Physicians May Make a Difference in Concussion Surveillance

Physicians and other independent observers may help improve concussion surveillance during ice hockey and other athletic events, according to a new study. (Image: Christopher O Driscoll/iStockphoto.com)

Physicians and other independent observers may help improve concussion surveillance during ice hockey and other athletic events, according to a new study. (Image: Christopher O Driscoll/iStockphoto.com)

A small study of college ice hockey players in Canada in which physicians and other independent observers watched games from the stands and evaluated injured players indicates that college hockey players’ concussion rates there may have improved over the past 2 years but remain vastly underreported.

Appearing today in Neurosurgical Focus, a peer-reviewed online journal, the study followed up 20 men and 25 women who played ice hockey for college teams in Canada during the 2011-2012 season. All players underwent comprehensive preseason neuropsychological testing and magnetic resonance imaging (MRI) scans. At each game, a sports medicine physician and an independent observer watched the action from seats positioned higher than rink level to get a clear view of injuries.

Physicians used a battery of tests to evaluate each player with a suspected concussion immediately after the injury occurred, while independent observers completed lengthy questionnaires describing how injuries took place. Whenever a physician diagnosed a concussion, the player was removed from the game and instructed to visit the physician’s office within 24 hours to have the tests repeated and undergo an MRI scan. Those results then were reviewed by an independent neuropsychologist. Players were reevaluated 6 days after an injury and then weekly until they were asymptomatic.

During the 55 games they observed, the physicians diagnosed 11 concussions. During regular season play, the concussion rate for men and women combined was 10.7 per 1000 athlete exposures. The rate was 11.8 among the men and 14.9 among the women.

The researchers said these rates were about half of those reported in a similar study they conducted during the 2009-2010 ice hockey season. But the current rates still are about 3 times higher for men and 5 times higher for women than those reported in the scientific literature on collegiate ice hockey injuries, they noted.

For example, they cited a 2005 study in the American Journal of Sports Medicine that reported a concussion rate of 3.1 per 1000 athlete exposures during 1 season of US Division I collegiate ice hockey play. A review published in 2007 in the peer-reviewed Journal of Athletic Training reported that 16 years of US National Collegiate Athletic Association data on men’s ice hockey injuries showed a concussion rate of 1.5 per 1000 exposures.

“Other studies have not been exclusively dependent upon prospective, direct, physician-based concussion identification, diagnosis, and follow-up,” the authors wrote. Instead, studies traditionally have relied on retrospective self-reporting from athletes or determinations by team trainers or first responders. Their results, the authors added, “demonstrate the need for improved and independent surveillance studies to be performed at all levels of sport.”



Categories: Neuroimaging, Neurology, Public Health, Sports Medicine

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