Comparative analysis of sport-related concussions in stick-handling sports

Concussions are common in stick-handling sports, including lacrosse or hockey, where high-speed play combines player contact with equipment- and projectile-related impacts. In a cohort of lacrosse and hockey athletes who sustained a sport-related concussion (SRC), this study compared: 1) injury mechanisms, 2) initial symptom burden, and 3) recovery timelines between the sports.

In this retrospective cohort study of patients (12-23 years) with SRC from lacrosse or hockey, injury mechanism was categorized as player-to-surface, player-to-player, player-to-stick, or player-to-ball/puck. Outcomes included initial Post-Concussion Symptom Scale (PCSS) score and time to return-to-learn (RTL), symptom resolution (SR), and return-to-play (RTP). Nonparametric tests compared groups, and multivariable linear regression evaluated associations between sport and injury mechanism with outcomes, adjusting for age, sex, and prior concussions.

Of 80 athletes (median age = 16.6), 37 played lacrosse (60% male) and 43 played hockey (86% male). Injury mechanism differed by sport (p = 0.03): lacrosse had more player-to-surface (35.1% vs. 27.9%), player-to-stick (24.3% vs. 11.6%), and player-to-ball/puck (21.6% vs 9.3%) injuries and less player-to-player (18.9% vs. 48.8%) injuries than hockey. Initial PCSS scores were higher after stick-related injuries (median = 47.5) than other mechanisms (surface = 26.0, player = 20.0, ball/puck = 31.0; p = 0.02), though mechanism was not a significant predictor in multivariable regression. Time to RTL, SR, and RTP did not differ by sport, injury mechanism, or competition setting.

Symptom severity and recovery timelines were similar between sports and setting. Stick and ball/puck impacts were associated with greater initial symptom burden and longer RTL, which may warrant closer early monitoring and enhanced school accommodations.