Study identifies predictors for playing time lost after concussion in professional hockey players

Post-concussion headache, low energy or fatigue, amnesia and abnormal neurologic findings are significant predictors of playing time lost among professional hockey players, according to a study conducted during 7 National Hockey League seasons and recently published in the Canadian Medical Association Journal.

The National Hockey League (NHL), in conjunction with the NHL Players’ Association, launched an initiative in 1997 to improve the understanding of concussions. As part of the initiative, investigators examined initial post-concussion signs, symptoms, physical examination findings and playing time lost for male professional ice hockey players.

These initial post-concussion clinical manifestations were assessed in terms of their use in predicting playing time lost among hockey players.

“Our results suggest that there was a trend toward a gradual increase in post-concussion time loss over the study period,” lead author Brian W. Benson, PhD, stated in a press release. “More should be done to educate everyone involved about the potential adverse effects associated with continuing to play while symptomatic, failing to report symptoms to medical staff and failure to recognize or evaluate any suspected concussion.”

More time lost

Benson and his colleagues conducted a prospective case series of concussions in an inclusive cohort of players during regular NHL seasons from 1997 to 2004. According to the study abstract, the primary outcome of the investigation was concussion with a secondary outcome of playing time lost. NHL team physicians were charged to document post-concussion clinical manifestations, as well as record the date at which affected players were medically cleared to resume play.

In all, 559 concussions were reported by team physicians during the study period, which amounted to 1.8 concussions per 1,000 player-hours. Headache was the most common post-concussion symptom (71%), with average time lost in days increasing 2.25 times for every subsequent concussion sustained during the study period.

Other post-concussion symptoms reported with frequency included dizziness (34%), nausea (24%), neck pain (23%), low energy or fatigue (22%), blurred vision (22%), amnesia (21%) and loss of consciousness (18%), according to the release. Regular-season game concussion rates decreased from a peak of 7.7 concussions per 100 players during the 2000-2001 NHL reason to 4.9 per 100 players in 2003-2004.

Decreased number of concussions

“One trend we saw was that while the number of concussions leveled out over the study period, the amount of time loss appeared to gradually increase over the years — which may be an indication of either greater severity or greater caution in treatment,” Benson stated in the release.

The authors wrote that after controlling for age and position, they found post-concussion headache, low energy or fatigue, amnesia and abnormal neurologic findings were significant predictors of playing time loss. When a previously suggested time loss cut-point of 10 days was used, headache and low energy or fatigue were significant predictors of time loss of greater than 10 days.

References:

Benson BW, et al. A prospective study of concussions among National Hockey League players during regular season games: The NHL-NHLPA Concussion Program. CMAJ. E-pub ahead of print April 18, 2011. doi: 10.1503/cmaj.092190.

http://ucalgary.ca/news/

Disclosure: No relevant financial disclosure was reported.

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