The Effects of Altitude on Concussion Incidence in the 2013-2017 National Hockey League Seasons

Abstract

Background and objectiveThe high incidence of traumatic brain injuries during contact sports has necessitated the need for further research pertaining to their implications and possible mitigation. Despite increasing attention to sports-related concussions, there is still a striking lack of detail pertaining to the environmental factors that contribute to their occurrence. One environmental condition that has yet to be considered is altitude. Altitude cannot be readily adjusted, yet can still impact quality of play and concussion incidence. The current body of published evidence evaluating environmental effects on concussion is divided on the degree to which altitude mitigates concussion incidence. We aim to systematically compare the prevalence of concussions that occur at high and low altitude utilizing 1000 feet (304.8 meters) as a cut-off marker for high altitude. Our research also takes a novel approach utilizing average games missed as a proxy for concussion severity. We hope to use this analysis to shed light on the implication of altitude on concussion incidence.MethodsIndividual player data on concussion incidence were retrospectively acquired for the 2013-2017 National Hockey League (NHL) seasons utilizing FOX Sports Injury tracker. NHL season schedules were acquired through the online source “Hockey Reference.” In order to establish cutoff criteria for high vs low altitude we adopted 1000 feet (304.8 meters) as high-low altitude cutoff. We also evaluated our data utilizing a previously published high-low altitude cutoff of 644 feet (196.3 meters). Specific altitudes of each NHL arena were derived from “elevationmap.net”. One caveat to our data collection was the striking lack of publicly available data pertaining to the concussions sustained by each NHL team. Data was analyzed utilizing SAS programing.ResultsOut of the 5281 games included in our data set, we documented a total of 133 concussions which occurred in 125 games through the 2013-2017 NHL seasons. We noted an increase in concussion reporting in the most recent 2016-2017 NHL season compared to the previous 2013-2016 seasons. Effect of altitude variance on concussion rate was evaluated utilizing 644 and 1000 ft as the low-high altitude split. We defined each variance by where the team is based at compared to where the game was played. This produced four distinct categories: 1) low-low altitude, 2) low-high altitude, 3) high-low altitude, and 4) high-high altitude. We noted a significant difference in concussion rate when teams based at high altitude above 1000 ft travel to play at low altitude; this trend was non-significant at 644 ft. The results of the average games missed analysis demonstrated that teams that play above 1000 feet had fewer games missed per concussion compared to teams that are based at a low altitude.ConclusionsThough underreported in the total number of concussions in the 2013-2017 NHL seasons, our data suggests that teams who are based at a high altitude (>1000ft) experience a reduction in mean concussion rate when traveli...

Modifying Factors for Concussion Incidence and Severity in the 2013-2017 National Hockey League Seasons

“…One caveat to our data collection was the striking lack of publicly available data pertaining to the concussions sustained by each NHL team. We noted an under-reporting of concussions in our data set on a season-to-season basis compared to similar papers evaluating concussions in the NHL [7].…”

“…Team demographics such as city and arena were acquired from our online sources (Table 1). One important caveat for our analysis was the omission of the recent Las Vegas expansion team whose first season was the end of 2017 through 2018 [7]​​​​​​​.…”

“…Data on concussion incidence for the 2013-2017 National Hockey League seasons was collected utilizing FOX Sports injury tracker [7]. Only injuries specifically diagnosed as concussions during regular and postseason games were utilized in our data set.…”

“…Total postseason games varied season to season based upon how quickly teams advanced through the seven game series to the Stanley Cup Final. Concussions sustained during team practices and preseason contests were not accounted for in our data set to control for inconsistent reporting [7].…”

“…FOX Sports injury tracker was utilized for source data. We acknowledge a limitation in this data set due to a lack of publicly available data pertaining to concussion injuries and consider it to be an under-reported representation of the total number of concussions that occurred between the 2013-2017 NHL seasons [7].…”