Physical Maturity and Concussion Symptom Duration among
Adolescent Ice Hockey Players

PK, Stein C, Kent J, Ruggieri D, Dolan E, O’Brien M, Meehan WP. J Pediatr.
2015: ahead of print

Take Home Message: Among
adolescent ice hockey players, early pubertal stage is associated with longer
concussion recovery in males. Young players should be discouraged from

to the cost and equipment restraints, many high schools lack age stratification
in youth ice hockey leagues. Therefore, it is not uncommon for younger, less
physically mature players to oppose more mature players that are faster and
stronger. Currently, there has been little research investigating concussion
injury risk due to level of physical maturity within these athletes. Therefore,
the authors conducted a prospective study within 145 high school ice hockey
players (101 boys and 44 girls) ages 13 to 18, seen at 3 outpatient concussion
clinics (Rhode Island Hospital, Boston Children’s Hospital, and South Shore Hospital)
to investigate the association between physical maturation and risk of
prolonged concussion symptoms (more than 28 days). At an initial evaluation the
authors collected demographic, anthropometric, and injury data. During initial
and follow up appointments the authors used the
Post Concussion Symptom Score (PCSS)
and a computerized neurocognitive assessment to measure concussion sign and
symptom severity and duration. The authors compared these assessments to
baseline when available. Then, time to symptom resolution was measured from
date of sign and symptom onset to the date the athlete self-reported no longer experiencing
symptoms from his/her concussion. Athletes were grouped by pubertal development
(early or late) using the
Pubertal Development Scale,
which involved 5 or 6 items about his/her physical growth (height, body hair,
skin changes, facial hair, voice changes in males, and breast growth in girls).
The average duration of concussion signs and symptoms was 45 days. Almost 50%
had concussion symptoms for more than 28 days. Male players in the early
pubertal category (45%) had longer symptom duration than those in the late
pubertal category (55%). Additionally, weight, pubertal development score, and initial
PCSS were each independently associated with prolonged symptom resolution time
(28 or more days). Specifically, lighter weight, higher PCSS and early pubertal
development scores were associated with increased odds of experiencing
prolonged symptoms. Most of the girls were in the late pubertal category (87%).
Additionally, most girls played in girl-only leagues (96%). Only, heavier
weight had an increased probability of experiencing prolonged concussions
within the girl cohort.

authors determined that there is an increased risk for prolonged concussion
signs and symptoms among the male adolescent ice hockey players. Both their
weight and pubertal development scores were associated with longer concussion
sign and symptom duration. This suggests that stratification by weight or
physical maturity may be beneficial for youth ice hockey leagues. Physical
maturity was not found to be problematic in the girl’s cohort; however, it may
be important to confirm these results in a study with more women who are in the
early pubertal category since this study only had 5 female players in the early
pubertal category. Heavier weight was found to be associated with longer signs
and symptoms; however, this may be statically significant and not clinically
significant. It was also interesting to note that nearly 50% of this cohort
suffered from prolonged concussion sign and symptom duration, and the mean time
for full symptom recovery was 45 days. Compared to previous reports (football
and soccer), where nearly all athletes recovered in 28 days these athletes on
average suffered concussion signs and symptoms an extra 20 days. Further
research should be done to determine if this increased recovery time is due to
participating in youth ice hockey, the age of the population, or other risk
factors. For now, medical professionals should educate athletes, parents, and
coaches on the risk of playing with more mature players, especially when the
athlete is not physically mature. Medical professionals can also use this study
to help young ice hockey players understand how long they may be symptomatic
after a concussion.

Questions for Discussion:
How often do you see athletes “playing up?” Do you think there should be
stratification to reduce risk of concussions?

Jane McDevitt, PhD
by: Jeff Driban


Sport-related Concussions: Knowledge Translation among Minor Hockey Coaches

Kriz, P., Stein, C., Kent, J., Ruggieri, D., Dolan, E., O’Brien, M., & Meehan, W. (2016). Physical Maturity and Concussion Symptom Duration among Adolescent Ice Hockey Players The Journal of Pediatrics DOI: 10.1016/j.jpeds.2015.12.006