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Concussion in Ice Hockey: Current Gaps and Future Directions in an Objective Diagnosis

Smith, Aynsley M. RN, PhD*; Stuart, Michael J. MD; Roberts, William O. MD, MS; Dodick, David W. MD§; Finnoff, Jonathan T. DO; Jorgensen, Janelle K. BA; Krause, David A. PT, DSc**

Clinical Journal of Sport Medicine: September 2017 - Volume 27 - Issue 5 - p 503–509
doi: 10.1097/JSM.0000000000000412
General Review

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.

*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.

Corresponding Author: Aynsley M. Smith, RN, PhD, Desk LC, Sports Medicine Center, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (

The authors report no conflicts of interest.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

Received May 31, 2016

Accepted October 09, 2016

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