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Attention problems as a risk factor for concussion in youth ice-hockey players
  1. Tommy Gerschman1,2,
  2. Kathryn Schneider1,3,4,
  3. Keith Yeates3,4,5,
  4. Brian L Brooks5,6,7,
  5. Courtney Kipps2,
  6. Carolyn Emery1,3,4
  1. 1Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
  2. 2Institute of Sport, Exercise and Health, University College London, UK
  3. 3Alberta Children’s Hospital Research Institute, Alberta, Canada
  4. 4Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
  5. 5Department of Psychology, University of Calgary, Calgary, Alberta, Canada
  6. 6Department of Pediatrics, University of Calgary, Alberta Children’s Hospital Research Institute
  7. 7Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada


Objective To examine attention problems in youth ice-hockey players as a risk factor for concussion.

Design Secondary analysis of two prospective cohort studies.

Setting Ice-rinks and Sport Medicine Centres in two Canadian cities over three ice-hockey seasons (2011/12, 2012/13, 2014/15).

Assessment of risk factors Self-report of formal diagnosis of attention or learning disorders were collected on previously validated preseason baseline questionnaires by all participating players. Parents and players completed the Behaviour Assessment System for Children (BASC-2), which includes inattention and hyperactivity scales.

Participants 2,364 Canadian ice-hockey players (11–17 years old, 87% male).

Outcome measures A previously validated prospective injury surveillance system was used. All suspected concussions were referred to the study physician for confirmation of diagnosis. Concussion risk ratios (RR) were estimated, including stratification by known risk factors.

Results One-hundred ninety-two of 2,215 players (9%) self-reported attention and/or learning disorders at baseline. Overall, 256 players (11%) sustained one or more concussions during a season. Players identified as “at-risk” for attention-deficit hyperactivity disorder (ADHD), based on BASC-2 T-scores (inattention and/or hyperactivity scale) greater than 60, had a greater risk of concussion during the season based on child report [RR=1.51 (95% CI 1.13–2.04)] and parent report [2.97 (95% CI 1.65–5.34)]. In players with no history of previous concussion, the RR based on child report was 1.88 (95% CI 1.22–2.90) and based on parent report was 5.03 (95% CI 2.45–10.29).

Conclusions Ice-hockey players identified as “at-risk” for ADHD on the basis of baseline BASC-2 scores are at a greater risk of concussion.

Competing interests None.

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