Hockey Concussions Underreported, Study Finds

A season-long medical study of head injuries among university hockey players found that there is “significant underreporting” of concussions in both men’s and women’s hockey. The Hockey Concussion Education Project (HCEP) conducted the study, which included advanced magnetic resonance imaging of players and the presence of specialists at the rinks watching the players and looking for signs of concussions. Allan Maki of The Globe and Mail reported November 30 on the study.

The investigators found the concussion rate to be three times greater in male hockey players and 5.5 times greater in female players than what researchers had recorded prior to 2009-2010. Eleven concussions were reported having occurred in 55 regular-season games last season, “yielding an incidence rate of 11.76 concussions per 1, 000 athlete exposures across the regular season and playoffs.”

The study examined two teams containing 45 players during the 2011-2012 Canadian Interuniversity Sport (CIS) hockey season. Physicians clinically evaluated the players, gave them neuropsychological assessments and MRI imaging both during the pre and postseason as well as post-injury. The athletes were also game monitored by independent physicians who noted how players reacted after a hit, if they appeared to be sluggish or out of position on the ice.

Dr. Paul Echlin, a physician based in Burlington, Ontario, who served as HCEP’s primary investigator, believes the study shines an intriguing and in-depth light on the concussion issue. “We did a previous study [one year ago] with the CIS without observers, ” Echlin said. “We didn’t do MRI imaging and there was only one reported concussion for that season. This past season, we were full on with multiple physicians at games, home and away, and we did imaging. It really demonstrates the underreporting of medical concussions.” Investigators believe that there is “significant underreporting” of concussions in both men’s and women’s hockey, Maki reported.

Three Canadian universities (British Columbia, Western, and Montreal) and two in the United States (Harvard, Illinois) analyzed the HCEP data. Dr. Inga Koerte, a senior researcher at the psychiatry, neuro-imaging lab at the Brigham and Women’s Hospital, Harvard Medical School, reviewed the specialized Diffusion Tensor Imaging of 25 male brains. What she discovered was unexpected.

What we found was that all the athletes had changes in their white matter, ” Koerte said, referring to the tissue that transmits signals from one region of the brain to another. “Two of the three subjects who had clinically diagnosed concussions had the most pronounced differences, but the surprise was you don’t have to have a concussion to see changes in the white matter.

The HCEP study revealed that the frequency of concussions was higher among female players (14.93 per 1, 000 athlete exposures) than their male counterparts (8.47). Researchers are not sure exactly why that is, although one suggestion is female players are more honest when it comes to reporting injuries.

“Obviously at some stages, there’s so much at stake for everyone involved, ” said Hugo Theoret, a psychology professor at the University of Montreal who helped evaluate the HCEP findings. “There’s a conscious reaction [not to report and to keep playing]. Coaches think it’s important to get a player back in the game. Some are consciously trying to limit the reporting of concussions to win more games. You see this in junior hockey where they’re all trying to get to the next level. In the university setting…it’s alarming.”