AIM Health Group Family Medicine, London, Ontario, Canada.
Neurosurg Focus. 2010 Nov;29(5):E4. doi: 10.3171/2010.9.FOCUS10186.
The objective of this study was to measure the incidence of concussion (scaled relative to number of athlete exposures) and recurrent concussion within 2 teams of fourth-tier junior ice hockey players (16-21 years old) during 1 regular season.
A prospective cohort study called the Hockey Concussion Education Project was conducted during 1 junior ice hockey regular season (2009-2010) involving 67 male fourth-tier ice hockey players (mean age 18.2 ± 1.2 years, range 16-21 years) from 2 teams. Prior to the start of the season, every player underwent baseline assessments using the Sideline Concussion Assessment Tool 2 (SCAT2) and the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT). The study protocol also required players who entered the study during the season to complete baseline SCAT2 and ImPACT testing. If the protocol was not followed, the postinjury test results of a player without true baseline test results would be compared against previously established age and gender group normative levels. Each regular season game was observed by a qualified physician and at least 1 other neutral nonphysician observer. Players who suffered a suspected concussion were evaluated at the game. If a concussion diagnosis was made, the player was subsequently examined in the physician's office for a full clinical evaluation and the SCAT2 and ImPACT were repeated. Based on these evaluations, players were counseled on the decision of when to return to play. Athlete exposure was defined as 1 game played by 1 athlete.
Twenty-one concussions occurred during the 52 physician-observed games (incidence 21.5 concussions per 1000 athlete exposures). Five players experienced repeat concussions. No concussions were reported during practice sessions. A concussion was diagnosed by the physician in 19 (36.5%) of the 52 observed games. One of the 5 individuals who suffered a repeat concussion sustained his initial concussion in a regular season game that was not observed by a physician, and as a result this single case was not included in the total of 21 total concussions. This initial concussion of the player was identified during baseline testing 2 days after the injury and was subsequently medically diagnosed and treated.
The incidence of game-related concussions (per 100 [corrected] athlete exposures) in these fourth-tier junior [corrected] ice hockey players was 7 [corrected] times higher than [corrected] previously reported in the literature. This difference may be the result of the use of standardized direct physician observation, diagnosis, and subsequent treatment. The results of this study demonstrate the need for follow-up studies involving larger and more diverse sample groups to reflect generalizability of the findings. These follow-up studies should involve other contact sports (for example football and rugby) and also include the full spectrum of gender, age, and skill levels.
本研究旨在测量两支第四级青少年冰球（16-21 岁）运动员中，1 个常规赛中（2009-2010 年）脑震荡（相对于运动员暴露次数的比例）和复发性脑震荡的发生率。
一项名为“冰球脑震荡教育项目”的前瞻性队列研究在 1 个青少年冰球常规赛（2009-2010 年）中进行，涉及 2 支队伍的 67 名第四级冰球男运动员（平均年龄 18.2±1.2 岁，范围 16-21 岁）。在赛季开始前，每位运动员都使用“场外脑震荡评估工具 2（SCAT2）”和“即刻后脑震荡评估和认知测试（ImPACT）”进行基线评估。研究方案还要求在赛季中进入研究的运动员完成基线 SCAT2 和 ImPACT 测试。如果不遵守方案，则没有真实基线测试结果的运动员的受伤后测试结果将与之前建立的年龄和性别组规范水平进行比较。每场常规赛都由合格的医生和至少 1 名其他中立的非医生观察员观察。在比赛中遭受疑似脑震荡的运动员将接受评估。如果做出脑震荡诊断，将在医生办公室对运动员进行全面临床评估并重复进行 SCAT2 和 ImPACT。根据这些评估，运动员将接受有关何时返回比赛的决策的咨询。运动员暴露定义为 1 名运动员参加 1 场比赛。
在 52 场医生观察的比赛中发生了 21 例脑震荡（每 1000 名运动员暴露 21.5 例脑震荡）。5 名运动员经历了重复脑震荡。练习期间未报告脑震荡。在 52 场观察比赛中，有 19 场（36.5%）由医生诊断为脑震荡。在重复脑震荡的 5 人中，有 1 人最初的脑震荡发生在未由医生观察到的常规赛中，因此该单个病例未包括在总共 21 例脑震荡中。该运动员的最初脑震荡是在受伤后第 2 天的基线测试中发现的，随后进行了医学诊断和治疗。
在这些第四级青少年冰球运动员中，与比赛相关的脑震荡发生率（每 100 名运动员暴露）是文献报道的 7 倍[已更正]。这种差异可能是由于使用了标准化的直接医生观察、诊断和随后的治疗。本研究的结果表明，需要进行后续研究，涉及更大和更多样化的样本组，以反映研究结果的普遍性。这些后续研究应涉及其他接触性运动（例如足球和橄榄球），并包括所有性别、年龄和技能水平。
