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Shorter Recovery Time in Concussed Elite Ice Hockey Players by Early Head-and-Neck Cooling : A Clinical Trial

Al-Husseini, Ali LU orcid ; Fazel Bakhsheshi, Mohammad LU ; Gard, Anna LU ; Tegner, Yelverton and Marklund, Niklas LU orcid (2023) In Journal of Neurotrauma 40(11-12). p.1075-1085
Abstract

A sports-related concussion (SRC) is most commonly sustained in contact sports, and is defined as a mild traumatic brain injury. An exercise-induced elevation of core body temperature is associated with increased brain temperature that may accelerate secondary injury processes following SRC, and exacerbate the brain injury. In a recent pilot study, acute head-neck cooling of 29 concussed ice hockey players resulted in shorter time to return-to-play. Here, we extended the clinical trial to include players of 19 male elite Swedish ice hockey teams over five seasons (2016-2021). In the intervention teams, acute head-neck cooling was implemented using a head cap for ≥45 min in addition to the standard SRC management used in controls. The... (More)

A sports-related concussion (SRC) is most commonly sustained in contact sports, and is defined as a mild traumatic brain injury. An exercise-induced elevation of core body temperature is associated with increased brain temperature that may accelerate secondary injury processes following SRC, and exacerbate the brain injury. In a recent pilot study, acute head-neck cooling of 29 concussed ice hockey players resulted in shorter time to return-to-play. Here, we extended the clinical trial to include players of 19 male elite Swedish ice hockey teams over five seasons (2016-2021). In the intervention teams, acute head-neck cooling was implemented using a head cap for ≥45 min in addition to the standard SRC management used in controls. The primary endpoint was time from SRC until return-to-play (RTP). Sixty-one SRCs were included in the intervention group and 71 SRCs in the control group. The number of previous SRCs was 2 (median and interquartile range [IQR]: 1.0-2.0) and 1 (IQR 1.0-2.0) in the intervention and control groups, respectively; p = 0.293. Median time to initiate head-neck cooling was 10 min (IQR 7-15; range 5-30 min) and median duration of cooling was 45 min (IQR 45-50; range 45-70 min). The median time to RTP was 9 days in the intervention group (IQR 7.0-13.5 days) and 13 days in the control group (IQR 9-30; p < 0.001). The proportion of players out from play for more than the expected recovery time of 14 days was 24.7% in the intervention group, and 43.7% in controls (p < 0.05). Study limitations include that: 1) allocation to cooling or control management was at the discretion of the medical staff of each team, decided prior to each season, and not by strict randomization; 2) no sham cap was used and evaluations could not be performed by blinded assessors; and 3) it could not be established with certainty that injury severity was similar between groups. While the results should thus be interpreted with caution, early head-neck cooling, with the aim of attenuating cerebral hyperthermia, may reduce post-SRC symptoms and lead to earlier return-to-play in elite ice hockey players.

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
clinical trial, cooling, ice hockey, return-to-play, sport related concussion
in
Journal of Neurotrauma
volume
40
issue
11-12
pages
11 pages
publisher
Mary Ann Liebert, Inc.
external identifiers
  • pmid:36222612
  • scopus:85160967232
ISSN
0897-7151
DOI
10.1089/neu.2022.0248
language
English
LU publication?
yes
id
cc5152f7-1315-4882-87ad-172fa1043260
date added to LUP
2023-08-21 12:38:49
date last changed
2024-04-20 01:06:09
@article{cc5152f7-1315-4882-87ad-172fa1043260,
  abstract     = {{<p>A sports-related concussion (SRC) is most commonly sustained in contact sports, and is defined as a mild traumatic brain injury. An exercise-induced elevation of core body temperature is associated with increased brain temperature that may accelerate secondary injury processes following SRC, and exacerbate the brain injury. In a recent pilot study, acute head-neck cooling of 29 concussed ice hockey players resulted in shorter time to return-to-play. Here, we extended the clinical trial to include players of 19 male elite Swedish ice hockey teams over five seasons (2016-2021). In the intervention teams, acute head-neck cooling was implemented using a head cap for ≥45 min in addition to the standard SRC management used in controls. The primary endpoint was time from SRC until return-to-play (RTP). Sixty-one SRCs were included in the intervention group and 71 SRCs in the control group. The number of previous SRCs was 2 (median and interquartile range [IQR]: 1.0-2.0) and 1 (IQR 1.0-2.0) in the intervention and control groups, respectively; p = 0.293. Median time to initiate head-neck cooling was 10 min (IQR 7-15; range 5-30 min) and median duration of cooling was 45 min (IQR 45-50; range 45-70 min). The median time to RTP was 9 days in the intervention group (IQR 7.0-13.5 days) and 13 days in the control group (IQR 9-30; p &lt; 0.001). The proportion of players out from play for more than the expected recovery time of 14 days was 24.7% in the intervention group, and 43.7% in controls (p &lt; 0.05). Study limitations include that: 1) allocation to cooling or control management was at the discretion of the medical staff of each team, decided prior to each season, and not by strict randomization; 2) no sham cap was used and evaluations could not be performed by blinded assessors; and 3) it could not be established with certainty that injury severity was similar between groups. While the results should thus be interpreted with caution, early head-neck cooling, with the aim of attenuating cerebral hyperthermia, may reduce post-SRC symptoms and lead to earlier return-to-play in elite ice hockey players.</p>}},
  author       = {{Al-Husseini, Ali and Fazel Bakhsheshi, Mohammad and Gard, Anna and Tegner, Yelverton and Marklund, Niklas}},
  issn         = {{0897-7151}},
  keywords     = {{clinical trial; cooling; ice hockey; return-to-play; sport related concussion}},
  language     = {{eng}},
  number       = {{11-12}},
  pages        = {{1075--1085}},
  publisher    = {{Mary Ann Liebert, Inc.}},
  series       = {{Journal of Neurotrauma}},
  title        = {{Shorter Recovery Time in Concussed Elite Ice Hockey Players by Early Head-and-Neck Cooling : A Clinical Trial}},
  url          = {{http://dx.doi.org/10.1089/neu.2022.0248}},
  doi          = {{10.1089/neu.2022.0248}},
  volume       = {{40}},
  year         = {{2023}},
}