title: Development of a risk prediction model among professional hockey players with visible signs of concussion.
abstract: BACKGROUND
  Little research examines how to best identify concussed athletes. The purpose of the present study was to develop a preliminary risk decision model that uses visible signs (VS) and mechanisms of injury (MOI) to predict the likelihood of subsequent concussion diagnosis.
  
  
  METHODS
  Coders viewed and documented VS and associated MOI for all NHL games over the course of the 2013-2014 and 2014-2015 regular seasons. After coding was completed, player concussions were identified from the NHL injury surveillance system and it was determined whether players exhibiting VS were subsequently diagnosed with concussions by club medical staff as a result of the coded event.
  
  
  RESULTS
  Among athletes exhibiting VS, suspected loss of consciousness, motor incoordination or balance problems, being in a fight, having an initial hit from another player's shoulder and having a secondary hit on the ice were all associated withincreasedrisk of subsequent concussion diagnosis. In contrast, having an initial hit with a stick was associated withdecreasedrisk of subsequent concussion diagnosis. A risk prediction model using a combination of the above VS and MOI was superior to approaches that relied on individual VS and associated MOI (sensitivity=81%, specificity=72%, positive predictive value=26%).
  
  
  CONCLUSIONS
  Combined use of VS and MOI significantly improves a clinician's ability to identify players who need to be evaluated for possible concussion. A preliminary concussion prediction log has been developed from these data. Pending prospective validation, the use of these methods may improve early concussion detection and evaluation.
authors.affiliation: Department of Psychology, University of Missouri - Kansas City, Kansas City, MO, USA.
authors.forename: Jared M
authors.initials: JM
authors.lastname: Bruce
authors.affiliation: Department of Psychology, University of Missouri - Kansas City, Kansas City, MO, USA.|Psychological and Neurobehavioral Associates, State College, Pennsylvania, USA.
authors.forename: Ruben J
authors.initials: RJ
authors.lastname: Echemendia
authors.affiliation: Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Willem
authors.initials: W
authors.lastname: Meeuwisse
authors.affiliation: Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Hutchison
authors.affiliation: Ottawa Sport Medicine Center, Ottawa, Ontario, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Aubry
authors.affiliation: Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Comper
mesh_terms: D056352:Athletes; D001265:Athletic Injuries / Q000175:diagnosis*; D001924:Brain Concussion / Q000175:diagnosis*; D000066491:Clinical Decision-Making; D006688:Hockey / Q000293:injuries*; D006801:Humans; D008962:Models, Theoretical; D018570:Risk Assessment
keywords: Concussion; Ice hockey; Sports