Concussion in Ice Hockey: Current Gaps and Future Directions in an Objective Diagnosis
Aynsley M Smith1, Michael J Stuart, William O Roberts
1*Department of Orthopedic Surgery and Physical Medicine and Rehabilitation, Sports Medicine Center, Mayo Clinic, Rochester, Minnesota; †Department of Orthopedic Surgery, Mayo Clinic Sports Medicine Center, Mayo Clinic, Rochester, Minnesota; ‡Department of Family Medicine and Community Health, University of Minnesota-Twin Cities, Minneapolis, Minnesota; §Department of Neurology, Mayo Clinic, Scottsdale, Arizona; ¶Department of Physical Medicine and Rehabilitation, Mayo Clinic Sports Medicine Center, Minneapolis, Minnesota; ‖Sports Medicine Center, Mayo Clinic, Rochester, Minnesota; and **Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota.
Objective:
This review provides an update on sport-related concussion (SRC) in ice hockey and makes a case for changes in clinical concussion evaluation. Standard practice should require that concussions be objectively diagnosed and provide quantitative measures of the concussion injury that will serve as a platform for future evidence-based treatment.
Methods:
The literature was surveyed to address several concussion-related topics: research in ice hockey-related head trauma, current subjective diagnosis, promising components of an objective diagnosis, and current and potential treatments.
Main Results:
Sport-related head trauma has marked physiologic, pathologic, and psychological consequences for athletes. Although animal models have been used to simulate head trauma for pharmacologic testing, the current diagnosis and subsequent treatment in athletes still rely on an athlete's motivation to report or deny symptoms. Bias-free, objective diagnostic measures are needed to guide quantification of concussion severity and assessment of treatment effects. Most of the knowledge and management guidelines of concussion in ice hockey are generalizable to other contact sports.
Conclusions:
There is a need for an objective diagnosis of SRC that will quantify severity, establish a prognosis, and provide effective evidence-based treatment. Potential methods to improve concussion diagnosis by health care providers include a standardized concussion survey, the King-Devick test, a quantified electroencephalogram, and blood analysis for brain cell-specific biomarkers.
