一项针对国家冰球联盟（NHL）常规赛中球员脑震荡的前瞻性研究：NHL-NHLPA 脑震荡项目。
A prospective study of concussions among National Hockey League players during regular season games: the NHL-NHLPA Concussion Program.
机构信息
Sport Medicine Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alta.
出版信息
CMAJ. 2011 May 17;183(8):905-11. doi: 10.1503/cmaj.092190. Epub 2011 Apr 18.
BACKGROUND
In 1997, the National Hockey League (NHL) and NHL Players' Association (NHLPA) launched a concussion program to improve the understanding of this injury. We explored initial postconcussion signs, symptoms, physical examination findings and time loss (i.e., time between the injury and medical clearance by the physician to return to competitive play), experienced by male professional ice-hockey players, and assessed the utility of initial postconcussion clinical manifestations in predicting time loss among hockey players.
METHODS
We conducted a prospective case series of concussions over seven NHL regular seasons (1997-2004) using an inclusive cohort of players. The primary outcome was concussion and the secondary outcome was time loss. NHL team physicians documented post-concussion clinical manifestations and recorded the date when a player was medically cleared to return to play.
RESULTS
Team physicians reported 559 concussions during regular season games. The estimated incidence was 1.8 concussions per 1000 player-hours. The most common postconcussion symptom was headache (71%). On average, time loss (in days) increased 2.25 times (95% confidence interval [CI] 1.41-3.62) for every subsequent (i.e., recurrent) concussion sustained during the study period. Controlling for age and position, significant predictors of time loss were postconcussion headache (p < 0.001), low energy or fatigue (p = 0.01), amnesia (p = 0.02) and abnormal neurologic examination (p = 0.01). Using a previously suggested time loss cut-point of 10 days, headache (odds ratio [OR] 2.17, 95% CI 1.33-3.54) and low energy or fatigue (OR 1.72, 95% CI 1.04-2.85) were significant predictors of time loss of more than 10 days.
INTERPRETATION
Postconcussion headache, low energy or fatigue, amnesia and abnormal neurologic examination were significant predictors of time loss among professional hockey players.
背景
1997 年，国家冰球联盟（NHL）和 NHL 球员协会（NHLPA）启动了一项脑震荡计划，以提高对此类损伤的认识。我们探讨了男性职业冰球运动员初次脑震荡后的体征、症状、体检结果和丧失比赛能力时间（即受伤到医生批准重返竞技比赛的时间），评估了初次脑震荡后的临床表现对预测冰球运动员丧失比赛能力时间的作用。
方法
我们对 NHL 七个常规赛赛季（1997-2004 年）期间的脑震荡病例进行了前瞻性病例系列研究，使用了包含所有运动员的队列。主要结局是脑震荡，次要结局是丧失比赛能力时间。NHL 队医记录了脑震荡后的临床表现，并记录了运动员被医学批准重返比赛的日期。
结果
队医在常规赛比赛中报告了 559 例脑震荡。估计的发病率为每 1000 名运动员小时 1.8 例脑震荡。最常见的脑震荡后症状是头痛（71%）。在研究期间，每次发生后续（即复发性）脑震荡时，丧失比赛能力时间（以天数计）平均增加 2.25 倍（95%置信区间 [CI] 1.41-3.62）。在控制年龄和位置因素后，丧失比赛能力时间的显著预测因素是脑震荡后头痛（p < 0.001）、精力或疲劳低下（p = 0.01）、健忘（p = 0.02）和神经检查异常（p = 0.01）。使用先前提出的 10 天丧失比赛能力时间切点，头痛（比值比 [OR] 2.17，95%CI 1.33-3.54）和精力或疲劳低下（OR 1.72，95%CI 1.04-2.85）是丧失比赛能力时间超过 10 天的显著预测因素。
解释
脑震荡后头痛、精力或疲劳低下、健忘和神经检查异常是职业冰球运动员丧失比赛能力时间的显著预测因素。
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