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

Abstract

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

More Physical Activity Is Correlated With Reduction in Kinesiophobia for Adolescents With Persistent Symptoms After Concussion

“…Individuals with high kinesiophobia ratings after concussion have previously been observed to also have high overall symptom burden, 16 and higher concussion symptom burden is associated with longer RTP clearance time. 27 Consistent with this past research, the interplay between symptom severity, kinesiophobia, and RTP clearance time may have contributed to our observed results. We observed higher initial symptom scores and higher TSK ratings in those with persistent symptoms compared with those without persistent symptoms.…”

Are Self-Reported and Parent-Reported Attention Problems and Hyperactivity Associated With Higher Rates of Concussion in Youth Ice Hockey Players?

“…Body checking league was not a significant predictor for concussion, contrary to previous youth ice hockey studies, including meta-analyses. 35,37,38,42,54 This finding may be related to the offset for exposure time in the analysis, which included practice and game hours. Teams who participate in leagues permitting body checking are found typically at higher levels of play and practice more often.…”

“…Data collected in 2 prospective cohort studies 34,35 were used for a secondary analysis of Canadian youth ice hockey players ages 11 to 17 years over 4 seasons of play (2011/2012, 2013/ 2014, 2014/2015, and 2015/2016).…”

“…41 This approach has been supported by several previous youth ice hockey studies. 35,37,38,42 Outcome (Injury/Concussion) All ice hockey-related injuries resulting in medical attention, the inability to complete a game or practice, or time loss (ie, any period of time for which a player was unable to train/ play), were identified and recorded by a team designate (eg, team manager or team therapist). All suspected concussions were referred to the study sport medicine physician for assessment and management recommendations.…”

“…Further details of each cohort have been previously described. 34,35,37,38 Players were only included in the current study if they had completed at least one of either the self-reported or parent-reported BASC-2 during a preseason assessment. Some players participated in multiple seasons, but only those seasons that included a preseason BASC-2 were included for analyses (Figure 1).…”