bluuebunny/crossref_metadata_2025_split huggingface dataset:
The value of computerised neurocognitive testing at medical clearance to return to play following a sport-related concussion in youth ice hockey players
Authors: Black Amanda M , Brooks Brian L , McLeod Regan S , Palacios-Derflingher Luz , Schneider Kathryn J , Blake Tracy A , Taylor Kirsten A , Meeuwisse Willem H , Emery Carolyn A 
Published: November 2017

ObjectiveTo determine the value of the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) tool in measuring neurocognitive recovery following concussion.DesignNested case-control.SettingSport Medicine Centre, Alberta, Canada.ParticipantsIce hockey players (n=96; 88.5% male, 11-17 years old) following concussion who completed ImPACT at baseline and medical clearance to return to play (RTP) were compared to controls (n=31) matched for age, sex, and testing time interval.Assessment of risk factorsPlayers who sustained a concussion were referred to a study physician for assessment and RTP clearance based on clinical assessment and SCAT2/3. Physicians were blinded to ImPACT scores.Outcome measuresImPACT composite scores were measured (i.?e., verbal memory, visual memory, reaction time, visual motor) at each time interval [i.e., baseline and RTP (cases)/second measurement (controls)]. Between-interval ImPACT reliable change scores (80%CI) were compared.Main resultsAt RTP (Median days since injury: 22, range: 2–84), 43/96 (44.8%) concussed players and 11/31 (35.5%) controls had ≥1 composite scores reliably worse than at baseline. Conditional logistic regression analysis (n=31 matched pairs) did not demonstrate a difference in the odds of having ≥1 reliably worse composite score between concussed and controls [OR=2.00 (95% CI: 0.5–8.0)] or ≥1 reliably better composite score [OR=1.2 (95% CI: 0.37–3.93)].ConclusionsThe utility of baseline ImPACT scores in medical decisions to RTP may be limited by the reliability of composite scores in youth populations. Caution is warranted when interpreting ImPACT scores post-concussion on an individual level using baseline performance. Future research including multivariable analyses is warranted in a larger sample.Competing interestsBrian Brooks is a co-author of a paediatric memory test for which he receives royalties. No financial interests in ImPACT are declared.None for all other authors.
A review of misnomers and misconceptions in concussion biomechanics
Authors: Patton Declan A , McIntosh Andrew S , Kleiven Svein 
Published: November 2017

ObjectiveTo identify potentially-misleading terms and concepts in concussion biomechanics.DesignLiterature review.SettingN/A.ParticipantsN/A.InterventionN/A.Outcome measuresMedia articles and scientific literature describing potentially-misleading terms and concepts in concussion biomechanics.Main resultsPotentially-misleading terms and concepts in concussion biomechanics were identified in media articles, clinical textbooks and some scientific articles. One such misconception is that during a concussion the brain ‘sloshes’ and slams into the skull. The brain, which has very high water content, is nearly incompressible and is tethered to an almost rigid cranial cavity. Therefore, the brain resists separation from the skull during radial impacts; however, there is little resistance to shear during oblique impacts, which results in brain tissue deformations. Another potentially-misleading concept is that the mass of headgear increases the angular acceleration of the head during an impact. Such a concept is incorrect as the mass of the headgear increases the moment of inertia of the head and, therefore, decreases the tendency of the head to rotate. Lastly, the term ‘sub-concussion’ originally referred to animal model head impacts not resulting in loss-of-consciousness. However, ‘sub-concussion’ is currently used to refer to any head impact not resulting in concussion, e.g. head accelerations experienced by a soccer player when heading a ball. A biomechanical threshold for concussion has yet to be identified; therefore, careful use of the term ‘sub-concussion’ is suggested.ConclusionsPotentially- misleading terms and concepts in concussion biomechanics have the potential to misinform and confound attempts to further the understanding of concussion.Competing interestsNone.
Costs and contexts: factors affecting self-report of concussion in a military academy
Authors: D’Lauro Christopher , Johnson Brian Rudolph , Foster Craig A , McGinty Gerald , Campbell Darren 
Published: November 2017

ObjectiveTo understand the factors affecting the decision to self-report a concussion – particularly among sub-groups like athletes and future pilots.DesignSurvey.SettingA United States military academy.ParticipantsVoluntarily participatingcadets (n=2,503, 23.9%=female).Assessment of risk factorsNCAA Division I athlete status, future pilot status, gender, school year were examined as factors affecting self-report.Outcome measureAnticipated Self-Report (ASR) of concussion on a scale from 1–9 (most to least likely to self-report). Cadets completed a 2-page survey matching ASR to demographic risk factors (above), and to self-report questions assessing Costs, Rewards, Attitude, Subjective Norms, Self-Efficacy, and Social Support.Main resultsCadets demonstrated an overall willingness to self-report a concussion – indicated by a mean ASR score of 6.07 (95% CI=5.97–6.17, SD=2.47, median=7.00, n=2.332) above the scale midpoint. Costs (r=−0.61, p<0.001), Rewards (r=0.67, p<0.001) and Attitude (r=0.70, p<0.001) were highly, significantly predictive of ASR. Cadet sub-populations revealed the importance of specific costs. Aspiring pilots – concerned about concussions affecting their pilot qualification status –steadily decreased ASR by year, while non-pilot cadets retained consistent ASR, shown by Future Pilot x Class Year ANOVA (F(3,2196)=11.78, p<0.001). NCAA Athletes, conversely, showed no ASR differences from non-athletes, t(2251)=0.16, p=0.87, CI =±0.23.ConclusionsSymptom self-report is a crucial factor in all stages of concussion care. Costs and rewards affecting self-report may have unique contexts that drive unexpected self-report patterns. Here, aspiring pilots showed lower self-report behaviour while athletes showed average self-report behaviour – based on perceived costs to career aspirations. These data will be used to design interventions to increase to concussion self-report.Competing interestsAll authors received funding from the National Collegiate Athletic Association and Department of Defense (NCAA Mind Matters Challenge).
Efficacy of a football rule to prevent concussion
Authors: Beaudouin Florian , Reinsberger Claus , Meyer Tim 
Published: November 2017

ObjectiveAlthough the incidence of concussion per athlete exposure is relatively low in comparison to high risk sports, absolute numbers of concussions are considerable in football, because of its high popularity and high number of athletes. In 2006, the International Football Association Board (IFAB) employed a modification of football rules to protect the brain and reduce head injuries. Starting during the season 2006/2007, an attack towards the head (e.g. by elbow check) was punished more consequently and can even lead to an elimination from the game, if performed on purpose. The objective of our study is to examine, whether the rule change resulted in a lower incidence of concussion in professional German football.DesignBased on data of a German football magazine (obtained by in depth coverage on each club of the German Bundesliga), a database of all head injuries in the German football Bundesliga between 2000/2001 and the current season was created. The incidence of concussion during six years before and six years after the initiation of the rule change was then calculated and compared. Furthermore, the number of missed days of practice and/or games and the mechanism of injury (based on player’s position and club) was analysed.Main resultsThe incidence of concussion during the seasons 2006/07 – 2012/13 is lower than the incidence during 2000/01 – 2005/06.ConclusionsA rule change with the intention to punish attacks to the head more consequently to protect the brain might be an effective means to prevent concussion in football.Competing interestsThis work was funded by a grant of the Federal Institute of Sports Science (Federal Ministry of the Interior).
Higher risk-taking behavioursbehaviors and sensation seeking needs in collegiate student-athletes with a history of multiple sport-related concussions
Authors: Beidler Erica , Covassin Tracey , Donnellan MB , Nogle Sally , Pontifex Matthew B , Kontos Anthony P 
Published: November 2017

ObjectiveTo investigate differences in risk-taking behaviours and sensation seeking needs between collegiate student-athletes with and without a history of sport-related concussion (SRC).DesignCross-sectional quantitative study.SettingFour National Collegiate Athletic Association (NCAA) universities.ParticipantsA total of 1,398 (68%) of 2,055 collegiate student-athletes completed the survey. There were 146 participants excluded due to: age<18, current SRC/acute musculoskeletal injury, SRC within 3-months, non-NCAA, non-SRC, and incomplete survey. Therefore, 1,252 subjects from 18 sports were included.Assessment of risk factorsA10-minute survey was administered that included demographic information, SRC history, Barratt Impulsiveness Scale (BIS) for risk-taking, and Brief Sensation Seeking Scale (BSSS). The independent variable was SRC history: 0(n=938), 1(n=205), 2+(n=109).Outcome measuresThe dependent variables were BIS total risk-taking impulsivity and BSSS total sensation seeking scores.Main resultsSignificant differences were found between SRC groups for the totalrisk-taking impulsivity [F(1,227)=7.15,p=0.00] and sensation seeking [F(1,214)=4.53,p=0.01] variables. Total risk-taking impulsivity was significantly higher for the 2+ SRC group compared to the 0 SRC group (MD±95%CI=0.18 ± 0.11,p=0.00) and the 1 SRC group (MD±95%CI=0.15 ± 0.12,p=0.02). Total sensation seeking scores were significantly higher for the 2+ SRC group compared to the 0 SRC group (MD±95%CI=0.19 ± 0.17, p=0.03).ConclusionsTotal risk-taking and sensation seeking scores were higher for collegiate student-athletes with a history of multiple SRC. This finding could be useful when implementing behaviour modifications for safer play. Future longitudinal research should adopt a pre-/post-test design to determine if increased risk-taking and sensation seeking are SRC risk-factors or if multiple SRCs cause an increase in psychological variables.Competing interestsNone.
Q. why doesn’t headgear prevent concussion? a. no one bothered to ask
Authors: McIntosh Andrew S , Patton Declan A 
Published: November 2017

ObjectiveThe study identifies barriers to the supply of helmets/headgear/headguards (headgear) that are likely to be effective in preventing concussion.DesignLiterature review and biomechanical testing.SettingAll sports.Outcome measuresSport federation rules on headgear and headgear impact performance with regards to concussion.Main resultsA review of laws and regulations showed that many sports have not developed relevant performance based technical specifications for headgear. World Rugby performance requirements comprise a drop height of 300 mm and pass level of greater than 200 g in impact energy attenuation tests. Testing of current World Rugby approved headgear showed peak linear headform accelerations (PLA) in the range 400 to 600 g in 200 mm and 300 mm drop tests. The performance of the exemplar models is arguably worse than in similar models tested circa 2000 and exceed informative concussion injury criteria, e.g. PLA<75 g. Combat sports generally do not mandate performance requirements. Similarly, there is a range of performance from good to poor in laboratory-tested combat sport headgear with respect to concussion prevention; e.g. for headgear tested at a 500 mm drop height, PLA ranged from 50 g to 466 g. PLA results were reflected in angular head acceleration performance in impact tests. Other sports will be considered, e.g. ice hockey and American football, where performance standards are mandated.ConclusionsThe availability of headgear designed to prevent concussion is limited because relevant performance requirements are absent and/or aligned with other head injury prevention goals, e.g. preventing severe head injury.Competing interestsNone.
The impact of mandatory helmet use on career length in the national hockey league (nhl)
Authors: Reinsberger Claus , Frick Bernd 
Published: November 2017

ObjectiveIn 1979, the National Hockey League (NHL) announced that helmets would become mandatory for incoming players. The objective of this study is to evaluate, whether the mandatory use of helmets has a positive impact on the career length in NHL players.DesignA public database (www.hockeydb.com) was utilised to extract career lengths of NHL players before and after 1979. Since the rule allowed players who signed professional contracts prior to June 1, 1979 to continue not to wear a helmet, career lengths of all players entering the NHL via the draft in ten seasons before (1969–1978) and ten seasons after (1979–1988) the introduction of the helmet rule was compared.Main resultsIn the 20 years analysed, 3952 players were selected by NHL teams of which 1818 eventually appeared in at least one match and were considered for further analysis. Controlling for draft round, draft number, individual players’ performance (games played per season, number of goals and assists per game, number of penalty minutes per game), year of entry and team picking the player, players during the era of mandatory helmet use had significantly longer careers (approximately 2.5 years, cox regression z=−0.768, p<0.01). Defenders and forwards benefit to the same extent from wearing a helmet.ConclusionsThe introduction of mandatory use of helmets in the NHL was associated with an increase in career length. Protection of head and brain together with associated conditions may be contributing to this observation.Competing interestsNone.
Ability of children aged 5-16 years to perform scat3 and child-scat3 testing in the emergency department
Authors: Babl Franz E , Dionisio Diana V , Davenport Lucy , Baylis Amy , Hearps Stephen , Bressan Silvia , Anderson Vicki , Oakley Ed , Davis Gavin A 
Published: November 2017

ObjectiveTo evaluate children’s ability to perform the child-SCAT3 and SCAT3 Sports Concussion Assessment Tool.DesignProspective observational study.SettingTertiary children’s hospital emergency department.Participants264 children presenting to ED with concussion (CONC, n=90) and two control groups (i) upper limb injury (ULI, n=90) and (ii) well children (WELL, n=84) with equal sized subgroups in three age bands of 5–8, 9–12, and 13–16 years.Assessment and outcomeAbility to complete SCAT subtests administered by trained research assistants, stratified by age band and participant group. Child-SCAT3 was used for 5–12 years, SCAT3 for 13–16 years.ResultsInability to complete at least one sub-test of child-SCAT3 occurred in 29 (32.2%) of the 5-8 year age band and 5 (5.5%) in the 9–12 year age band. The 5 and 6 year olds had the lowest completion rates. In the 13–16 year age band 11 (13.3%) participants were unable to complete at least one sub-test of SCAT3.The most frequent reasons for inability to complete any sub-test (n=116) were ‘did not understand’ (n=45), and ‘refusal to continue’ (n=26). Fewer were due to ‘feeling too unwell to continue’ (n=13).The subtests with the highest rates of inability to complete were child-SCAT3 and SCAT symptoms scale (n=17), BESS (n=9), coordination (n=9), digits backwards (n=8) and concentration (n=8).ConclusionsChild-SCAT3 should be applied with caution in young children due to an inability to understand certain test items and may need to be modified. SCAT3 can be reliably applied in teenagers 13–16 years of age.Competing interestsGAD is an honorary member of the Australian Football League Concussion Working Group, and has attended meetings organised by sporting organisations including the National Football League (USA), National Rugby League (Australia) and FIFA (Switzerland); however has not received any payment, research funding, or other monies from these groups other than for travel costs. GAD is a member of the International Concussion in Sport group that developed the SCAT3 and ChildSCAT3.
How to interpret post-concussion symptom severities of scat3 in professional ice hockey players
Authors: Hänninen Timo , Parkkari Jari , Tuominen Markku , Iverson Grant L , Vartiainen Matti , Öhman Juha , Luoto Teemu M 
Published: November 2017

ObjectiveTo characterise the baseline to post-concussion variation of each SCAT3 symptom.DesignProspective cohort.SettingFinnish professional ice hockey league.ParticipantsSCAT3 baseline testing has been mandatory in the Finnish hockey league since 2013. The league recommends day of injury testing for all players with suspected concussion. Of the reported day of injury SCAT3s, between seasons 2013–2016, a total of 29 concussions were confirmed by the teams’ medical staff.InterventionOutcome measuresThe day of concussion symptom severities for each of the 22 symptoms were compared to (i) the league’s normative reference values [based on 2013–2014 preseason baselines (n=270)] and (ii) the baseline scores of the 29 concussed players. The change between day of concussion score and players’ individual baseline score was compared to: (i) the reference variation of the league’s two preseason baselines [2013–2014 and 2014–2015 (n=179)], and (ii) the variation between two preseason baselines of the concussed players.Main resultsThe most prevalent post-concussion symptoms were: “Don’t feel right” (100%), headache (97%), and pressure in the head (90%). In addition, these symptoms were the most common to worsen on the day of concussion compared to players’ individual baseline. “Feeling like in a fog”, confusion, and dizziness were common on the day of injury (each reported by 72%) but rare on baselines (1–2%). Fatigue or low energy and neck pain were the most common and unstable baseline symptoms in the league.ConclusionsHeadache and “Don’t feel right” were the most useful symptoms on the SCAT3 in acute concussion recognition.Competing interestsNone.Timo Hnninen, Jari Parkkari, Markku Tuominen, Matti Vartiainen, Juha hman, Teemu M. Luoto: None.Grant L. Iverson has been reimbursed by the government, professional scientific bodies, and commercial organisations for discussing or presenting research relating to mild TBI and sport-related concussion at meetings, scientific conferences, and symposiums. He has a clinical and consulting practice in forensic neuropsychology involving individuals who have sustained mild TBIs (including professional athletes). He has received research funding from several test publishing companies, including ImPACT Applications, Inc., CNS Vital Signs, and Psychological Assessment Resources (PAR, Inc.). He has not received research support from a test publishing company in the past 5 years.
A preliminary video review of in-game head injury incidents (hii) and use of the head injury assessment (hia) from the 2015 super rugby season
Authors: Kohler Ryan , Makdissi Michael , McDonald Warren , Partridge Bradley , Gardner Andrew J 
Published: November 2017

ObjectiveTo complete a video evaluation of the management of players suspected of sustaining concussion in professional Rugby Union during the 2015 season.DesignRetrospective, observational study.SettingSuper Rugby match play.ParticipantsPlayers representing Australian Super Rugby franchises who were evaluated by their team doctor (TD) and an independent match day doctor (MDD) for concussion during the 2015 season.Outcome measuresIn-game ‘head injury incidents’ (HII) and use of the World Rugby (WR) Head Injury Assessment (HIA) process were recorded. TD and MDD had access to video during games which allowed review of HIIs as part of their decision making process. A retrospective review of the video of each incident by three experienced clinicians was conducted to assess the decision-making process (i.e., permanent removal, remain-in-play, or return-to-play).Main resultsThere were 47 ‘head injury incidents’ (HII) evaluated by TD and MDD. Using WR HIA criteria, 18 incidents resulted in a player’s permanent removal, of which 16 were subsequently diagnosed with concussion. On retrospective video review, the in-game decision to permanently remove a player was agreed upon in 78% (14/18) of cases. Using WR HIA criteria, there were 28 decisions to temporarily remove a player and conduct a HIA. On retrospective review, the in-game decision to complete a HIA was agreed upon in 68% (19/28) of cases.ConclusionsReviewing match video footage can be a useful addition to the TDs’ and MDDs’ in-game clinical assessment of concussion. The clinical relevance of some brief signs on video review warrants further investigation.Competing interestsRyan Kohler, Bradley Partridge – None.Michael Makdissi (see declaration form for full disclosures)Warren McDonald is the Chief Medical Officer of the Australian Rugby Union (ARU). He also operates his own private sports and exercise medicine practice in Canberra, Australia.Andrew Gardner has a clinical practice in neuropsychology involving individuals who have sustained sport-related concussion (including current and former athletes). He serves, in a voluntary capacity, as a member of the Australian Rugby Union (ARU) concussion advisory group. He has received travel funding from the Australian Football League (AFL) to present at the Concussion in Football Conference in 2013. Previous grant funding includes the NSW Sporting Injuries Committee, the Brain Foundation and the Hunter Medical Research Institute (HMRI), supported by Jennie Thomas. He is currently receiving research funding through the HMRI, supported by Anne Greaves.
Feasibility study of a simple reaction test for immediate sideline-analysis â€“ preliminary results$
Authors: Gnsslen Axel , Krutsch Werner 
Published: November 2017

ObjectiveReaction testing is an integral part of sideline testing in sport-related concussion. Present established tools include time-demanding computer-based tools and analysis of the clinical reaction time with a special apparatus. The present tool is a mobile phone program using a simple reaction time equivalent.DesignCase control study.SettingProfessional German Hockey League Players and regional youth players.Participants20 professional ice-hockey players.Interventions (or Assessment of risk factors)Analysis of a simple dual task reaction time (sRT; one of two symbols) and a complex one of four symbol reaction time (cRT).Outcome measuresAnalysis of average baseline times, fastest and slowest 10% values, overall application time and comparison to 4 players sustaining concussions.Main resultsMean sRT was 0,354s (95% confidence intervals (0,330;0,377) with fastest 10% 0,294s and slowest time 0,539s. The overall procedure needed 65,4s. Mean cRT was 0,43s (95% confidence intervals (0,423;0,437) with fastest 10% 0,34s and slowest time 0,592s. The overall procedure needed 117,364. The 4 patients with sustained concussion had immediately a sRT and a cRT of 0,518s and 0,677s, respectively. A value of 0,5s is probably an expected cut-off.ConclusionsThis simple web- and mobile-phone-based program allows safe analysis of prolonged reaction times in concussed athletes.Competing interestsNone.