Concussion Characteristics in the National Hockey League Before and After the Introduction of Rule 48.

Importance: A rule prohibiting a direct hit to the lateral side of the head (ie, Rule 48-Illegal Check to the Head) was introduced in the National Hockey League (NHL) in the 2010-2011 season and refined in the 2011-2012 season to widen the application to include direct contact to all areas of the head. Objective: To compare the incidence and proportion of concussions that occurred following hits to the head before and after the implementation of Rule 48. Design, Setting, and Participants: This retrospective cohort study used a before and after design to evaluate concussions among NHL players in regular season games. Data from the 4 seasons preceding the implementation of Rule 48 (2006-2007 to 2009-2010) were compared with data from 5 seasons following its implementation (2014-2015 to 2018-2019). Data were analyzed from October 31, 2021, to November 30, 2022. Main Outcomes and Measures: The incidence and relative proportion of concussion characteristics and mechanisms before and after the introduction of Rule 48. Results: In the analysis of 688 concussions for NHL seasons spanning 2006 to 2010 (n = 231) and 2014 to 2019 (n = 457), there was an overall increase in the incidence of concussion between the 2 time frames, although the incidence of concussions due to hits to the lateral aspect of the head decreased from 1.6/100 games to 1.0/100 games (estimated difference, 0.6/100 games [90% credible interval (CrI), 0.30/100 games to 0.90/100 games). There was also a reduction of 18.8 (90% CrI, 13.0-23.7) percentage points in the proportion of concussions due to hits to the lateral aspect of the head from 80 of 231 concussions (34.6%) to 61 of 457 concussions (13.3%). The incidence of concussions following hits to the head from body checks using the shoulder, arm, and glove was similar before and following the implementation of Rule 48. However, the proportion was reduced 14.7 percentage points from 113 of 231 concussions (48.9%) before to 149 of 457 concussions (32.6%) after implementation of Rule 48 (90% CrI of the difference, 8.9-20.7 percentage points). Conclusions and Relevance: The findings of this cohort study of NHL players suggest that after the introduction of Rule 48, the incidence rate and proportion of concussions from contact to the lateral aspect of the head decreased, as did the proportion of concussions following direct hits to the head.

Amsterdam 2022 process: A summary of the methodology for the Amsterdam International Consensus on Concussion in Sport.

The purpose of this paper is to summarise the consensus methodology that was used to inform the International Consensus Statement on Concussion in Sport (Amsterdam 2022). Building on a Delphi process to inform the questions and outcomes from the 5th International Conference on Concussion in Sport, the Scientific Committee identified key questions, the answers to which would help encapsulate the current science in sport-related concussion and help guide clinical practice. Over 3½ years, delayed by 2 years due to the pandemic, author groups conducted systematic reviews on each selected topic. The 6th International Conference on Concussion in Sport was held in Amsterdam (27-30 October 2022) and consisted of 2 days of systematic review presentations, panel discussions, question and answer engagement with the 600 attendees, and abstract presentations. This was followed by a closed third day of consensus deliberations by an expert panel of 29 with observers in attendance. The fourth day, also closed, was dedicated to a workshop to discuss and refine the sports concussion tools (Concussion Recognition Tool 6 (CRT6), Sport Concussion Assessment Tool 6 (SCAT6), Child SCAT6, Sport Concussion Office Assessment Tool 6 (SCOAT6) and Child SCOAT6). We include a summary of recommendations for methodological improvements for future research that grew out of the systematic reviews.

Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport-Amsterdam, October 2022.

For over two decades, the Concussion in Sport Group has held meetings and developed five international statements on concussion in sport. This 6th statement summarises the processes and outcomes of the 6th International Conference on Concussion in Sport held in Amsterdam on 27-30 October 2022 and should be read in conjunction with the (1) methodology paper that outlines the consensus process in detail and (2) 10 systematic reviews that informed the conference outcomes. Over 3½ years, author groups conducted systematic reviews of predetermined priority topics relevant to concussion in sport. The format of the conference, expert panel meetings and workshops to revise or develop new clinical assessment tools, as described in the methodology paper, evolved from previous consensus meetings with several new components. Apart from this consensus statement, the conference process yielded revised tools including the Concussion Recognition Tool-6 (CRT6) and Sport Concussion Assessment Tool-6 (SCAT6, Child SCAT6), as well as a new tool, the Sport Concussion Office Assessment Tool-6 (SCOAT6, Child SCOAT6). This consensus process also integrated new features including a focus on the para athlete, the athlete's perspective, concussion-specific medical ethics and matters related to both athlete retirement and the potential long-term effects of SRC, including neurodegenerative disease. This statement summarises evidence-informed principles of concussion prevention, assessment and management, and emphasises those areas requiring more research.

Characterizing Symptoms Before and Following Concussion in Professional Hockey.

OBJECTIVE: Examine SCAT5 baseline and acute symptom subscales in professional hockey players. DESIGN: Longitudinal case-control. SETTING: Preseason medical evaluations and suspected concussion evaluations. PARTICIPANTS: NHL/AHL players were given the NHL-modified SCAT5 before the 2018-2019 season (n = 1924). During the season, English-speaking players evaluated within 1 day of injury and diagnosed with concussion (n = 140) were compared with players evaluated for possible concussion, but not given a concussion diagnosis (n = 174). INDEPENDENT VARIABLES: Concussion diagnosis and demographic characteristics. MAIN OUTCOME MEASURES: Postconcussion Symptoms Scale (PCSS) items were subdivided into affective/emotional, cognitive, somatic/physical, sleep, and headache subscales. RESULTS: Cognitive (13%), somatic/physical (10%), sleep (26%), affective (18%), and headache (6%) symptoms were reported by players at baseline. Concussed players reported more acute symptoms than active controls on each of the subscales (all P's < 0.001). Players who underwent a suspected concussion evaluation were more likely to be diagnosed with concussion if they reported affective/emotional symptoms at baseline (P < 0.001). Postinjury cognitive (P < 0.001), somatic/physical (P < 0.001), and headache (P < 0.001) symptoms best differentiated concussed players and active controls. CONCLUSIONS: Player reports of increased cognitive difficulties, somatic/physical difficulties, and headache were most associated with concussion diagnosis at the acute evaluation. An abbreviated "acute" PCSS that includes only headache, cognitive, and/or physical symptoms may be useful for diagnostic purposes when evaluation time is limited. Approximately 2% of players reported significantly elevated affective/emotional symptoms at baseline and report of affective/emotional symptoms at baseline was associated with an increased likelihood of concussion diagnosis among players referred for a suspected concussion evaluation.

Determining Sport Concussion Assessment Tool fifth Edition (SCAT5) reliable change in male professional hockey players.

OBJECTIVES: The purpose of this paper is to provide reliable change metrics and assess the test-retest psychometrics of the Sport Concussion Assessment Tool fifth Edition (SCAT5) in a multilingual sample of professional ice hockey players. METHODS: The SCAT5 was administered to National Hockey League and American Hockey League male professional ice hockey players as part of the 2018 and 2019 season medical evaluations. We extracted data from an existing clinical database of players who were administered two consecutive baseline evaluations and had no intervening concussions to assess psychometric properties (eg, test-retest reliability) and develop reliable change metrics. RESULTS: Overall, 1007 players met inclusion criteria. Players were reassessed on average 344.52 (±62.52) days following their first baseline. Test-retest reliability ranged from r=0.3 to r=0.5. Reliable change metrics for Immediate Memory varied considerably dependent on form order. Significant differences were found between English versus non-English language preference on Immediate Memory and Concentration but not Delayed Memory or the modified Balance Error Scoring System (mBESS). Reliable change indices at the 90% CI were: Symptom Severity (5), Total Symptoms (3), Immediate Memory (3-8), Concentration (2), mBESS (5) and Delayed Memory (2-4). CONCLUSIONS: Our findings highlight the importance of considering form differences and language preference when determining reliable change from baseline on the SCAT5 in male professional hockey players. The relatively modest test-retest reliability of the measures leaves room for improved psychometric properties and increased sensitivity to concussion in future iterations of the SCAT.

The Utility of the King-Devick Test in Evaluating Professional Ice Hockey Players With Suspected Concussion.

OBJECTIVE: The purpose of this study was to (1) examine the diagnostic utility of the King-Devick (KD) in professional ice hockey players and (2) determine whether the KD provides unique variance in predicting a diagnosis of concussion when given in combination with the SCAT-5. STUDY DESIGN: Cohort Study. SETTING: Primary care. PATIENTS/PARTICIPANTS: Professional ice hockey players. INDEPENDENT VARIABLES: Diagnosis versus no diagnosis of concussion. MAIN OUTCOME MEASURES: King-Devick and SCAT-5 component scores. METHODS: In part 1, players suspected of having a concussion were evaluated at baseline and acutely with the KD and either the SCAT-3 or the SCAT-5. Players evaluated and not diagnosed with concussion served as active controls. In part 2, a separate group of players suspected of having a concussion was evaluated acutely with both the KD and SCAT-5. RESULTS: In part 1 of this study, 53 concussed players declined in performance on the KD from baseline to acute evaluation, whereas the performance of 76 active controls improved significantly. In part 2 of the study, 75 players were diagnosed with concussion and compared with 80 active controls who were evaluated and not diagnosed with concussion. Concussed players revealed a decline in KD performance from baseline to acute evaluation when compared with controls. However, the KD did not account for significant unique variance in predicting a diagnosis of concussion after accounting for SCAT-5 data. CONCLUSIONS: The KD is useful in differentiating concussed and not concussed athletes acutely, but the KD does not seem to add additional diagnostic value over and above the SCAT-5.

A Cross-Sectional Decision-Making Approach to Inform Neuropsychological Battery Development in Professional Hockey.

OBJECTIVE: Neuropsychologists commonly use a large battery of tests to inform clinical decisions. Decision analysis can be used to determine which individual tests play a role in the decision-making process. The objective of this project was to conduct quantitative and qualitative decision analysis of decisions by team neuropsychologists with professional hockey players being evaluated as part of the National Hockey League (NHL)/NHL Players Association Concussion Protocol. METHOD: We extracted neuropsychological data from an NHL clinical program database. Team neuropsychologists evaluated concussed players using a hybrid neuropsychological test battery. The neuropsychologists then determined whether players were experiencing concussion-related cognitive difficulties. Logistic regression was used to examine which tests accounted for unique variance in the decision-making process. We also conducted a survey of NHL neuropsychologists, asking them to rate the usefulness of each test in the battery. RESULTS: Five of the fifteen measures accounted for unique variance in team neuropsychologists' decisions, including the ImPACT Verbal Memory Composite, Visual Motor Composite, Reaction Time Composite, Symptom Score, and Brief Visuospatial Memory Test-Revised Delayed Recall. Notable discrepancies were uncovered between quantitative indications of usefulness and self-reported qualitative perceptions of test usefulness when making decisions. Qualitatively, clinicians reported that the Hopkins Verbal Learning Test-Revised, Symbol Digit Modalities Test, ImPACT Reaction Time, and Color Trails 2 were the most useful tests when making decisions. CONCLUSIONS: Along with validation studies, decision analysis can be used as part of a comprehensive evaluation process to inform the development of best-practice batteries for use among athletes with sports concussion.

Prevalence of Inflammatory Heart Disease Among Professional Athletes With Prior COVID-19 Infection Who Received Systematic Return-to-Play Cardiac Screening.

Importance: The major North American professional sports leagues were among the first to return to full-scale sport activity during the coronavirus disease 2019 (COVID-19) pandemic. Given the unknown incidence of adverse cardiac sequelae after COVID-19 infection in athletes, these leagues implemented a conservative return-to-play (RTP) cardiac testing program aligned with American College of Cardiology recommendations for all athletes testing positive for COVID-19. Objective: To assess the prevalence of detectable inflammatory heart disease in professional athletes with prior COVID-19 infection, using current RTP screening recommendations. Design, Setting, and Participants: This cross-sectional study reviewed RTP cardiac testing performed between May and October 2020 on professional athletes who had tested positive for COVID-19. The professional sports leagues (Major League Soccer, Major League Baseball, National Hockey League, National Football League, and the men's and women's National Basketball Association) implemented mandatory cardiac screening requirements for all players who had tested positive for COVID-19 prior to resumption of team-organized sports activities. Exposures: Troponin testing, electrocardiography (ECG), and resting echocardiography were performed after a positive COVID-19 test result. Interleague, deidentified cardiac data were pooled for collective analysis. Those with abnormal screening test results were referred for additional testing, including cardiac magnetic resonance imaging and/or stress echocardiography. Main Outcomes and Measures: The prevalence of abnormal RTP test results potentially representing COVID-19-associated cardiac injury, and results and outcomes of additional testing generated by the initial screening process. Results: The study included 789 professional athletes (mean [SD] age, 25 [3] years; 777 men [98.5%]). A total of 460 athletes (58.3%) had prior symptomatic COVID-19 illness, and 329 (41.7%) were asymptomatic or paucisymptomatic (minimally symptomatic). Testing was performed a mean (SD) of 19 (17) days (range, 3-156 days) after a positive test result. Abnormal screening results were identified in 30 athletes (3.8%; troponin, 6 athletes [0.8%]; ECG, 10 athletes [1.3%]; echocardiography, 20 athletes [2.5%]), necessitating additional testing; 5 athletes (0.6%) ultimately had cardiac magnetic resonance imaging findings suggesting inflammatory heart disease (myocarditis, 3; pericarditis, 2) that resulted in restriction from play. No adverse cardiac events occurred in athletes who underwent cardiac screening and resumed professional sport participation. Conclusions and Relevance: This study provides large-scale data assessing the prevalence of relevant COVID-19-associated cardiac pathology with implementation of current RTP screening recommendations. While long-term follow-up is ongoing, few cases of inflammatory heart disease have been detected, and a safe return to professional sports activity has thus far been achieved.

Concussion Burden, Recovery, and Risk Factors in Elite Youth Ice Hockey Players.

OBJECTIVE: To examine rates of concussion and more severe concussion (time loss of greater than 10 days) in elite 13- to 17-year-old ice hockey players. METHODS: This is a prospective cohort study (Alberta, Canada). Bantam (13-14 years) and Midget (15-17 years) male and female elite (top 20% by division of play) youth ice hockey players participated in this study. Players completed a demographic and medical history questionnaire and clinical test battery at the beginning of the season. A previously validated injury surveillance system was used to document exposure hours and injury during one season of play (8 months). Players with a suspected ice hockey-related concussion were referred to the study sport medicine physicians for assessment. Time loss from hockey participation was documented on an injury report form. RESULTS: Overall, 778 elite youth ice hockey players (659 males and 119 females; aged 13-17 years) participated in this study. In total, 143 concussions were reported. The concussion incidence rate (IR) was 17.60 concussions/100 players (95% CI, 15.09-20.44). The concussion IR was 1.31 concussions/1000 player-hours (95% CI, 1.09-1.57). Time loss of greater than 10 days was reported in 74% of cases (106/143), and 20% (n = 28) had time loss of greater than 30 days. CONCLUSIONS: Concussion is a common injury in elite youth ice hockey players. In this study population, a large proportion of concussions (74%) resulted in a time loss of greater than 10 days, possibly reflecting more conservative management or longer recovery in youth athletes.

Return to sport for North American professional sport leagues in the context of COVID-19.

COVID-19 is a respiratory illness that can spread from person to person. A range of clinical scenarios exist, from an asymptomatic disease course to SARS and death. This document describes important considerations for 5 North American professional sports leagues (Major League Baseball, Major League Soccer, National Basketball Association, National Football League and National Hockey league) assessing when and how to resume phased operations, including practices and games. Sports should prioritise and promote the health and safety of athletes, team and operational staff, and other participants, and should not unduly increase those individuals' relative health risk while contributing to economic recovery, providing entertainment for the public and leading a responsible restoration of civic life. Because elite professional sport ordinarily is conducted in a controlled environment, professional sports leagues may be able to achieve these goals. This document is focused on professional sports leagues in North America, and although many of the statements are generalisable to professional sporting settings throughout the world, other considerations may apply to sports in other countries.

Use of the Sport Concussion Assessment Tool 5 (SCAT5) in professional hockey, part 1: cross-cultural normative data.

OBJECTIVES: This paper provides comprehensive normative data stratified by language preference and age on the components of the National Hockey League (NHL) Sport Concussion Assessment Tool 5 (SCAT5) in a multilingual sample of professional ice hockey players and compares the findings from a paper form of the NHL SCAT5 with an electronic (App) version of the tool. METHODS: A total of 1924 male NHL and American Hockey League (AHL) players (ages 17-41) were assessed during preseason medical evaluations (baseline); 1881 were assessed with the NHL SCAT5 App via tablet and 43 received the paper version of the NHL Modified SCAT5. RESULTS: No significant differences between the App and paper modes of administration emerged in a subsample of English preference players. Significant SCAT5 differences among language preference groups emerged on measures of cognitive functioning (Immediate Memory,Concentration). No language preference differences emerged on the Delayed Recall component. Using age as a continuous variable, older participants outperformed younger players on Immediate Memory, Delayed Recall and Concentration. Players wearing skates demonstrated significantly more modified Balance Error Scoring System (mBESS) total errors than barefoot players. Normative data tables for language preference groups are presented. CONCLUSIONS: Significant differences were found between English and non-English language preference groups on the components of SCAT5, which suggest that language-specific normative data, rather than aggregated normative data, are preferable when interpreting test scores. Similarly, age-specific normative data tables may provide greater precision in data interpretation. Due to clear ceiling effects on the mBESS single leg and tandem stances, players should not be tested while wearing skates.

Use of the Sport Concussion Assessment Tool 5 (SCAT5) in professional hockey, part 2: which components differentiate concussed and non-concussed players?

OBJECTIVES: To examine the utility of Sport Concussion Assessment Tool (SCAT5) subcomponents in differentiating physician diagnosed concussed players from controls. METHODS: We evaluated 1924 professional hockey players at training camp using the National Hockey League (NHL) Modified SCAT5 prior to the 2018-2019 season. Over the course of the season, 314 English-speaking players received SCAT5 evaluations within 1 day of a suspected concussive event. Of these players, 140 (45%) were subsequently diagnosed with concussion by their team physicians. RESULTS: Concussed players reported more symptoms (Concussed M=8.52, SD=4.78; Control M=3.32, SD=3.97), and recalled fewer words than Controls on both the Immediate Memory (Concussed M=19.34, SD=4.06; Control M=21.53, SD=2.94) and Delayed Recall (Concussed z=-0.91; Control z=-0.09) tasks during the acute evaluation. Concussed players also made more errors than Controls on the mBESS and were more likely to report double vision and exhibit clinician-observed balance problems than controls. There were no between-group differences on the Concentration component of the SCAT5. Stepwise regression revealed that symptom report and list learning tasks both accounted for independent variance in identifying players diagnosed with concussion. CONCLUSIONS: These findings provide support for use of the SCAT5 to assist in identifying concussed professional hockey players. When examining SCAT5 subtests, both symptom report and the 10-item word list accounted for independent variance in identifying concussion status in this sample of professional hockey players. The mBESS also differentiated Concussed players and Controls. The Concentration component of the SCAT5 did not significantly differentiate Concussed players and Controls.

Concussion Guidelines in National and International Professional and Elite Sports.

The Berlin statement on sport-related concussion was published in 2017 using evidence-based recommendations. We aimed to examine (1) the implementation of, distribution and education based on the Berlin recommendations, and the development of sport-specific protocols/guidelines among professional and elite sports, (2) the implementation of guidelines at the community level, (3) translation of guidelines into different languages, and (4) research activities. Senior medical advisers and chief medical officers from Australian Football League, All Japan Judo Federation, British Horseracing Authority, Cricket Australia, Fédération Equestre Internationale, Football Association, Gaelic Athletic Association, International Boxing Association, Irish Horseracing Regulatory Board, Major League Baseball, National Football League, National Hockey League, National Rugby League, and World Rugby completed a questionnaire. The results demonstrated that all 14 sporting organizations have published concussion protocols/guidelines based on the Berlin recommendations, including Recognize, Removal from play, Re-evaluation, Rest, Recovery, and Return to play. There is variable inclusion of Prolonged symptoms. Prevention and Risk reduction and Long-term effects are addressed in the guidelines, rules and regulations, and/or sport-specific research. There is variability in education programs, monitoring compliance with guidelines, and publication in other languages. All sporting bodies are actively involved in concussion research. We conclude that the Berlin recommendations have been included in concussion protocols/guidelines by all the sporting bodies, with consistency in the essential components of the recommendations, whilst also allowing for sport- and regional-specific variations. Education at the elite, community, and junior levels remains an ongoing challenge, and future iterations of guidelines may consider multiple language versions, and community- and junior-level guidelines.

Sport Medicine Diagnostic Coding System (SMDCS) and the Orchard Sports Injury and Illness Classification System (OSIICS): revised 2020 consensus versions.

Coding in sports medicine generally uses sports-specific coding systems rather than the International Classification of Diseases (ICD), because of superior applicability to the profile of injury and illness presentations in sport. New categories for coding were agreed on in the 'International Olympic Committee (IOC) consensus statement: Methods for recording and reporting of epidemiological data on injury and illness in sports 2020.' We explain the process for determining the new categories and update both the Sport Medicine Diagnostic Coding System (SMDCS) and the Orchard Sports Injury and Illness Classification System (OSIICS) with new versions that operationalise the new consensus categories. The author group included members from an expert group attending the IOC consensus conference. The primary authors of the SMDCS (WM) and OSIICS (JO) produced new versions that were then agreed on by the remaining authors using expert consensus methodology. The SMDCS and OSIICS systems have been adjusted and confirmed through a consensus process to align with the IOC consensus statement to facilitate translation between the two systems. Problematic areas for defining body part categories included the groin and ankle regions. For illness codes, in contrast to the ICD, we elected to have a taxonomy of 'organ system/region' (eg, cardiovascular and respiratory), followed by an 'aetiology/pathology' (eg, environmental, infectious disease and allergy). Companion data files have been produced that provide translations between the coding systems. The similar structure of coding underpinning the OSIICS and SMDCS systems aligns the new versions of these systems with the IOC consensus statement and also facilitates easier translation between the two systems. These coding systems are freely available to the sport and exercise research community.

International Olympic Committee Consensus Statement: Methods for Recording and Reporting of Epidemiological Data on Injury and Illness in Sports 2020 (Including the STROBE Extension for Sports Injury and Illness Surveillance (STROBE-SIIS)).

BACKGROUND: Injury and illness surveillance, and epidemiological studies, are fundamental elements of concerted efforts to protect the health of the athlete. To encourage consistency in the definitions and methodology used, and to enable data across studies to be compared, research groups have published 11 sport- or setting-specific consensus statements on sports injury (and, eventually, illnesses) epidemiology to date. OBJECTIVE: To further strengthen consistency in data collection, injury definitions, and research reporting through an updated set of recommendations for sports injury and illness studies, including a new Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist extension. STUDY DESIGN: Consensus statement of the International Olympic Committee (IOC). METHODS: The IOC invited a working group of international experts to review relevant literature and provide recommendations. The procedure included an open online survey, several stages of text drafting and consultation by working groups, and a 3-day consensus meeting in October 2019. RESULTS: This statement includes recommendations for data collection and research reporting covering key components: defining and classifying health problems, severity of health problems, capturing and reporting athlete exposure, expressing risk, burden of health problems, study population characteristics, and data collection methods. Based on these, we also developed a new reporting guideline as a STROBE extension-the STROBE Sports Injury and Illness Surveillance (STROBE-SIIS). CONCLUSION: The IOC encourages ongoing in- and out-of-competition surveillance programs and studies to describe injury and illness trends and patterns, understand their causes, and develop measures to protect the health of the athlete. The implementation of the methods outlined in this statement will advance consistency in data collection and research reporting.

International Olympic Committee consensus statement: methods for recording and reporting of epidemiological data on injury and illness in sport 2020 (including STROBE Extension for Sport Injury and Illness Surveillance (STROBE-SIIS)).

Injury and illness surveillance, and epidemiological studies, are fundamental elements of concerted efforts to protect the health of the athlete. To encourage consistency in the definitions and methodology used, and to enable data across studies to be compared, research groups have published 11 sport-specific or setting-specific consensus statements on sports injury (and, eventually, illness) epidemiology to date. Our objective was to further strengthen consistency in data collection, injury definitions and research reporting through an updated set of recommendations for sports injury and illness studies, including a new Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist extension. The IOC invited a working group of international experts to review relevant literature and provide recommendations. The procedure included an open online survey, several stages of text drafting and consultation by working groups and a 3-day consensus meeting in October 2019. This statement includes recommendations for data collection and research reporting covering key components: defining and classifying health problems; severity of health problems; capturing and reporting athlete exposure; expressing risk; burden of health problems; study population characteristics and data collection methods. Based on these, we also developed a new reporting guideline as a STROBE Extension-the STROBE Sports Injury and Illness Surveillance (STROBE-SIIS). The IOC encourages ongoing in- and out-of-competition surveillance programmes and studies to describe injury and illness trends and patterns, understand their causes and develop measures to protect the health of the athlete. Implementation of the methods outlined in this statement will advance consistency in data collection and research reporting.

Neuropsychological Assessment of Professional Ice Hockey Players: A Cross-Cultural Examination of Baseline Data Across Language Groups.

OBJECTIVE: Neuropsychological testing in sports has become routine across all levels of play. The National Hockey League (NHL) has conducted baseline neuropsychological assessment of all players since 1997. This study seeks to examine baseline differences among linguistically and culturally diverse groups within the NHL and to present comprehensive normative data for these groups. METHOD: Baseline data were obtained from 3,145 professional hockey players' baseline symptom reporting, neuropsychological test performance on a battery of traditional "paper and pencil" measures, and self-reported concussion history. In addition, 604 baseline post-injury paper and pencil evaluations were conducted the season following a concussion and 4,780 computerized baseline ImPACT administrations were obtained following the introduction of computerized testing. RESULTS: Normative data for paper and pencil tests and ImPACT are presented for the major language groups within the league: English, French, Swedish, Russian, Czech, Finnish, and German (ImPACT only). It was found that symptom reporting, the number of concussions sustained, and neuropsychological test results vary significantly based on a players' language of origin. This variability was also present when players were tested in their language of origin. CONCLUSIONS: This study provides insight into the significant baseline differences that exist among NHL players regarding symptoms, concussion history, and cognitive functioning. The findings are discussed with respect to the evaluation and management of NHL players who sustain concussion and more generally in the context of neuropsychological assessment in cross-cultural settings, including the importance of examining neuropsychological functioning using culturally specific norms.

Jumper's Knee: A Prospective Evaluation of Risk Factors in Volleyball Players Using a Novel Measure of Injury.

OBJECTIVES: To examine potential intrinsic risk factors that may contribute to the onset of jumper's knee in elite level-male volleyball players. DESIGN: Prospective Cohort Study. SETTING: Varsity and National team volleyball gymnasiums. PARTICIPANTS: Sixty elite adult male volleyball players from Canada. ASSESSMENT OF RISK FACTORS: Players completed a series of risk factor assessments at the commencement of their seasons, including vertical jump (cm), ankle dorsiflexion range (degrees), dynamic balance (normalized distance reached; cm), dynamic knee alignment (degrees), and landing mechanics (degrees). MAIN OUTCOME MEASURE: Self-reported knee problems, captured via short message service. RESULTS: Knee problem prevalence was 75% [95% confidence intervals (CIs): 62.2-84.6] and the incidence rate for substantial injuries over the study period was 30 injuries/100 players/season (95% CI: 19.5-43.1). No risk factor was found to significantly predict the future occurrence of developing jumper's knee. The odds ratios were close to unity (range: 0.94-1.07) with narrow confidence intervals and P > 0.05. CONCLUSIONS: A more sensitive capture of overuse knee problems did not result in the identification of distinct risk factors for the development of jumper's knee. These findings highlight a lack of available methodology to accurately assess risk factors for overuse injuries.