddocks
- Melbourne Neuropsychology Services & Perry Maddocks Trollope Lawyers, Melbourne, Victoria, Australia
| | - Geoff Manley
- Neurosurgery, University of California, San Francisco, San Francisco, California, USA
| | - Michael McCrea
- Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Laura K Purcell
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | | | - Haruhiko Sato
- Neurosurgery, Seirei Mikatahara Hospital, Hamamatsu, Japan
| | | | - Michael Turner
- International Concussion and Head Injury Research Foundation, London, UK
- University College London, London, UK
| | | | - Stanley A Herring
- Department of Rehabilitation Medicine, Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington, USA
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
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5
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Echemendia RJ, Thelen J, Meeuwisse W, Comper P, Hutchison MG, Rizos J, Bruce JM. The Utility of the King-Devick Test in Evaluating Professional Ice Hockey Players With Suspected Concussion. Clin J Sport Med 2022; 32:265-271. [PMID: 32941373 DOI: 10.1097/jsm.0000000000000841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 02/11/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study was to (1) examine the diagnostic utility of the King-Devick (KD) in professional ice hockey players and (2) determine whether the KD provides unique variance in predicting a diagnosis of concussion when given in combination with the SCAT-5. STUDY DESIGN Cohort Study. SETTING Primary care. PATIENTS/PARTICIPANTS Professional ice hockey players. INDEPENDENT VARIABLES Diagnosis versus no diagnosis of concussion. MAIN OUTCOME MEASURES King-Devick and SCAT-5 component scores. METHODS In part 1, players suspected of having a concussion were evaluated at baseline and acutely with the KD and either the SCAT-3 or the SCAT-5. Players evaluated and not diagnosed with concussion served as active controls. In part 2, a separate group of players suspected of having a concussion was evaluated acutely with both the KD and SCAT-5. RESULTS In part 1 of this study, 53 concussed players declined in performance on the KD from baseline to acute evaluation, whereas the performance of 76 active controls improved significantly. In part 2 of the study, 75 players were diagnosed with concussion and compared with 80 active controls who were evaluated and not diagnosed with concussion. Concussed players revealed a decline in KD performance from baseline to acute evaluation when compared with controls. However, the KD did not account for significant unique variance in predicting a diagnosis of concussion after accounting for SCAT-5 data. CONCLUSIONS The KD is useful in differentiating concussed and not concussed athletes acutely, but the KD does not seem to add additional diagnostic value over and above the SCAT-5.
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Affiliation(s)
- Ruben J Echemendia
- University Orthopedic Center, State College, Pennsylvania
- Department of Psychology, University of Missouri-Kansas City, Kansas City, Missouri
| | - Joanie Thelen
- Department of Psychology, University of Missouri-Kansas City, Kansas City, Missouri
| | | | - Paul Comper
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Michael G Hutchison
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - John Rizos
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada ; and
| | - Jared M Bruce
- Department of Biomedical and Health Informatics, UMKC School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
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Bruce JM, Meeuwisse W, Hutchison MG, Comper P, Echemendia RJ. Determining Sport Concussion Assessment Tool fifth Edition (SCAT5) reliable change in male professional hockey players. Br J Sports Med 2022; 56:bjsports-2021-104851. [PMID: 35338037 DOI: 10.1136/bjsports-2021-104851] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES The purpose of this paper is to provide reliable change metrics and assess the test-retest psychometrics of the Sport Concussion Assessment Tool fifth Edition (SCAT5) in a multilingual sample of professional ice hockey players. METHODS The SCAT5 was administered to National Hockey League and American Hockey League male professional ice hockey players as part of the 2018 and 2019 season medical evaluations. We extracted data from an existing clinical database of players who were administered two consecutive baseline evaluations and had no intervening concussions to assess psychometric properties (eg, test-retest reliability) and develop reliable change metrics. RESULTS Overall, 1007 players met inclusion criteria. Players were reassessed on average 344.52 (±62.52) days following their first baseline. Test-retest reliability ranged from r=0.3 to r=0.5. Reliable change metrics for Immediate Memory varied considerably dependent on form order. Significant differences were found between English versus non-English language preference on Immediate Memory and Concentration but not Delayed Memory or the modified Balance Error Scoring System (mBESS). Reliable change indices at the 90% CI were: Symptom Severity (5), Total Symptoms (3), Immediate Memory (3-8), Concentration (2), mBESS (5) and Delayed Memory (2-4). CONCLUSIONS Our findings highlight the importance of considering form differences and language preference when determining reliable change from baseline on the SCAT5 in male professional hockey players. The relatively modest test-retest reliability of the measures leaves room for improved psychometric properties and increased sensitivity to concussion in future iterations of the SCAT.
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Affiliation(s)
- Jared M Bruce
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Willem Meeuwisse
- Department of Player Health, National Hockey League, New York City, New York, USA
| | - Michael G Hutchison
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Paul Comper
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Ruben J Echemendia
- Department of Psychology, University of Missouri-Kansas City, Kansas City, Missouri, USA
- Psychological and Neurobehavioral Associates, Inc, State College, Pennsylvania, USA
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Bruce JM, Meeuwisse W, Thelen J, Hutchison MG, Comper P, Echemendia RJ. A Cross-Sectional Decision-Making Approach to Inform Neuropsychological Battery Development in Professional Hockey. Arch Clin Neuropsychol 2021; 37:621-632. [PMID: 34929026 DOI: 10.1093/arclin/acab092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Neuropsychologists commonly use a large battery of tests to inform clinical decisions. Decision analysis can be used to determine which individual tests play a role in the decision-making process. The objective of this project was to conduct quantitative and qualitative decision analysis of decisions by team neuropsychologists with professional hockey players being evaluated as part of the National Hockey League (NHL)/NHL Players Association Concussion Protocol. METHOD We extracted neuropsychological data from an NHL clinical program database. Team neuropsychologists evaluated concussed players using a hybrid neuropsychological test battery. The neuropsychologists then determined whether players were experiencing concussion-related cognitive difficulties. Logistic regression was used to examine which tests accounted for unique variance in the decision-making process. We also conducted a survey of NHL neuropsychologists, asking them to rate the usefulness of each test in the battery. RESULTS Five of the fifteen measures accounted for unique variance in team neuropsychologists' decisions, including the ImPACT Verbal Memory Composite, Visual Motor Composite, Reaction Time Composite, Symptom Score, and Brief Visuospatial Memory Test-Revised Delayed Recall. Notable discrepancies were uncovered between quantitative indications of usefulness and self-reported qualitative perceptions of test usefulness when making decisions. Qualitatively, clinicians reported that the Hopkins Verbal Learning Test-Revised, Symbol Digit Modalities Test, ImPACT Reaction Time, and Color Trails 2 were the most useful tests when making decisions. CONCLUSIONS Along with validation studies, decision analysis can be used as part of a comprehensive evaluation process to inform the development of best-practice batteries for use among athletes with sports concussion.
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Affiliation(s)
- Jared M Bruce
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City, Kansas City, MO 64108, USA
| | | | - Joan Thelen
- Department of Psychology, University of Missouri-Kansas City, Kansas City, MO 64108, USA
| | - Michael G Hutchison
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON MS55 1A1, Canada
| | - Paul Comper
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON MS55 1A1, Canada.,Toronto Rehabilitation Institute, Toronto, ON M5G 2A2, Canada
| | - Ruben J Echemendia
- Psychological and Neurobehavioral Associates, Inc., State College, PA 16801, USA
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8
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Martinez MW, Tucker AM, Bloom OJ, Green G, DiFiori JP, Solomon G, Phelan D, Kim JH, Meeuwisse W, Sills AK, Rowe D, Bogoch II, Smith PT, Baggish AL, Putukian M, Engel DJ. Prevalence of Inflammatory Heart Disease Among Professional Athletes With Prior COVID-19 Infection Who Received Systematic Return-to-Play Cardiac Screening. JAMA Cardiol 2021; 6:745-752. [PMID: 33662103 DOI: 10.1001/jamacardio.2021.0565] [Citation(s) in RCA: 168] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The major North American professional sports leagues were among the first to return to full-scale sport activity during the coronavirus disease 2019 (COVID-19) pandemic. Given the unknown incidence of adverse cardiac sequelae after COVID-19 infection in athletes, these leagues implemented a conservative return-to-play (RTP) cardiac testing program aligned with American College of Cardiology recommendations for all athletes testing positive for COVID-19. Objective To assess the prevalence of detectable inflammatory heart disease in professional athletes with prior COVID-19 infection, using current RTP screening recommendations. Design, Setting, and Participants This cross-sectional study reviewed RTP cardiac testing performed between May and October 2020 on professional athletes who had tested positive for COVID-19. The professional sports leagues (Major League Soccer, Major League Baseball, National Hockey League, National Football League, and the men's and women's National Basketball Association) implemented mandatory cardiac screening requirements for all players who had tested positive for COVID-19 prior to resumption of team-organized sports activities. Exposures Troponin testing, electrocardiography (ECG), and resting echocardiography were performed after a positive COVID-19 test result. Interleague, deidentified cardiac data were pooled for collective analysis. Those with abnormal screening test results were referred for additional testing, including cardiac magnetic resonance imaging and/or stress echocardiography. Main Outcomes and Measures The prevalence of abnormal RTP test results potentially representing COVID-19-associated cardiac injury, and results and outcomes of additional testing generated by the initial screening process. Results The study included 789 professional athletes (mean [SD] age, 25 [3] years; 777 men [98.5%]). A total of 460 athletes (58.3%) had prior symptomatic COVID-19 illness, and 329 (41.7%) were asymptomatic or paucisymptomatic (minimally symptomatic). Testing was performed a mean (SD) of 19 (17) days (range, 3-156 days) after a positive test result. Abnormal screening results were identified in 30 athletes (3.8%; troponin, 6 athletes [0.8%]; ECG, 10 athletes [1.3%]; echocardiography, 20 athletes [2.5%]), necessitating additional testing; 5 athletes (0.6%) ultimately had cardiac magnetic resonance imaging findings suggesting inflammatory heart disease (myocarditis, 3; pericarditis, 2) that resulted in restriction from play. No adverse cardiac events occurred in athletes who underwent cardiac screening and resumed professional sport participation. Conclusions and Relevance This study provides large-scale data assessing the prevalence of relevant COVID-19-associated cardiac pathology with implementation of current RTP screening recommendations. While long-term follow-up is ongoing, few cases of inflammatory heart disease have been detected, and a safe return to professional sports activity has thus far been achieved.
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Affiliation(s)
- Matthew W Martinez
- Morristown Medical Center, Atlantic Health System, Morristown, New Jersey.,National Basketball Players Association, New York, New York.,Major League Soccer, US.,National Football League General Medical Committee, US
| | - Andrew M Tucker
- National Football League General Medical Committee, US.,MedStar Sports Medicine, MedStar Union Memorial Sports Medicine, Lutherville, Maryland
| | - O Josh Bloom
- Carolina Family Practice & Sports Medicine, Duke Private Diagnostic Clinic, Duke University School of Medicine, Durham, North Carolina
| | - Gary Green
- Major League Baseball.,Division of Sports Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - John P DiFiori
- National Basketball Association, US.,Sports Medicine Institute, Hospital for Special Surgery, New York, New York
| | - Gary Solomon
- National Football League, US.,Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee.,Department of Orthopedic Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee.,Department of Rehabilitation, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Dermot Phelan
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina
| | - Jonathan H Kim
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | | | - Allen K Sills
- National Football League, US.,Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee.,Department of Orthopedic Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee.,Department of Rehabilitation, Vanderbilt University School of Medicine, Nashville, Tennessee.,Department of Psychiatry and Behavioral Sciences, Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | - Isaac I Bogoch
- Division of Infectious Diseases, Toronto General Hospital, Toronto, Ontario, Canada
| | - Paul T Smith
- Division of Infectious Diseases, Weill Cornell Medical College, New York, New York
| | - Aaron L Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston
| | | | - David J Engel
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York
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9
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Echemendia RJ, Thelen J, Meeuwisse W, Hutchison MG, Rizos J, Comper P, Bruce JM. Erratum to: Neuropsychological Assessment of Professional Ice Hockey Players: A Cross-Cultural Examination of Baseline Data Across Language Groups. Arch Clin Neuropsychol 2021; 36:639. [PMID: 33693523 DOI: 10.1093/arclin/acab010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ruben J Echemendia
- Psychological and Neurobehavioral Associates, Inc., University of Missouri, Kansas City, MO, USA
| | - Joanie Thelen
- University of Missouri - Kansas City, Kansas City, MO, USA
| | - Willem Meeuwisse
- University of Calgary Sport Medicine Centre, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Michael G Hutchison
- Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - John Rizos
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Paul Comper
- Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - Jared M Bruce
- University of Missouri - Kansas City, Kansas City, MO, USA
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10
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Davis GA, Makdissi M, Bloomfield P, Clifton P, Cowie C, Echemendia R, Falvey EC, Fuller GW, Green GA, Harcourt P, Hill J, Leahy K, Loosemore MP, McCrory P, McGoldrick A, Meeuwisse W, Moran K, Nagahiro S, Orchard JW, Pugh J, Raftery M, Sills AK, Solomon GS, Valadka AB. Concussion Guidelines in National and International Professional and Elite Sports. Neurosurgery 2021; 87:418-425. [PMID: 32232354 DOI: 10.1093/neuros/nyaa057] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/11/2020] [Indexed: 11/13/2022] Open
Abstract
The Berlin statement on sport-related concussion was published in 2017 using evidence-based recommendations. We aimed to examine (1) the implementation of, distribution and education based on the Berlin recommendations, and the development of sport-specific protocols/guidelines among professional and elite sports, (2) the implementation of guidelines at the community level, (3) translation of guidelines into different languages, and (4) research activities. Senior medical advisers and chief medical officers from Australian Football League, All Japan Judo Federation, British Horseracing Authority, Cricket Australia, Fédération Equestre Internationale, Football Association, Gaelic Athletic Association, International Boxing Association, Irish Horseracing Regulatory Board, Major League Baseball, National Football League, National Hockey League, National Rugby League, and World Rugby completed a questionnaire. The results demonstrated that all 14 sporting organizations have published concussion protocols/guidelines based on the Berlin recommendations, including Recognize, Removal from play, Re-evaluation, Rest, Recovery, and Return to play. There is variable inclusion of Prolonged symptoms. Prevention and Risk reduction and Long-term effects are addressed in the guidelines, rules and regulations, and/or sport-specific research. There is variability in education programs, monitoring compliance with guidelines, and publication in other languages. All sporting bodies are actively involved in concussion research. We conclude that the Berlin recommendations have been included in concussion protocols/guidelines by all the sporting bodies, with consistency in the essential components of the recommendations, whilst also allowing for sport- and regional-specific variations. Education at the elite, community, and junior levels remains an ongoing challenge, and future iterations of guidelines may consider multiple language versions, and community- and junior-level guidelines.
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Affiliation(s)
- Gavin A Davis
- Australian Football League Concussion Working Group, Melbourne, Australia
| | | | | | | | - Charlotte Cowie
- The Football Association, St George's Park, Needwood, England
| | | | | | - Gordon Ward Fuller
- Centre for Urgent and Emergency Care Research, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | | | | | - Jerry Hill
- British Horseracing Authority, London, United Kingdom
| | - Kevin Leahy
- Gaelic Athletic Association, Dublin, Ireland
| | - Mike P Loosemore
- Institute Sport Exercise & Health, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London, London, United Kingdom
| | | | | | | | - Kevin Moran
- Gaelic Athletic Association, Dublin, Ireland
| | | | - John W Orchard
- School of Public Health, University of Sydney, NSW, Australia
| | - Jennifer Pugh
- The Irish Horseracing Regulatory Body, The Curragh, Ireland
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11
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DiFiori JP, Green G, Meeuwisse W, Putukian M, Solomon GS, Sills A. Return to sport for North American professional sport leagues in the context of COVID-19. Br J Sports Med 2020; 55:417-421. [PMID: 32967854 DOI: 10.1136/bjsports-2020-103227] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2020] [Indexed: 01/29/2023]
Abstract
COVID-19 is a respiratory illness that can spread from person to person. A range of clinical scenarios exist, from an asymptomatic disease course to SARS and death. This document describes important considerations for 5 North American professional sports leagues (Major League Baseball, Major League Soccer, National Basketball Association, National Football League and National Hockey league) assessing when and how to resume phased operations, including practices and games. Sports should prioritise and promote the health and safety of athletes, team and operational staff, and other participants, and should not unduly increase those individuals' relative health risk while contributing to economic recovery, providing entertainment for the public and leading a responsible restoration of civic life. Because elite professional sport ordinarily is conducted in a controlled environment, professional sports leagues may be able to achieve these goals. This document is focused on professional sports leagues in North America, and although many of the statements are generalisable to professional sporting settings throughout the world, other considerations may apply to sports in other countries.
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Affiliation(s)
| | - Gary Green
- Major League Baseball, New York City, NY, USA
| | | | | | | | - Allen Sills
- National Football League, New York City, NY, USA
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12
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Echemendia RJ, Thelen J, Meeuwisse W, Hutchison MG, Comper P, Rizos J, Bruce JM. Use of the Sport Concussion Assessment Tool 5 (SCAT5) in professional hockey, part 1: cross-cultural normative data. Br J Sports Med 2020; 55:bjsports-2020-102071. [PMID: 32847811 DOI: 10.1136/bjsports-2020-102071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This paper provides comprehensive normative data stratified by language preference and age on the components of the National Hockey League (NHL) Sport Concussion Assessment Tool 5 (SCAT5) in a multilingual sample of professional ice hockey players and compares the findings from a paper form of the NHL SCAT5 with an electronic (App) version of the tool. METHODS A total of 1924 male NHL and American Hockey League (AHL) players (ages 17-41) were assessed during preseason medical evaluations (baseline); 1881 were assessed with the NHL SCAT5 App via tablet and 43 received the paper version of the NHL Modified SCAT5. RESULTS No significant differences between the App and paper modes of administration emerged in a subsample of English preference players. Significant SCAT5 differences among language preference groups emerged on measures of cognitive functioning (Immediate Memory,Concentration). No language preference differences emerged on the Delayed Recall component. Using age as a continuous variable, older participants outperformed younger players on Immediate Memory, Delayed Recall and Concentration. Players wearing skates demonstrated significantly more modified Balance Error Scoring System (mBESS) total errors than barefoot players. Normative data tables for language preference groups are presented. CONCLUSIONS Significant differences were found between English and non-English language preference groups on the components of SCAT5, which suggest that language-specific normative data, rather than aggregated normative data, are preferable when interpreting test scores. Similarly, age-specific normative data tables may provide greater precision in data interpretation. Due to clear ceiling effects on the mBESS single leg and tandem stances, players should not be tested while wearing skates.
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Affiliation(s)
- Ruben J Echemendia
- Psychology, University of Missouri - Kansas City, Kansas City, Missouri, USA
- Concussion Care Clinic, University Orthopedics Center, State College, Pennsylvania, USA
| | - Joanie Thelen
- National Hockey League, New York City, New York, USA
- University of Missouri Kansas City, Kansas City, Missouri, USA
| | | | - Michael G Hutchison
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Paul Comper
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - John Rizos
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jared M Bruce
- Department of Biomedical and Health Informatics, University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA
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13
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Bruce JM, Thelen J, Meeuwisse W, Hutchison MG, Rizos J, Comper P, Echemendia RJ. Use of the Sport Concussion Assessment Tool 5 (SCAT5) in professional hockey, part 2: which components differentiate concussed and non-concussed players? Br J Sports Med 2020; 55:bjsports-2020-102072. [PMID: 32847812 DOI: 10.1136/bjsports-2020-102072] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To examine the utility of Sport Concussion Assessment Tool (SCAT5) subcomponents in differentiating physician diagnosed concussed players from controls. METHODS We evaluated 1924 professional hockey players at training camp using the National Hockey League (NHL) Modified SCAT5 prior to the 2018-2019 season. Over the course of the season, 314 English-speaking players received SCAT5 evaluations within 1 day of a suspected concussive event. Of these players, 140 (45%) were subsequently diagnosed with concussion by their team physicians. RESULTS Concussed players reported more symptoms (Concussed M=8.52, SD=4.78; Control M=3.32, SD=3.97), and recalled fewer words than Controls on both the Immediate Memory (Concussed M=19.34, SD=4.06; Control M=21.53, SD=2.94) and Delayed Recall (Concussed z=-0.91; Control z=-0.09) tasks during the acute evaluation. Concussed players also made more errors than Controls on the mBESS and were more likely to report double vision and exhibit clinician-observed balance problems than controls. There were no between-group differences on the Concentration component of the SCAT5. Stepwise regression revealed that symptom report and list learning tasks both accounted for independent variance in identifying players diagnosed with concussion. CONCLUSIONS These findings provide support for use of the SCAT5 to assist in identifying concussed professional hockey players. When examining SCAT5 subtests, both symptom report and the 10-item word list accounted for independent variance in identifying concussion status in this sample of professional hockey players. The mBESS also differentiated Concussed players and Controls. The Concentration component of the SCAT5 did not significantly differentiate Concussed players and Controls.
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Affiliation(s)
- Jared M Bruce
- Department of Biomedical and Health Informatics, University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Joanie Thelen
- National Hockey League, New York City, New York, USA
- University of Missouri Kansas City, Kansas City, Missouri, USA
| | | | - Michael G Hutchison
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - John Rizos
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Paul Comper
- Department of Family and Community Medicine, University Health Network, Toronto, Ontario, Canada
| | - Ruben J Echemendia
- Concussion Care Clinic, University Orthopedics Center, State College, Pennsylvania, USA
- Department of Psychology, University of Missouri - Kansas City, Kansas City, Missouri, USA
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14
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Bahr R, Clarsen B, Derman W, Dvorak J, Emery CA, Finch CF, Hägglund M, Junge A, Kemp S, Khan KM, Marshall SW, Meeuwisse W, Mountjoy M, Orchard JW, Pluim B, Quarrie KL, Reider B, Schwellnus M, Soligard T, Stokes KA, Timpka T, Verhagen E, Bindra A, Budgett R, Engebretsen L, Erdener U, Chamari K. International Olympic Committee consensus statement: methods for recording and reporting of epidemiological data on injury and illness in sport 2020 (including STROBE Extension for Sport Injury and Illness Surveillance (STROBE-SIIS)). Br J Sports Med 2020; 54:372-389. [PMID: 32071062 PMCID: PMC7146946 DOI: 10.1136/bjsports-2019-101969] [Citation(s) in RCA: 352] [Impact Index Per Article: 88.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2020] [Indexed: 12/16/2022]
Abstract
Injury and illness surveillance, and epidemiological studies, are fundamental elements of concerted efforts to protect the health of the athlete. To encourage consistency in the definitions and methodology used, and to enable data across studies to be compared, research groups have published 11 sport-specific or setting-specific consensus statements on sports injury (and, eventually, illness) epidemiology to date. Our objective was to further strengthen consistency in data collection, injury definitions and research reporting through an updated set of recommendations for sports injury and illness studies, including a new Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist extension. The IOC invited a working group of international experts to review relevant literature and provide recommendations. The procedure included an open online survey, several stages of text drafting and consultation by working groups and a 3-day consensus meeting in October 2019. This statement includes recommendations for data collection and research reporting covering key components: defining and classifying health problems; severity of health problems; capturing and reporting athlete exposure; expressing risk; burden of health problems; study population characteristics and data collection methods. Based on these, we also developed a new reporting guideline as a STROBE Extension-the STROBE Sports Injury and Illness Surveillance (STROBE-SIIS). The IOC encourages ongoing in- and out-of-competition surveillance programmes and studies to describe injury and illness trends and patterns, understand their causes and develop measures to protect the health of the athlete. Implementation of the methods outlined in this statement will advance consistency in data collection and research reporting.
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Affiliation(s)
- Roald Bahr
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Ben Clarsen
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
| | - Wayne Derman
- Institute of Sport and Exercise Medicine, Division of Orthopaedic Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Jiri Dvorak
- Spine Unit, Swiss Concussion Center and Swiss Golf Medical Center, Schulthess Clinic, Zurich, Switzerland
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Caroline F Finch
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Martin Hägglund
- Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden
| | - Astrid Junge
- Medical School Hamburg, Hamburg, Germany
- Swiss Concussion Centre, Schulthess Clinic, Zurich, Switzerland
| | - Simon Kemp
- Rugby Football Union, London, UK
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Karim M Khan
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
- British Journal of Sports Medicine, London, UK
| | - Stephen W Marshall
- Injury Prevention Research Center and Department of Epidemiology at the Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Willem Meeuwisse
- Sport Injury Prevention Research Centre, University of Calgary, Calgary, Alberta, Canada
- National Hockey League, Calgary, Alberta, Canada
| | - Margo Mountjoy
- Department of Family Medicine (Sport Medicine), McMaster University, Hamilton, Ontario, Canada
- FINA Bureau (Sport Medicine), Lausanne, Switzerland
| | - John W Orchard
- School of Public Health, University of Sydney, New South Wales, Sydney, Australia
| | - Babette Pluim
- Department of Sports Medicine, Royal Netherlands Lawn Tennis Association, Amstelveen, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), AMC/VUmc IOC Research Center of Excellence, Amsterdam, The Netherlands
- Faculty of Health Sciences, University of Pretoria, Hatfield, South Africa
| | - Kenneth L Quarrie
- New Zealand Rugby, Wellington, New Zealand
- Sports Performance Research Institute New Zealand, AUT University, Auckland, New Zealand
| | - Bruce Reider
- Department of Orthopaedic Surgery and Rehabilitation, University of Chicago, Chicago, Illinois, USA
| | - Martin Schwellnus
- Sport, Exercise Medicine and Lifestyle Research Institute (SEMLI), University of Pretoria, Hatfield, South Africa
| | - Torbjørn Soligard
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, Calgary, Alberta, Canada
| | - Keith A Stokes
- Department for Health, University of Bath, Bath, UK
- Rugby Football Union, Twickenham, UK
| | - Toomas Timpka
- Athletics Research Center, Linköping University, Linköping, Sweden
- Centre for Healthcare Development, Region Östergötland, Linköping, Sweden
| | - Evert Verhagen
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, The Netherlands
| | - Abhinav Bindra
- Athlete Commission, International Olympic Committee, Lausanne, Switzerland
| | - Richard Budgett
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | - Lars Engebretsen
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | - Uğur Erdener
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | - Karim Chamari
- Aspetar Sports Medicine and Orthopedic Hospital, Doha, Qatar
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15
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Orchard JW, Meeuwisse W, Derman W, Hägglund M, Soligard T, Schwellnus M, Bahr R. Sport Medicine Diagnostic Coding System (SMDCS) and the Orchard Sports Injury and Illness Classification System (OSIICS): revised 2020 consensus versions. Br J Sports Med 2020; 54:397-401. [PMID: 32114487 DOI: 10.1136/bjsports-2019-101921] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2020] [Indexed: 11/04/2022]
Abstract
Coding in sports medicine generally uses sports-specific coding systems rather than the International Classification of Diseases (ICD), because of superior applicability to the profile of injury and illness presentations in sport. New categories for coding were agreed on in the 'International Olympic Committee (IOC) consensus statement: Methods for recording and reporting of epidemiological data on injury and illness in sports 2020.' We explain the process for determining the new categories and update both the Sport Medicine Diagnostic Coding System (SMDCS) and the Orchard Sports Injury and Illness Classification System (OSIICS) with new versions that operationalise the new consensus categories. The author group included members from an expert group attending the IOC consensus conference. The primary authors of the SMDCS (WM) and OSIICS (JO) produced new versions that were then agreed on by the remaining authors using expert consensus methodology. The SMDCS and OSIICS systems have been adjusted and confirmed through a consensus process to align with the IOC consensus statement to facilitate translation between the two systems. Problematic areas for defining body part categories included the groin and ankle regions. For illness codes, in contrast to the ICD, we elected to have a taxonomy of 'organ system/region' (eg, cardiovascular and respiratory), followed by an 'aetiology/pathology' (eg, environmental, infectious disease and allergy). Companion data files have been produced that provide translations between the coding systems. The similar structure of coding underpinning the OSIICS and SMDCS systems aligns the new versions of these systems with the IOC consensus statement and also facilitates easier translation between the two systems. These coding systems are freely available to the sport and exercise research community.
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Affiliation(s)
- John W Orchard
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Willem Meeuwisse
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Wayne Derman
- UCT/MRC Research Unit for Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Cape Town, South Africa.,International Olympic Committee Research Centre, University of Cape Town, Cape Town, South Africa
| | - Martin Hägglund
- Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Torbjørn Soligard
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | - Martin Schwellnus
- Sports, Exercise, Medicine and Lifestyle Research Institute (SEMLI), University of Pretoria, Pretoria, South Africa
| | - Roald Bahr
- Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
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16
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Bahr R, Clarsen B, Derman W, Dvorak J, Emery CA, Finch CF, Hägglund M, Junge A, Kemp S, Khan KM, Marshall SW, Meeuwisse W, Mountjoy M, Orchard JW, Pluim B, Quarrie KL, Reider B, Schwellnus M, Soligard T, Stokes KA, Timpka T, Verhagen E, Bindra A, Budgett R, Engebretsen L, Erdener U, Chamari K. International Olympic Committee Consensus Statement: Methods for Recording and Reporting of Epidemiological Data on Injury and Illness in Sports 2020 (Including the STROBE Extension for Sports Injury and Illness Surveillance (STROBE-SIIS)). Orthop J Sports Med 2020; 8:2325967120902908. [PMID: 32118084 PMCID: PMC7029549 DOI: 10.1177/2325967120902908] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 01/03/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Injury and illness surveillance, and epidemiological studies, are fundamental elements of concerted efforts to protect the health of the athlete. To encourage consistency in the definitions and methodology used, and to enable data across studies to be compared, research groups have published 11 sport- or setting-specific consensus statements on sports injury (and, eventually, illnesses) epidemiology to date. OBJECTIVE To further strengthen consistency in data collection, injury definitions, and research reporting through an updated set of recommendations for sports injury and illness studies, including a new Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist extension. STUDY DESIGN Consensus statement of the International Olympic Committee (IOC). METHODS The IOC invited a working group of international experts to review relevant literature and provide recommendations. The procedure included an open online survey, several stages of text drafting and consultation by working groups, and a 3-day consensus meeting in October 2019. RESULTS This statement includes recommendations for data collection and research reporting covering key components: defining and classifying health problems, severity of health problems, capturing and reporting athlete exposure, expressing risk, burden of health problems, study population characteristics, and data collection methods. Based on these, we also developed a new reporting guideline as a STROBE extension-the STROBE Sports Injury and Illness Surveillance (STROBE-SIIS). CONCLUSION The IOC encourages ongoing in- and out-of-competition surveillance programs and studies to describe injury and illness trends and patterns, understand their causes, and develop measures to protect the health of the athlete. The implementation of the methods outlined in this statement will advance consistency in data collection and research reporting.
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Affiliation(s)
| | - Roald Bahr
- Roald Bahr, MD, PhD, Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, PB 4014 Ullevål Stadion, 0806 Oslo, Norway ()
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17
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Echemendia RJ, Thelen J, Meeuwisse W, Hutchison MG, Rizos J, Comper P, Bruce JM. Neuropsychological Assessment of Professional Ice Hockey Players: A Cross-Cultural Examination of Baseline Data Across Language Groups. Arch Clin Neuropsychol 2020; 35:240-256. [DOI: 10.1093/arclin/acz077] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
Neuropsychological testing in sports has become routine across all levels of play. The National Hockey League (NHL) has conducted baseline neuropsychological assessment of all players since 1997. This study seeks to examine baseline differences among linguistically and culturally diverse groups within the NHL and to present comprehensive normative data for these groups.
Method
Baseline data were obtained from 3,145 professional hockey players’ baseline symptom reporting, neuropsychological test performance on a battery of traditional “paper and pencil” measures, and self-reported concussion history. In addition, 604 baseline post-injury paper and pencil evaluations were conducted the season following a concussion and 4,780 computerized baseline ImPACT administrations were obtained following the introduction of computerized testing.
Results
Normative data for paper and pencil tests and ImPACT are presented for the major language groups within the league: English, French, Swedish, Russian, Czech, Finnish, and German (ImPACT only). It was found that symptom reporting, the number of concussions sustained, and neuropsychological test results vary significantly based on a players’ language of origin. This variability was also present when players were tested in their language of origin.
Conclusions
This study provides insight into the significant baseline differences that exist among NHL players regarding symptoms, concussion history, and cognitive functioning. The findings are discussed with respect to the evaluation and management of NHL players who sustain concussion and more generally in the context of neuropsychological assessment in cross-cultural settings, including the importance of examining neuropsychological functioning using culturally specific norms.
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Affiliation(s)
- Ruben J Echemendia
- Psychological and Neurobehavioral Associates, Inc., University of Missouri, Kansas City, MO, USA
| | - Joanie Thelen
- University of Missouri - Kansas City, Kansas City, MO, USA
| | - Willem Meeuwisse
- University of Calgary Sport Medicine Centre, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Michael G Hutchison
- Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - John Rizos
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Paul Comper
- Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - Jared M Bruce
- University of Missouri - Kansas City, Kansas City, MO, USA
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18
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Echemendia RJ, Thelen J, Meeuwisse W, Comper P, Hutchison MG, Bruce JM. Testing the hybrid battery approach to evaluating sports-related concussion in the National Hockey League: A factor analytic study. Clin Neuropsychol 2019; 34:899-918. [PMID: 31777320 DOI: 10.1080/13854046.2019.1690051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: There has been an increased interest in the use of "Hybrid" neuropsychological test batteries to evaluate neurocognitive functioning prior to and following sports-related concussion. Typically, these test batteries include a combination of traditional "paper and pencil" (P&P) and computerized measures. The National Hockey League (NHL) employs a Hybrid approach consisting of ImPACT and a brief battery of P&P measures. The purpose of this paper was to examine the NHL's Hybrid model by means of factor analytic techniques in order to determine the extent to which the measures included in the battery are independent of each other or share common variance.Method: Principal components analyses with promax rotations were conducted on the P&P measures alone and when combined with ImPACT. A total of 360 recently concussed NHL players underwent testing using the combined hybrid battery.Results: A principal components analysis with promax rotation of the combined hybrid battery yielded 5 factors (Verbal Learning/Memory, Visual Learning/Memory, Processing Speed/Executive Functioning, Cued/Recognition Memory and Reaction Time/Speed). The factors appear to be relatively independent of each other with the P&P measures comprising the Verbal Learning/Memory, Visual Learning/Memory, and Processing Speed/Executive Functioning and ImPACT loading on the Cued/Recognition Memory and Reaction Time/Speed factors.Conclusions: These data provide support for the Hybrid model with evidence that the P&P measures and ImPACT do not measure the same domains of cognitive functioning. The clinical implications of the findings are discussed in detail.
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Affiliation(s)
- Ruben J Echemendia
- Psychological and Neurobehavioral Associates, Inc, University of Missouri - Kansas City, Kansas City, MO, USA
| | - Joanie Thelen
- Department of Psychology, University of Missouri - Kansas City, Kansas City, MO, USA
| | | | - Paul Comper
- Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - Michael G Hutchison
- Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Jared M Bruce
- Department of Biomedical and Health Informatics, University of Missouri, Kansas City School of Medicine, MO, USA
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19
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Echemendia RJ, Bruce JM, Thelen J, Hutchison M, Comper P, Meeuwisse W. Testing the Hybrid Battery Approach to Evaluating Sports-Related Concussion in the National Hockey League: A Factor Analytic Study. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz026.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Purpose
Traditional “paper and pencil” neuropsychological tests and computerized test batteries have been employed in the assessment of sports-related concussion (SRC). Each type of test has inherent strengths and weaknesses. The NHL has constructed a “hybrid” battery of tests that uses both traditional and computerized measures in the evaluation of its players suspected of SRC. The purpose of this paper is to use factor analytic techniques to examine the relationships among the measures that comprise this battery.
Methods
Post-injury neuropsychological test data using the hybrid battery were obtained from 343 NHL players following their first concussion while playing in the league. ImPACT was used as the computer test battery. The traditional battery included: Hopkins Verbal Learning Test, Brief Visuospatial Memory Test, Color Trails, PSU Cancellation, Symbol Digits Modalities Test (including incidental memory), and Verbal Fluency.
Results
Five factors were extracted explaining 64.55% of the variance. The factor labels and the measures principally loading on each factor were as follows: Factor 1, Verbal Learning and Memory (HVLT Total and Delayed Recall); Factor 2, Processing Speed (Color Trails A/B, PSU Cancellation, and SDMT-Total); Factor 3, Visual Memory (BVMT- Total and Delayed); Factor 4, Cued Memory (ImPACT-Visual and Verbal Memory Composites); and Factor 5, Reaction Time (ImPACT Reaction Time and Visual Motor Speed composites).
Conclusion
These data underscore the unique contributions of traditional and ImPACT neuropsychological measures to the evaluation SRC in a sample of professional hockey players. It appears that both approaches measure different aspects of cognitive functioning. The next logical step is to use these data in evaluating the diagnostic utility of these measures as part of a combined battery.
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20
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Echemendia RJ, Bruce JM, Thelen J, Comper P, Hutchison M, Meeuwisse W. The Utility of the King-Devick Test in Evaluating Professional Ice Hockey Players with Suspected Concussion. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz026.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Purpose
The King-Devick (KD) is a measure of rapid number naming used in the evaluation of sports-related concussion (SRC). Recent data from the Canadian Football League and Rugby Union suggest that the KD should not be used as a stand-alone measure of SRC. The purpose of this study was to examine the diagnostic utility of the KD in professional ice hockey players.
Methods
NHL players who were suspected of having a concussion were evaluated with the KD and either the SCAT3 or the SCAT5. Players who were evaluated and not diagnosed with concussion served as Active controls. A small group of non-Active control players was also tested twice and was included in the present study for comparison.
Results
1605 players were evaluated with the KD at baseline. Of these, 53 were diagnosed with concussion, 76 were Active controls, and 11 were non-Active controls. Concussed players revealed a decline in performance from baseline to acute evaluation, t(52)=3.05, p<.01, d=.42 while Active controls significantly improved, t(75)=2.05, p<.05, d=.24. No significant change between baseline and acute testing was observed for non-Active controls. Using a cut score of any decline in performance from baseline to suspected injury evaluation yielded Sensitivity=64%, Specificity=61%, Positive Predictive Value=53% and Negative Predictive Value=71%.
Conclusion
Our data are consistent with previous studies suggesting that while the KD is useful in differentiating concussed and not concussed athletes acutely, the relatively low predictive values indicate that a decline in KD performance should not be used as a standalone measure to diagnose concussion.
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21
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Yeates KO, Tang K, Barrowman N, Freedman SB, Gravel J, Gagnon I, Sangha G, Boutis K, Beer D, Craig W, Burns E, Farion KJ, Mikrogianakis A, Barlow K, Dubrovsky AS, Meeuwisse W, Gioia G, Meehan WP, Beauchamp MH, Kamil Y, Grool AM, Hoshizaki B, Anderson P, Brooks BL, Vassilyadi M, Klassen T, Keightley M, Richer L, DeMatteo C, Osmond MH, Zemek R, Xie J, Chatfield J, Dow N, Papadimitropoulos R, Levesque T, Langford C, Tran TT, McGahern C, DiGirolamo V, Mazza J, Lagacé M, Cook R, Fitzpatrick E, MacIntyre J, Moore J. Derivation and Initial Validation of Clinical Phenotypes of Children Presenting with Concussion Acutely in the Emergency Department: Latent Class Analysis of a Multi-Center, Prospective Cohort, Observational Study. J Neurotrauma 2019; 36:1758-1767. [DOI: 10.1089/neu.2018.6009] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Keith Owen Yeates
- Department of Psychology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Kenneth Tang
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Nick Barrowman
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Stephen B. Freedman
- Department of Pediatrics, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Jocelyn Gravel
- Department of Pediatrics, Hospital Sainte Justine, University of Montreal, Montreal, Quebec, Canada
| | - Isabelle Gagnon
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Gurinder Sangha
- Department of Pediatrics, Children's Hospital of Western Ontario, Western University, London, Ontario, Canada
| | - Kathy Boutis
- Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Darcy Beer
- Department of Pediatrics, Manitoba Children's Hospital, Winnipeg, Manitoba, Canada
| | - William Craig
- Department of Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Emma Burns
- Department of Emergency Medicine, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Ken J. Farion
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Angelo Mikrogianakis
- Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Alberta
| | - Karen Barlow
- Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Alberta
| | - Alexander S. Dubrovsky
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Willem Meeuwisse
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Gerard Gioia
- Department of Neuropsychology, Children's National Health System, George Washington University School of Medicine, Rockville, Maryland
| | - William P. Meehan
- Sports Concussion Clinic, Boston Children's Hospital, Boston, Massachusetts
| | - Miriam H. Beauchamp
- Ste. Justine Research Center, University of Montreal, Montreal, Quebec, Canada
| | - Yael Kamil
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Anne M. Grool
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Blaine Hoshizaki
- Department of Kinesiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Peter Anderson
- Department of Psychology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Brian L. Brooks
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Michael Vassilyadi
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Terry Klassen
- Department of Pediatrics, Manitoba Children's Hospital, Winnipeg, Manitoba, Canada
| | - Michelle Keightley
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Lawrence Richer
- Department of Neurology, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Carol DeMatteo
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Martin H. Osmond
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Roger Zemek
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
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22
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Hainline B, Derman W, Vernec A, Budgett R, Deie M, Dvorak J, Harle CA, Herring S, McNamee M, Meeuwisse W, Moseley GL, Omololu B, Orchard J, Pipe A, Pluim BM, Raeder J, Siebert D, Stewart M, Stuart MC, Turner J, Ware M, Zideman D, Engebretsen L. Infographic. International Olympic Committee consensus statement on pain management in athletes: non-pharmacological strategies. Br J Sports Med 2019; 53:785-786. [PMID: 30952826 DOI: 10.1136/bjsports-2019-100853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2019] [Indexed: 11/03/2022]
Affiliation(s)
- Brian Hainline
- National Collegiate Athletic Association (NCAA), Indianapolis, Indiana, USA
| | - Wayne Derman
- Instiute of Sport and Exercise Medicine, Department of Surgical Sciences, Stellenbosch University, Cape Town, South Africa.,International Olympic Committee Research Centre, Cape Town, South Africa
| | | | | | - Masataka Deie
- Orthopedic Surgery, Aichi Ika Daigaku, Aichi-gun, Aichi, Japan
| | - Jiri Dvorak
- Swiss Concussion Center, Zurich, Switzerland.,Spine Unit, Schulthess Clinic, Zurich, Switzerland
| | - Christopher A Harle
- Health Policy and Management, Indiana University, Indianapolis, Indiana, USA
| | - Stanley Herring
- Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | | | - Willem Meeuwisse
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | | | - Bade Omololu
- Orthopaedic Surgery, University of Ibadan College of Medicine, Ibadan, Western Nigeria, Nigeria
| | - John Orchard
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Andrew Pipe
- Sports Medicine, Royal Netherlands Lawn Tennis Association, Amersfoort, The Netherlands
| | - Babette M Pluim
- Sports Medicine, Royal Netherlands Lawn Tennis Association, Amersfoort, The Netherlands.,Home, Ede, The Netherlands
| | | | - David Siebert
- Family Medicine, University of Washington, Seattle, Washington, USA
| | - Mike Stewart
- Physical Therapy, East Kent Hospitals University, Canterbury, UK
| | | | - Judith Turner
- Psychology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Mark Ware
- Pain Management, McGill University Health Centre, Montreal, Quebec, Canada
| | - David Zideman
- International Olympic Committee Medical and Scientific Games Group, Lausanne, Switzerland
| | - Lars Engebretsen
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
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23
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Davis GA, Makdissi M, Bloomfield P, Clifton P, Echemendia RJ, Falvey ÉC, Fuller GW, Green G, Harcourt P, Hill T, McGuirk N, Meeuwisse W, Orchard J, Raftery M, Sills AK, Solomon GS, Valadka A, McCrory P. International consensus definitions of video signs of concussion in professional sports. Br J Sports Med 2019; 53:1264-1267. [PMID: 30954947 DOI: 10.1136/bjsports-2019-100628] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND The use of video to assist professional sporting bodies with the diagnosis of sport-related concussion (SRC) has been well established; however, there has been little consistency across sporting codes with regards to which video signs should be used, and the definitions of each of these signs. AIM The aims of this study were to develop a consensus for the video signs considered to be most useful in the identification of a possible SRC and to develop a consensus definition for each of these video signs across the sporting codes. METHODS A brief questionnaire was used to assess which video signs were considered to be most useful in the identification of a possible concussion. Consensus was defined as >90% agreement by respondents. Existing definitions of these video signs from individual sports were collated, and individual components of the definitions were assessed and ranked. A modified Delphi approach was then used to create a consensus definition for each of the video signs. RESULTS Respondents representing seven sporting bodies (Australian Football League, Cricket Australia, Major League Baseball, NFL, NHL, National Rugby League, World Rugby) reached consensus on eight video signs of concussion. Thirteen representatives from the seven professional sports ranked the definition components. Consolidation and refinement of the video signs and their definitions resulted in consensus definitions for six video signs of possible concussion: lying motionless, motor incoordination, impact seizure, tonic posturing, no protective action-floppy and blank/vacant look. CONCLUSIONS These video signs and definitions have reached international consensus, are indicated for use by professional sporting bodies and will form the basis for further collaborative research.
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Affiliation(s)
- Gavin A Davis
- Florey Institute of Neuroscience and Mental Health-Austin Campus, Heidelberg, Victoria, Australia .,Neurosurgery, Cabrini Hospital, Malvern, Victoria, Australia
| | - Michael Makdissi
- Florey Institute of Neuroscience and Mental Health-Austin Campus, Heidelberg, Victoria, Australia.,La Trobe Sport and Exercise Medicine Research Centre, Melbourne, Victoria, Australia
| | - Paul Bloomfield
- National Rugby League (NRL), Sydney, New South Wales, Australia
| | | | | | | | - Gordon Ward Fuller
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Gary Green
- Major League Baseball, New York, New York, USA
| | - Peter Harcourt
- Australian Football League, Melbourne, Victoria, Australia
| | - Thomas Hill
- Cricket Australia, Melbourne, Victoria, Australia
| | - Nathan McGuirk
- National Rugby League, Sydney, New South Wales, Australia
| | | | - John Orchard
- Cricket Australia, Sydney, New South Wales, Australia
| | | | | | | | | | - Paul McCrory
- Melbourne Brain Centre, Florey Institute of Neuroscience and Mental Health-Austin Campus, Heidelberg, Victoria, Australia
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24
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Brooks BL, Plourde V, Beauchamp MH, Tang K, Yeates KO, Keightley M, Anderson P, Désiré N, Barrowman N, Zemek R, Aglipay M, Barlow K, Beer D, Boutis K, Burns E, Craig W, DeMatteo C, Dubrovsky AS, Farion KJ, Freedman SB, Gagnon I, Gioia G, Gravel J, Grool AM, Hoshizaki B, Kamil Y, Klassen T, McGahern C, Meehan III WP, Meeuwisse W, Mikrogianakis A, Osmond MH, Richer L, Sangha G, Vassilyadi M. Predicting Psychological Distress after Pediatric Concussion. J Neurotrauma 2019; 36:679-685. [DOI: 10.1089/neu.2018.5792] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Brian L. Brooks
- Alberta Children's Hospital, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Departments of Pediatrics, Clinical Neurosciences, and Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Vickie Plourde
- Faculty Saint-Jean, University of Alberta, Edmonton, Alberta, Canada
| | - Miriam H. Beauchamp
- Department of Psychology, University of Montreal & Ste-Justine Hospital Research Center, Montreal, Quebec, Canada
| | - Ken Tang
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Keith Owen Yeates
- Departments of Pediatrics, Clinical Neurosciences, and Psychology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Michelle Keightley
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Departments of Occupational Science and Occupational Therapy and Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Peter Anderson
- Children's Hospital of Eastern Ontario Research Institute, Behavioral Neurosciences & Consultation-Liaison Program, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Naddley Désiré
- Alberta Children's Hospital, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Nick Barrowman
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Roger Zemek
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Departments of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
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25
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Davis GA, Makdissi M, Bloomfield P, Clifton P, Echemendia RJ, Falvey ÉC, Fuller GW, Green G, Harcourt PR, Hill T, McGuirk N, Meeuwisse W, Orchard JW, Raftery M, Sills AK, Solomon GS, Valadka A, McCrory P. International study of video review of concussion in professional sports. Br J Sports Med 2018; 53:1299-1304. [DOI: 10.1136/bjsports-2018-099727] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/29/2018] [Accepted: 08/30/2018] [Indexed: 11/03/2022]
Abstract
BackgroundVideo review has become an important tool in professional sporting codes to help sideline identification and management of players with a potential concussion.AimTo assess current practices related to video review of concussion in professional sports internationally, and compare protocols and diagnostic criteria used to identify and manage potential concussions.MethodsCurrent concussion management guidelines from professional national and international sporting codes were reviewed. Specific criteria and definitions of video signs associated with concussion were compared between codes. Rules and regulations adopted across the codes for processes around video review were also assessed.ResultsSix sports with specific diagnostic criteria and definitions for signs of concussion identified on video review participated in this study (Australian football, American football, world rugby, cricket, rugby league and ice hockey). Video signs common to all sports include lying motionless/loss of responsiveness and motor incoordination. The video signs considered by the majority of sports as most predictive of a diagnosis of concussion include motor incoordination, impact seizure, tonic posturing and lying motionless. Regulatory requirements, sideline availability of video, medical expertise of video reviewers and use of spotters differ across sports and geographical boundaries. By and large, these differences reflect a pragmatic approach from each sport, with limited underlying research and development of the video review process in some instances.ConclusionsThe use of video analysis in assisting medical staff with the diagnosis or identification of potential concussion is well established across different sports internationally. The diagnostic criteria used and the expertise of the video review personnel are not clearly established, and research efforts would benefit from a collaborative harmonisation across sporting codes.
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26
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Patricios JS, Ardern CL, Hislop MD, Aubry M, Bloomfield P, Broderick C, Clifton P, Echemendia RJ, Ellenbogen RG, Falvey ÉC, Fuller GW, Grand J, Hack D, Harcourt PR, Hughes D, McGuirk N, Meeuwisse W, Miller J, Parsons JT, Richiger S, Sills A, Moran KB, Shute J, Raftery M. Implementation of the 2017 Berlin Concussion in Sport Group Consensus Statement in contact and collision sports: a joint position statement from 11 national and international sports organisations. Br J Sports Med 2018; 52:635-641. [PMID: 29500252 PMCID: PMC5931244 DOI: 10.1136/bjsports-2018-099079] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2018] [Indexed: 01/25/2023]
Abstract
The 2017 Berlin Concussion in Sport Group Consensus Statement provides a global summary of best practice in concussion prevention, diagnosis and management, underpinned by systematic reviews and expert consensus. Due to their different settings and rules, individual sports need to adapt concussion guidelines according to their specific regulatory environment. At the same time, consistent application of the Berlin Consensus Statement's themes across sporting codes is likely to facilitate superior and uniform diagnosis and management, improve concussion education and highlight collaborative research opportunities. This document summarises the approaches discussed by medical representatives from the governing bodies of 10 different contact and collision sports in Dublin, Ireland in July 2017. Those sports are: American football, Australian football, basketball, cricket, equestrian sports, football/soccer, ice hockey, rugby league, rugby union and skiing. This document had been endorsed by 11 sport governing bodies/national federations at the time of being published.
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Affiliation(s)
- Jon S Patricios
- University of Pretoria, Section of Sports Medicine, Faculty of Health Sciences, Johannesburg, South Africa
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Clare L Ardern
- Department of Physiotherapy, Linköping University, Linköping, Sweden
- School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | | | - Mark Aubry
- International Ice Hockey Federation, Zurich, Switzerland
| | | | | | - Patrick Clifton
- Australian Football League, Melbourne, Victoria, Australia
- Australian Institute of Sport, Canberra, Australia
| | - Ruben J Echemendia
- National Hockey League, New York, USA
- University Orthopedic Center, Concussion Care Clinic, State College, Pennsylvania, USA
- University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Richard G Ellenbogen
- National Football League, New York, USA
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | | | - Gordon Ward Fuller
- Centre for Urgent and Emergency Care Research, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Dallas Hack
- National Collegiate Athletic Association, Indianapolis, Indiana, USA
| | | | - David Hughes
- Australian Football League, Melbourne, Victoria, Australia
- Australian Institute of Sport, Canberra, Australia
| | - Nathan McGuirk
- National Rugby League, Sydney, New South Wales, Australia
| | | | | | - John T Parsons
- National Collegiate Athletic Association, Indianapolis, Indiana, USA
| | | | - Allen Sills
- National Football League, New York, USA
- Fédération Equestre Internationale, Lausanne, Switzerland
| | | | - Jenny Shute
- Fédération Internationale de Ski, Oberhofen and Thunersee, Switzerland
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27
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Soligard T, Steffen K, Palmer D, Alonso JM, Bahr R, Lopes AD, Dvorak J, Grant ME, Meeuwisse W, Mountjoy M, Costa LOP, Salmina N, Budgett R, Engebretsen L. Infographic: Injury and illness, the 2016 Olympic Games. Br J Sports Med 2018; 53:404-405. [PMID: 29440038 DOI: 10.1136/bjsports-2018-099090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2018] [Indexed: 11/03/2022]
Affiliation(s)
- Torbjørn Soligard
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | - Kathrin Steffen
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo Sports Trauma Research Center, Oslo, Norway
| | - Debbie Palmer
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
| | - Juan Manuel Alonso
- Department of Sports Medicine, Aspetar, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Roald Bahr
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo Sports Trauma Research Center, Oslo, Norway.,Aspetar, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Alexandre Dias Lopes
- Department of Physical Therapy, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Jiri Dvorak
- Swiss Concussion Center, Zurich, Switzerland.,Spine Unit, Schulthess Clinic, Zurich, Switzerland
| | - Marie-Elaine Grant
- Institute of Sport and Health, University College Dublin, Dublin, Ireland
| | - Willem Meeuwisse
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | | | - Leonardo O P Costa
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de Sao Paulo, Sao Paulo, Brazil
| | | | | | - Lars Engebretsen
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
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28
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McCrory P, Feddermann-Demont N, Dvořák J, Cassidy JD, McIntosh A, Vos PE, Echemendia RJ, Meeuwisse W, Tarnutzer AA. What is the definition of sports-related concussion: a systematic review. Br J Sports Med 2017; 51:877-887. [PMID: 29098981 DOI: 10.1136/bjsports-2016-097393] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Various definitions for concussion have been proposed, each having its strengths and weaknesses. We reviewed and compared current definitions and identified criteria necessary for an operational definition of sports-related concussion (SRC) in preparation of the 5th Concussion Consensus Conference (Berlin, Germany). We also assessed the role of biomechanical studies in informing an operational definition of SRC. DESIGN This is a systematic literature review. DATA SOURCES Data sources include MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Clinical Trials and SPORT Discus (accessed 14 September 2016). ELIGIBILITY CRITERIA FOR SELECTING STUDIES Eligibility criteria were studies reporting (clinical) criteria for diagnosing SRC and studies containing SRC impact data. RESULTS Out of 1601 articles screened, 36 studies were included (2.2%), 14 reported on criteria for SRC definitions and 22 on biomechanical aspects of concussions. Six different operational definitions focusing on clinical findings and their dynamics were identified. Biomechanical studies were obtained almost exclusively on American football players. Angular and linear head accelerations linked to clinically confirmed concussions demonstrated considerable individual variation. SUMMARY/CONCLUSIONS SRC is a traumatic brain injury that is defined as a complex pathophysiological process affecting the brain, induced by biomechanical forces with several common features that help define its nature. Limitations identified include that the current criteria for diagnosing SRC are clinically oriented and that there is no gold/standard to assess their diagnostic properties. A future, more valid definition of SRC would better identify concussed players by demonstrating high predictive positive/negative values. Currently, the use of helmet-based systems to study the biomechanics of SRC is limited to few collision sports. New approaches need to be developed to provide objective markers for SRC.
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Affiliation(s)
- Paul McCrory
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Nina Feddermann-Demont
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.,Swiss Concussion Center, Schulthess Clinic, Zurich, Switzerland
| | - Jiří Dvořák
- Swiss Concussion Center, Schulthess Clinic, Zurich, Switzerland.,Department of Neurology, Schulthess Clinic, Zurich, Switzerland
| | - J David Cassidy
- Division of Health Care and Outcomes Research, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Division of Epidemiology, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Sport Science and Clinical Biomechanics, Faculty of Health, University of Southern Denmark, Odense, Denmark
| | - Andrew McIntosh
- Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Victoria, Australia.,Monash University Accident Research Centre, Monash University, Melbourne, Australia
| | - Pieter E Vos
- Department of Neurology, Slingeland Ziekenhuis, Doetinchem, The Netherlands
| | - Ruben J Echemendia
- UOC Concussion Care Clinic, State College, Pennsylvania, USA.,Department of Psychology, University of Missouri - Kansas City, State College, Pennsylvania, USA
| | - Willem Meeuwisse
- Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, Calgary, Alberta, Canada
| | - Alexander A Tarnutzer
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.,Swiss Concussion Center, Schulthess Clinic, Zurich, Switzerland
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Blake T, Meeuwisse W, Doyle-Baker P, Brooks B, Palacios-Derflingher L, Emery C. When public health and sport injury prevention meet: The relationship between physical activity volume and concussion risk in male youth ice hockey players. Phys Ther Sport 2017. [DOI: 10.1016/j.ptsp.2017.08.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Hainline B, Derman W, Vernec A, Budgett R, Deie M, Dvořák J, Harle C, Herring SA, McNamee M, Meeuwisse W, Lorimer Moseley G, Omololu B, Orchard J, Pipe A, Pluim BM, Ræder J, Siebert C, Stewart M, Stuart M, Turner JA, Ware M, Zideman D, Engebretsen L. International Olympic Committee consensus statement on pain management in elite athletes. Br J Sports Med 2017; 51:1245-1258. [DOI: 10.1136/bjsports-2017-097884] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/10/2017] [Accepted: 06/26/2017] [Indexed: 12/18/2022]
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Soligard T, Steffen K, Palmer D, Alonso JM, Bahr R, Lopes AD, Dvorak J, Grant ME, Meeuwisse W, Mountjoy M, Pena Costa LO, Salmina N, Budgett R, Engebretsen L. Sports injury and illness incidence in the Rio de Janeiro 2016 Olympic Summer Games: A prospective study of 11274 athletes from 207 countries. Br J Sports Med 2017; 51:1265-1271. [PMID: 28756389 DOI: 10.1136/bjsports-2017-097956] [Citation(s) in RCA: 221] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/28/2017] [Accepted: 06/29/2017] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To describe the pattern of injuries and illnesses sustained during the Games of the XXXI Olympiad, hosted by Rio de Janeiro from 5 to 21 August 2016. METHODS We recorded the daily incidence of athlete injuries and illnesses (1) through the reporting of all National Olympic Committee (NOC) medical teams and (2) in the polyclinic and medical venues by the Rio 2016 medical staff. RESULTS In total, 11 274 athletes (5089 women, 45%; 6185 men, 55%) from 207 NOCs participated in the study. NOC and Rio 2016 medical staff reported 1101 injuries and 651 illnesses, equalling 9.8 injuries and 5.4 illnesses per 100 athletes over the 17-day period. Altogether, 8% of the athletes incurred at least one injury and 5% at least one illness. The injury incidence was highest in BMX cycling (38% of the athletes injured), boxing (30%), mountain bike cycling (24%), taekwondo (24%), water polo (19%) and rugby (19%), and lowest in canoe slalom, rowing, shooting, archery, swimming, golf and table tennis (0%-3%). Of the 1101 injuries recorded, 40% and 20% were estimated to lead to ≥1 and >7 days of absence from sport, respectively. Women suffered 40% more illnesses than men. Illness was generally less common than injury, with the highest incidence recorded in diving (12%), open-water marathon (12%), sailing (12%), canoe slalom (11%), equestrian (11%) and synchronised swimming (10%). Illnesses were also less severe; 18% were expected to result in time loss. Of the illnesses, 47% affected the respiratory system and 21% the gastrointestinal system. The anticipated problem of infections in the Rio Olympic Games did not materialise, as the proportion of athletes with infectious diseases mirrored that of recent Olympic Games (3%). CONCLUSION Overall, 8% of the athletes incurred at least one injury during the Olympic Games, and 5% an illness, which is slightly lower than in the Olympic Summer Games of 2008 and 2012.
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Affiliation(s)
- Torbjørn Soligard
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Kathrin Steffen
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Debbie Palmer
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Juan Manuel Alonso
- Department of Sports Medicine, Aspetar Qatar Orthopedics and Sports Medicine Hospital, Doha, Qatar
| | - Roald Bahr
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Alexandre Dias Lopes
- Department of Physical Therapy, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Jiri Dvorak
- Department of Neurology, Spine Unit, Schulthess Clinic, Zurich, Switzerland
| | - Marie-Elaine Grant
- Institute of Sport and Health, University College Dublin, Dublin, Ireland
| | - Willem Meeuwisse
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Margo Mountjoy
- Fédération International de Natation (FINA), Lausanne, Switzerland
| | | | | | - Richard Budgett
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | - Lars Engebretsen
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Department of Orthopaedic Surgery, University of Oslo, Oslo, Norway
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Lishchynsky J, Palacios-Derflinger L, Toomey C, Emery C, Yeates K, Meeuwisse W, Schneider K. The association between moderate and vigorous physical activity and time to medical clearance to return to play following sport-related concussion in youth ice-hockey players. Br J Sports Med 2017. [DOI: 10.1136/bjsports-2016-097270.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Echemendia RJ, Meeuwisse W, McCrory P, Davis GA, Putukian M, Leddy J, Makdissi M, Sullivan SJ, Broglio SP, Raftery M, Schneider K, Kissick J, McCrea M, Dvorak J, Sills AK, Aubry M, Engebretsen L, Lossemore M, Fuller G, Kutcher J, Ellenbogen R, Guskiewicz K, Patricios J, Herring S. The Concussion Recognition Tool 5th Edition (CRT5). Br J Sports Med 2017; 51:870-871. [DOI: 10.1136/bjsports-2017-097508] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2017] [Indexed: 11/03/2022]
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Echemendia RJ, Meeuwisse W, McCrory P, Davis GA, Putukian M, Leddy J, Makdissi M, Sullivan SJ, Broglio SP, Raftery M, Schneider K, Kissick J, McCrea M, Dvorak J, Sills AK, Aubry M, Engebretsen L, Loosemore M, Fuller G, Kutcher J, Ellenbogen R, Guskiewicz K, Patricios J, Herring S. The Sport Concussion Assessment Tool 5th Edition (SCAT5). Br J Sports Med 2017; 51:848-850. [DOI: 10.1136/bjsports-2017-097506] [Citation(s) in RCA: 205] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2017] [Indexed: 11/03/2022]
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Davis GA, Purcell L, Schneider KJ, Yeates KO, Gioia GA, Anderson V, Ellenbogen RG, Echemendia RJ, Makdissi M, Sills A, Iverson GL, Dvořák J, McCrory P, Meeuwisse W, Patricios J, Giza CC, Kutcher JS. The Child Sport Concussion Assessment Tool 5th Edition (Child SCAT5): Background and rationale. Br J Sports Med 2017; 51:859-861. [PMID: 28446452 DOI: 10.1136/bjsports-2017-097492] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2017] [Indexed: 11/04/2022]
Abstract
This article presents the Child Sport Concussion Assessment Tool 5th Edition (Child SCAT5). The Sport Concussion Assessment Tool was introduced in 2004, following the 2nd International Conference on Concussion in Sport in Prague, Czech Republic. Following the 4th International Consensus Conference, held in Zurich, Switzerland, in 2012, the SCAT 3rd edition (Child SCAT3) was developed for children aged between 5 and12 years. Research to date was reviewed and synthesised for the 5th International Consensus Conference on Concussion in Sport in Berlin, Germany, leading to the current revision of the test, the Child SCAT5. This article describes the development of the Child SCAT5.
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Affiliation(s)
- Gavin A Davis
- Murdoch Childrens Research Institute, Melbourne, Australia.,Florey Institute of Neuroscience and Mental Health, Austin Campus, Melbourne Brain Centre, Heidelberg, Australia
| | - Laura Purcell
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute for Child & Maternal Health, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
| | - Keith Owen Yeates
- Department of Psychology, Alberta Children's Research Institute, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Gerard A Gioia
- Division of Pediatric Neuropsychology, Children's National Health System, George Washington University School of Medicine, Washington, DC, USA.,Department of Pediatrics and Psychiatry & Behavioral Sciences, George Washington University School of Medicine, Washington, DC, USA
| | - Vicki Anderson
- Murdoch Childrens Research Institute, Melbourne, Australia
| | - Richard G Ellenbogen
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Ruben J Echemendia
- University Orthopaedic Center, Concussion Care Clinic, State College, PA, USA; University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Michael Makdissi
- Florey Institute of Neuroscience and Mental Health, Austin Campus, Melbourne Brain Centre, Heidelberg, Australia.,Olympic Park Sports Medicine Centre, Melbourne, Australia
| | - Allen Sills
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Grant L Iverson
- Center for Health and Rehabilitation Research, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, Massachusetts, USA
| | - Jiří Dvořák
- Swiss Concussion Center, Schulthess Clinic Zurich, Switzerland
| | - Paul McCrory
- Florey Institute of Neuroscience and Mental Health, Austin Campus, Melbourne Brain Centre, Heidelberg, Australia
| | - Willem Meeuwisse
- Sport Injury Prevention Research Centre, Faculty of Kinesiolgy, University of Calgary, Canada
| | - Jon Patricios
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Christopher C Giza
- UCLA Steve Tisch BrainSPORT Program, Operation MEND TBI Program, Los Angeles, USA
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McCrory P, Meeuwisse W, Dvorak J, Aubry M, Bailes J, Broglio S, Cantu RC, Cassidy D, Echemendia RJ, Castellani RJ, Davis GA, Ellenbogen R, Emery C, Engebretsen L, Feddermann-Demont N, Giza CC, Guskiewicz KM, Herring S, Iverson GL, Johnston KM, Kissick J, Kutcher J, Leddy JJ, Maddocks D, Makdissi M, Manley GT, McCrea M, Meehan WP, Nagahiro S, Patricios J, Putukian M, Schneider KJ, Sills A, Tator CH, Turner M, Vos PE. Consensus statement on concussion in sport—the 5thinternational conference on concussion in sport held in Berlin, October 2016. Br J Sports Med 2017; 51:838-847. [DOI: 10.1136/bjsports-2017-097699] [Citation(s) in RCA: 917] [Impact Index Per Article: 131.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2017] [Indexed: 11/03/2022]
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Bruce JM, Echemendia RJ, Meeuwisse W, Hutchison MG, Aubry M, Comper P. Measuring cognitive change with ImPACT: the aggregate baseline approach. Clin Neuropsychol 2017; 31:1329-1340. [PMID: 28397546 DOI: 10.1080/13854046.2017.1311375] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) is commonly used to assess baseline and post-injury cognition among athletes in North America. Despite this, several studies have questioned the reliability of ImPACT when given at intervals employed in clinical practice. Poor test-retest reliability reduces test sensitivity to cognitive decline, increasing the likelihood that concussed athletes will be returned to play prematurely. We recently showed that the reliability of ImPACT can be increased when using a new composite structure and the aggregate of two baselines to predict subsequent performance. The purpose of the present study was to confirm our previous findings and determine whether the addition of a third baseline would further increase the test-retest reliability of ImPACT. METHODS Data from 97 English speaking professional hockey players who had received at least 4 ImPACT baseline evaluations were extracted from a National Hockey League Concussion Program database. Linear regression was used to determine whether each of the first three testing sessions accounted for unique variance in the fourth testing session. RESULTS Results confirmed that the aggregate baseline approach improves the psychometric properties of ImPACT, with most indices demonstrating adequate or better test-retest reliability for clinical use. CONCLUSIONS The aggregate baseline approach provides a modest clinical benefit when recent baselines are available - and a more substantial benefit when compared to approaches that obtain baseline measures only once during the course of a multi-year playing career. Pending confirmation in diverse samples, neuropsychologists are encouraged to use the aggregate baseline approach to best quantify cognitive change following sports concussion.
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Affiliation(s)
- Jared M Bruce
- a Department of Psychology , University of Missouri - Kansas City , Kansas City , MO , USA
| | - Ruben J Echemendia
- a Department of Psychology , University of Missouri - Kansas City , Kansas City , MO , USA.,b Psychological and Neurobehavioral Associates , State College , PA , USA
| | - Willem Meeuwisse
- c Faculty of Kinesiology , Sport Injury Prevention Research Centre, University of Calgary , Calgary , Canada
| | - Michael G Hutchison
- d Faculty of Kinesiology and Physical Education , University of Toronto , Toronto , Canada
| | - Mark Aubry
- e Ottawa Sport Medicine Center , Ottawa , Canada
| | - Paul Comper
- d Faculty of Kinesiology and Physical Education , University of Toronto , Toronto , Canada
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Bruce JM, Echemendia RJ, Meeuwisse W, Hutchison MG, Aubry M, Comper P. Development of a risk prediction model among professional hockey players with visible signs of concussion. Br J Sports Med 2017; 52:1143-1148. [DOI: 10.1136/bjsports-2016-097091] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2017] [Indexed: 11/04/2022]
Abstract
BackgroundLittle research examines how to best identify concussed athletes. The purpose of the present study was to develop a preliminary risk decision model that uses visible signs (VS) and mechanisms of injury (MOI) to predict the likelihood of subsequent concussion diagnosis.MethodsCoders viewed and documented VS and associated MOI for all NHL games over the course of the 2013–2014 and 2014–2015 regular seasons. After coding was completed, player concussions were identified from the NHL injury surveillance system and it was determined whether players exhibiting VS were subsequently diagnosed with concussions by club medical staff as a result of the coded event.ResultsAmong athletes exhibiting VS, suspected loss of consciousness, motor incoordination or balance problems, being in a fight, having an initial hit from another player’s shoulder and having a secondary hit on the ice were all associated with increased risk of subsequent concussion diagnosis. In contrast, having an initial hit with a stick was associated with decreased risk of subsequent concussion diagnosis. A risk prediction model using a combination of the above VS and MOI was superior to approaches that relied on individual VS and associated MOI (sensitivity=81%, specificity=72%, positive predictive value=26%).ConclusionsCombined use of VS and MOI significantly improves a clinician’s ability to identify players who need to be evaluated for possible concussion. A preliminary concussion prediction log has been developed from these data. Pending prospective validation, the use of these methods may improve early concussion detection and evaluation.
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Echemendia RJ, Bruce JM, Meeuwisse W, Hutchison MG, Comper P, Aubry M. Can visible signs predict concussion diagnosis in the National Hockey League? Br J Sports Med 2017; 52:1149-1154. [PMID: 28377445 DOI: 10.1136/bjsports-2016-097090] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND Early identification and evaluation of concussions is critical. We examined the utility of using visible signs (VS) of concussion in predicting subsequent diagnosis of concussion in NHL players. METHODS VS of concussion were identified through video review. Coders were trained to detect and record specific visual signs while viewing videos of NHL regular season games. 2460 games were reviewed by at least two independent coders across two seasons. The reliability, sensitivity and specificity of these VS were examined. RESULTS VS were reliably coded with inter-rater agreement rates ranging from 73% to 98.9%. 1215 VS were identified in 861 events that occurred in 735 games. 47% of diagnosed concussions were associated with a VS but 53% of diagnosed concussions had no VS. Of the VS, only loss of consciousness, motor incoordination, and blank/vacant look had positive likelihood ratios greater than 1, indicating a positive association with concussion diagnoses. Slow to get up and clutching of the head were observed frequently but had low positive predictive values. Sensitivity decreased and specificity increased when multiple VS occurred together. CONCLUSIONS Non-medical personnel can be trained to reliably identify events in which VS occur and to reliably identify specific VS within each of those events. VS can be useful to detect concussion early but they are not enough since more than half of physician diagnosed concussions occurred without the presence of a visual sign. The results underscore the complexity of this injury and highlight the need for comprehensive approaches to injury detection.
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Affiliation(s)
- Ruben J Echemendia
- University Orthopedic Center Concussion Care Clinic, State College, Pennsylvania, USA.,Department of Psychology, University of Missouri - Kansas City, Missouri, USA
| | - Jared M Bruce
- Department of Psychology, University of Missouri - Kansas City, Missouri, USA
| | - Willem Meeuwisse
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Michael G Hutchison
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Paul Comper
- Toronto Rehabilitation Institute, Toronto, Canada
| | - Mark Aubry
- Ottawa Sport Medicine Centre, Ottawa, Canada
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Eliason P, McKay C, Meeuwisse W, Hagel B, Nadeau L, Emery C. EFFECT OF PREVIOUS CONCUSSION ON SPORT-SPECIFIC SKILLS IN YOUTH ICE HOCKEY PLAYERS. Br J Sports Med 2017. [DOI: 10.1136/bjsports-2016-097372.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Grool AM, Aglipay M, Momoli F, Meehan WP, Freedman SB, Yeates KO, Gravel J, Gagnon I, Boutis K, Meeuwisse W, Barrowman N, Ledoux AA, Osmond MH, Zemek R. Association Between Early Participation in Physical Activity Following Acute Concussion and Persistent Postconcussive Symptoms in Children and Adolescents. JAMA 2016; 316:2504-2514. [PMID: 27997652 DOI: 10.1001/jama.2016.17396] [Citation(s) in RCA: 191] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Although concussion treatment guidelines advocate rest in the immediate postinjury period until symptoms resolve, no clear evidence has determined that avoiding physical activity expedites recovery. OBJECTIVE To investigate the association between participation in physical activity within 7 days postinjury and incidence of persistent postconcussive symptoms (PPCS). DESIGN, SETTING, AND PARTICIPANTS Prospective, multicenter cohort study (August 2013-June 2015) of 3063 children and adolescents aged 5.00-17.99 years with acute concussion from 9 Pediatric Emergency Research Canada network emergency departments (EDs). EXPOSURES Early physical activity participation within 7 days postinjury. MAIN OUTCOMES AND MEASURES Physical activity participation and postconcussive symptom severity were rated using standardized questionnaires in the ED and at days 7 and 28 postinjury. PPCS (≥3 new or worsening symptoms on the Post-Concussion Symptom Inventory) was assessed at 28 days postenrollment. Early physical activity and PPCS relationships were examined by unadjusted analysis, 1:1 propensity score matching, and inverse probability of treatment weighting (IPTW). Sensitivity analyses examined patients (≥3 symptoms) at day 7. RESULTS Among 2413 participants who completed the primary outcome and exposure, (mean [SD] age, 11.77 [3.35] years; 1205 [39.3%] females), PPCS at 28 days occurred in 733 (30.4%); 1677 (69.5%) participated in early physical activity including light aerobic exercise (n = 795 [32.9%]), sport-specific exercise (n = 214 [8.9%]), noncontact drills (n = 143 [5.9%]), full-contact practice (n = 106 [4.4%]), or full competition (n = 419 [17.4%]), whereas 736 (30.5%) had no physical activity. On unadjusted analysis, early physical activity participants had lower risk of PPCS than those with no physical activity (24.6% vs 43.5%; Absolute risk difference [ARD], 18.9% [95% CI,14.7%-23.0%]). Early physical activity was associated with lower PPCS risk on propensity score matching (n = 1108 [28.7% for early physical activity vs 40.1% for no physical activity]; ARD, 11.4% [95% CI, 5.8%-16.9%]) and on inverse probability of treatment weighting analysis (n = 2099; relative risk [RR], 0.74 [95% CI, 0.65-0.84]; ARD, 9.7% [95% CI, 5.7%-13.7%]). Among only patients symptomatic at day 7 (n = 803) compared with those who reported no physical activity (n = 584; PPCS, 52.9%), PPCS rates were lower for participants of light aerobic activity (n = 494 [46.4%]; ARD, 6.5% [95% CI, 5.7%-12.5%]), moderate activity (n = 176 [38.6%]; ARD, 14.3% [95% CI, 5.9%-22.2%]), and full-contact activity (n = 133 [36.1%]; ARD, 16.8% [95% CI, 7.5%-25.5%]). No significant group difference was observed on propensity-matched analysis of this subgroup (n = 776 [47.2% vs 51.5%]; ARD, 4.4% [95% CI, -2.6% to 11.3%]). CONCLUSIONS AND RELEVANCE Among participants aged 5 to 18 years with acute concussion, physical activity within 7 days of acute injury compared with no physical activity was associated with reduced risk of PPCS at 28 days. A well-designed randomized clinical trial is needed to determine the benefits of early physical activity following concussion.
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Affiliation(s)
- Anne M Grool
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Mary Aglipay
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Franco Momoli
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - William P Meehan
- Sports Concussion Clinic, Boston Children's Hospital, Boston, Massachusetts
| | - Stephen B Freedman
- Department of Pediatrics, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, University of Calgary, Alberta, Canada
| | - Keith Owen Yeates
- Department of Psychology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
| | - Jocelyn Gravel
- Department of Pediatrics, Hospital Ste Justine, University of Montreal, Montreal, Quebec, Canada
| | - Isabelle Gagnon
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Kathy Boutis
- Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Willem Meeuwisse
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Nick Barrowman
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Andrée-Anne Ledoux
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Martin H Osmond
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Roger Zemek
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
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Little CE, Emery C, Scott SH, Meeuwisse W, Palacios-Derflingher L, Dukelow SP. Do children and adolescent ice hockey players with and without a history of concussion differ in robotic testing of sensory, motor and cognitive function? J Neuroeng Rehabil 2016; 13:89. [PMID: 27729040 PMCID: PMC5059996 DOI: 10.1186/s12984-016-0195-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 09/22/2016] [Indexed: 11/30/2022] Open
Abstract
Background KINARM end point robotic testing on a range of tasks evaluating sensory, motor and cognitive function in children/adolescents with no neurologic impairment has been shown to be reliable. The objective of this study was to determine whether differences in baseline performance on multiple robotic tasks could be identified between pediatric/adolescent ice hockey players (age range 10–14) with and without a history of concussion. Methods Three hundred and eighty-five pediatric/adolescent ice hockey players (ages 10–14) completed robotic testing (94 with and 292 without a history of concussion). Five robotic tasks characterized sensorimotor and/or cognitive performance with assessment of reaching, position sense, bimanual motor function, visuospatial skills, attention and decision-making. Seventy-six performance parameters are reported across all tasks. Results There were no significant differences in performance demonstrated between children with a history of concussion [median number of days since last concussion: 480 (range 8–3330)] and those without across all five tasks. Performance by the children with no history of concussion was used to identify parameter reference ranges that spanned 95 % of the group. All 76 parameter means from the concussion group fell within the normative reference ranges. Conclusions There are no differences in sensorimotor and/or cognitive performance across multiple parameters using KINARM end point robotic testing in children/adolescents with or without a history of concussion.
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Affiliation(s)
- C Elaine Little
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.
| | - Carolyn Emery
- Faculty of Kinesiology and Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Stephen H Scott
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Willem Meeuwisse
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Luz Palacios-Derflingher
- Faculty of Kinesiology, Cumming School of Medicine, and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Echemendia RJ, Bruce JM, Meeuwisse W, Comper P, Aubry M, Hutchison M. Long-term reliability of ImPACT in professional ice hockey. Clin Neuropsychol 2016; 30:328-37. [DOI: 10.1080/13854046.2016.1158320] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Zemek R, Barrowman N, Freedman SB, Gravel J, Gagnon I, McGahern C, Aglipay M, Sangha G, Boutis K, Beer D, Craig W, Burns E, Farion KJ, Mikrogianakis A, Barlow K, Dubrovsky AS, Meeuwisse W, Gioia G, Meehan WP, Beauchamp MH, Kamil Y, Grool AM, Hoshizaki B, Anderson P, Brooks BL, Yeates KO, Vassilyadi M, Klassen T, Keightley M, Richer L, DeMatteo C, Osmond MH. Clinical Risk Score for Persistent Postconcussion Symptoms Among Children With Acute Concussion in the ED. JAMA 2016; 315:1014-25. [PMID: 26954410 DOI: 10.1001/jama.2016.1203] [Citation(s) in RCA: 556] [Impact Index Per Article: 69.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Approximately one-third of children experiencing acute concussion experience ongoing somatic, cognitive, and psychological or behavioral symptoms, referred to as persistent postconcussion symptoms (PPCS). However, validated and pragmatic tools enabling clinicians to identify patients at risk for PPCS do not exist. OBJECTIVE To derive and validate a clinical risk score for PPCS among children presenting to the emergency department. DESIGN, SETTING, AND PARTICIPANTS Prospective, multicenter cohort study (Predicting and Preventing Postconcussive Problems in Pediatrics [5P]) enrolled young patients (aged 5-<18 years) who presented within 48 hours of an acute head injury at 1 of 9 pediatric emergency departments within the Pediatric Emergency Research Canada (PERC) network from August 2013 through September 2014 (derivation cohort) and from October 2014 through June 2015 (validation cohort). Participants completed follow-up 28 days after the injury. EXPOSURES All eligible patients had concussions consistent with the Zurich consensus diagnostic criteria. MAIN OUTCOMES AND MEASURES The primary outcome was PPCS risk score at 28 days, which was defined as 3 or more new or worsening symptoms using the patient-reported Postconcussion Symptom Inventory compared with recalled state of being prior to the injury. RESULTS In total, 3063 patients (median age, 12.0 years [interquartile range, 9.2-14.6 years]; 1205 [39.3%] girls) were enrolled (n = 2006 in the derivation cohort; n = 1057 in the validation cohort) and 2584 of whom (n = 1701 [85%] in the derivation cohort; n = 883 [84%] in the validation cohort) completed follow-up at 28 days after the injury. Persistent postconcussion symptoms were present in 801 patients (31.0%) (n = 510 [30.0%] in the derivation cohort and n = 291 [33.0%] in the validation cohort). The 12-point PPCS risk score model for the derivation cohort included the variables of female sex, age of 13 years or older, physician-diagnosed migraine history, prior concussion with symptoms lasting longer than 1 week, headache, sensitivity to noise, fatigue, answering questions slowly, and 4 or more errors on the Balance Error Scoring System tandem stance. The area under the curve was 0.71 (95% CI, 0.69-0.74) for the derivation cohort and 0.68 (95% CI, 0.65-0.72) for the validation cohort. CONCLUSIONS AND RELEVANCE A clinical risk score developed among children presenting to the emergency department with concussion and head injury within the previous 48 hours had modest discrimination to stratify PPCS risk at 28 days. Before this score is adopted in clinical practice, further research is needed for external validation, assessment of accuracy in an office setting, and determination of clinical utility.
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Affiliation(s)
- Roger Zemek
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - Nick Barrowman
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Stephen B Freedman
- Department of Pediatrics, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
| | - Jocelyn Gravel
- Department of Pediatrics, Hospital Ste Justine, University of Montreal, Montreal, Quebec, Canada
| | - Isabelle Gagnon
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Candice McGahern
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Mary Aglipay
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Gurinder Sangha
- Department of Pediatrics, Children's Hospital of Western Ontario, Western University, London, Canada
| | - Kathy Boutis
- Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Darcy Beer
- Department of Pediatrics, Manitoba Children's Hospital, Winnipeg, Canada
| | - William Craig
- Department of Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Emma Burns
- Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Ken J Farion
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | | | - Karen Barlow
- Department of Pediatrics and Clinical Neurosciences, Alberta's Children's Hospital, University of Calgary, Calgary, Canada
| | - Alexander S Dubrovsky
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Willem Meeuwisse
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Gerard Gioia
- Department of Neuropsychology, Children's National Health System, George Washington University School of Medicine, Rockville, Maryland
| | - William P Meehan
- Sports Concussion Clinic, Boston Children's Hospital, Boston, Massachusetts
| | - Miriam H Beauchamp
- Ste Justine Research Center, University of Montreal, Montreal, Quebec, Canada
| | - Yael Kamil
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Anne M Grool
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Blaine Hoshizaki
- Department of Kinesiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Peter Anderson
- Department of Psychology, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Brian L Brooks
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
| | - Keith Owen Yeates
- Department of Psychology, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
| | - Michael Vassilyadi
- Department of Neurosurgery, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Terry Klassen
- Department of Pediatrics, Manitoba Children's Hospital, Winnipeg, Canada
| | - Michelle Keightley
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Lawrence Richer
- Department of Neurology, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Carol DeMatteo
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Martin H Osmond
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
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Bruce J, Echemendia R, Tangeman L, Meeuwisse W, Comper P, Hutchison M, Aubry M. Two baselines are better than one: Improving the reliability of computerized testing in sports neuropsychology. Appl Neuropsychol Adult 2016; 23:336-42. [PMID: 26786726 DOI: 10.1080/23279095.2015.1064002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Computerized neuropsychological tests are frequently used to assist in return-to-play decisions following sports concussion. However, due to concerns about test reliability, the Centers for Disease Control and Prevention recommends yearly baseline testing. The standard practice that has developed in baseline/postinjury comparisons is to examine the difference between the most recent baseline test and postconcussion performance. Drawing from classical test theory, the present study investigated whether temporal stability could be improved by taking an alternate approach that uses the aggregate of 2 baselines to more accurately estimate baseline cognitive ability. One hundred fifteen English-speaking professional hockey players with 3 consecutive Immediate Postconcussion Assessment and Testing (ImPACT) baseline tests were extracted from a clinical program evaluation database overseen by the National Hockey League and National Hockey League Players' Association. The temporal stability of ImPACT composite scores was significantly increased by aggregating test performance during Sessions 1 and 2 to predict performance during Session 3. Using this approach, the 2-factor Memory (r = .72) and Speed (r = .79) composites of ImPACT showed acceptable long-term reliability. Using the aggregate of 2 baseline scores significantly improves temporal stability and allows for more accurate predictions of cognitive change following concussion. Clinicians are encouraged to estimate baseline abilities by taking into account all of an athlete's previous baseline scores.
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Affiliation(s)
- Jared Bruce
- a Department of Psychology , University of Missouri-Kansas City , Kansas City , Missouri , USA
| | - Ruben Echemendia
- a Department of Psychology , University of Missouri-Kansas City , Kansas City , Missouri , USA.,b Psychological and Neurobehavioral Associates , State College , Pennsylvania , USA
| | - Lindy Tangeman
- a Department of Psychology , University of Missouri-Kansas City , Kansas City , Missouri , USA
| | - Willem Meeuwisse
- c Faculty of Kinesiology, University of Calgary , Calgary , Alberta , Canada
| | - Paul Comper
- d Faculty of Kinesiology and Physical Education , University of Toronto , Toronto , Ontario , Canada
| | - Michael Hutchison
- d Faculty of Kinesiology and Physical Education , University of Toronto , Toronto , Ontario , Canada
| | - Mark Aubry
- e Ottawa Sport Medicine Center , Ottawa , Ontario , Canada
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Little CE, Emery C, Black A, Scott SH, Meeuwisse W, Nettel-Aguirre A, Benson B, Dukelow S. Test-retest reliability of KINARM robot sensorimotor and cognitive assessment: in pediatric ice hockey players. J Neuroeng Rehabil 2015; 12:78. [PMID: 26341424 PMCID: PMC4560901 DOI: 10.1186/s12984-015-0070-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 08/27/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Better diagnostic and prognostic tools are needed to address issues related to early diagnosis and management of concussion across the continuum of aging but particularly in children and adolescents. The purpose of the current study was to evaluate the reliability of robotic technology (KINARM robot) assessments of reaching, position sense, bimanual motor function, visuospatial skills, attention and decision making in youth ice hockey players (ages 10-14). METHODS Thirty-four male children attended two testing days, one week apart. On day one, each subject completed five tasks on the robot with two examiners (alternating examiner sequence); the 2(nd) examiner followed the same procedure as the 1(st) immediately afterwards. One consistent examiner tested subjects one week later. This is a test-retest reliability study. The robotic tasks characterize sensorimotor and/or cognitive performance; 63 parameters from 5 tasks are reported. Session 1 was the 1(st) time the subject performed the 5 tasks, session 2 the 2(nd) time on day 1, and session 3 one week following. RESULTS Intra-class correlation coefficients ranged from 0.06 to 0.91 and 0.09 to 0.90 for session 1 to 2 and 2 to 3, respectively. Bland-Altman plots showed agreement in a majority of the parameters and a learning effect in 25 % and 24 % of parameters in session 1 vs 2 and 1 vs 3, respectively but none for session 2 vs 3. Of those that showed a learning effect, only 8 % of parameters in session 1 vs 2 and 10 % in session 1 vs 3 had a clinical relevance measure ≥ 0.8. CONCLUSIONS The relative homogeneity of the sample and the effect of learning seen in some of the task parameters appears to have negatively impacted the intra-class correlation coefficients from session 1 to 2, with less impact for 2 to 3. The Bland-Altman analysis supports good absolute reliability in healthy male children with no neurological impairment ranging in age from 10 to 14. The clinically relevant learning effect seen, in a small number of parameters could be addressed by creating a learning effect adjustment factor and/or implementing a practice session, which would eliminate the learning effect.
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Affiliation(s)
- C Elaine Little
- Department of Kinesiology, University of Calgary, Calgary, Alberta, Canada.
| | - Carolyn Emery
- Department of Kinesiology, University of Calgary, Calgary, Alberta, Canada.
| | - Amanda Black
- Department of Kinesiology, University of Calgary, Calgary, Alberta, Canada.
| | - Stephen H Scott
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada.
| | - Willem Meeuwisse
- Department of Kinesiology, University of Calgary, Calgary, Alberta, Canada.
| | - Alberto Nettel-Aguirre
- Departments of Pediatrics & Community Health Sciences, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada.
| | - Brian Benson
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
| | - Sean Dukelow
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
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Samuels C, James L, Lawson D, Meeuwisse W. The Athlete Sleep Screening Questionnaire: a new tool for assessing and managing sleep in elite athletes. Br J Sports Med 2015; 50:418-22. [DOI: 10.1136/bjsports-2014-094332] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2015] [Indexed: 11/03/2022]
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Soligard T, Steffen K, Palmer-Green D, Aubry M, Grant ME, Meeuwisse W, Mountjoy M, Budgett R, Engebretsen L. Sports injuries and illnesses in the Sochi 2014 Olympic Winter Games. Br J Sports Med 2015; 49:441-7. [PMID: 25631542 DOI: 10.1136/bjsports-2014-094538] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Systematic surveillance of injuries and illnesses is the foundation for developing preventive measures in sport. AIM To analyse the injuries and illnesses that occurred during the XXII Olympic Winter Games, held in Sochi in 2014. METHODS We recorded the daily occurrence (or non-occurrence) of injuries and illnesses (1) through the reporting of all National Olympic Committee (NOC) medical teams and (2) in the polyclinic and medical venues by the Sochi 2014 medical staff. RESULTS NOC and Sochi 2014 medical staff reported 391 injuries and 249 illnesses among 2780 athletes from 88 NOCs, equalling incidences of 14 injuries and 8.9 illnesses per 100 athletes over an 18-day period of time. Altogether, 12% and 8% of the athletes incurred at least one injury or illness, respectively. The percentage of athletes injured was highest in aerial skiing, snowboard slopestyle, snowboard cross, slopestyle skiing, halfpipe skiing, moguls skiing, alpine skiing, and snowboard halfpipe. Thirty-nine per cent of the injuries were expected to prevent the athlete from participating in competition or training. Women suffered 50% more illnesses than men. The rate of illness was highest in skeleton, short track, curling, cross-country skiing, figure skating, bobsleigh and aerial skiing. A total of 159 illnesses (64%) affected the respiratory system, and the most common cause of illness was infection (n=145, 58%). CONCLUSIONS Overall, 12% of the athletes incurred at least one injury during the games, and 8% an illness, which is similar to prior Olympic Games. The incidence of injuries and illnesses varied substantially between sports.
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Affiliation(s)
- Torbjørn Soligard
- Medical & Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | - Kathrin Steffen
- Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
| | - Debbie Palmer-Green
- Department of Academic Orthopaedics, Trauma and Sports Medicine, University of Nottingham, Nottingham, UK
| | - Mark Aubry
- International Ice Hockey Federation (IIHF), Zurich, Switzerland
| | - Marie-Elaine Grant
- Institute of Sport and Health, University College Dublin, Dublin, Ireland
| | - Willem Meeuwisse
- Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, Calgary, Alberta, Canada
| | - Margo Mountjoy
- Fédération International de Natation (FINA), Lausanne, Switzerland
| | - Richard Budgett
- Medical & Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | - Lars Engebretsen
- Medical & Scientific Department, International Olympic Committee, Lausanne, Switzerland Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway Department of Orthopaedic Surgery, University of Oslo, Oslo, Norway
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Russell K, Meeuwisse W, Nettel-Aguirre A, Emery CA, Gushue S, Wishart J, Romanow N, Rowe BH, Goulet C, Hagel BE. Listening to a personal music player is associated with fewer but more serious injuries among snowboarders in a terrain park: a case-control study. Br J Sports Med 2014; 49:62-6. [DOI: 10.1136/bjsports-2014-093487] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Woollings K, McKay C, Kang J, Meeuwisse W, Emery CA. INJURY RATES, MECHANISMS, AND RISK FACTORS FOR INJURY IN YOUTH ROCK CLIMBERS. Br J Sports Med 2014. [DOI: 10.1136/bjsports-2014-093494.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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