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. 2024 Nov 12;12(11):23259671241285075.
doi: 10.1177/23259671241285075. eCollection 2024 Nov.

Examining the Reliability and Validity of Coding Perceived Force Severity and Bracing in the NHL Concussion Spotter Program

Kaitlin E Riegler  1 , Ruben Echemendia  2 , Willem Meeuwisse  3 , Paul Comper  4   5 , Michael G Hutchison  4 , J Scott Delaney  6   7 , Jared M Bruce  8   9
Affiliations

Examining the Reliability and Validity of Coding Perceived Force Severity and Bracing in the NHL Concussion Spotter Program

Kaitlin E Riegler et al. Orthop J Sports Med. .

Abstract

Background: Data obtained from the National Hockey League (NHL) have shown that a risk prediction model, including both visible signs and mechanisms of injury, improves the identification of possible concussion. However, only about half of concussions diagnosed by club medical staff in the NHL exhibit visible signs. At present, the NHL concussion spotter protocol does not include central league spotters' subjective judgments of the severity of forces associated with a direct hit to the head (perceived force severity [PFS]) or whether players brace before a hit (bracing).

Purpose: To examine the interrater reliability, preliminary validity, and association with concussion diagnosis of central league spotter determinations of PFS and bracing.

Study design: Cross-sectional study.

Methods: Video footage of 1071 events after a direct or indirect blow to the head were observed from the 2020-2021 and 2021-2022 NHL seasons. These events were classified into 4 groups: concussion with visible signs; concussion without visible signs; no concussion with visible signs; and no concussion without visible signs. A total of 50 events were randomly selected from the total events in each group. Then, 2 raters (NHL central league spotters) coded PFS for each of the 200 video events as low, medium, or high. Bracing was coded as no bracing, insufficient bracing, or full bracing.

Results: Interrater reliability was fair to moderate for the categorical and continuous ratings of both PFS (κ = 0.36 and 0.45, respectively) and bracing (κ = 0.40 and 0.49, respectively). There was no significant association between concussion diagnosis and either PFS (Z = 0.00, P = .99) or bracing (Z = 0.77, P = .44). Exploratory, post hoc analyses suggested a possible relationship between bracing and reduced concussion risk among a select subsample of events with no visible signs (r = -0.29, P < .01).

Conclusion: The interrater reliability for PFS and for bracing was fair to moderate. Neither PFS nor bracing were significantly related to concussion diagnosis, but they were significantly associated with other visible signs and mechanisms of injury.

Keywords: concussion; early diagnosis; ice hockey; video analysis; visible signs.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: K.E.R. is a part-time employee of the NHL. R.E. is a paid consultant for the NHL, co-chair of the NHL/NHLPA concussion subcommittee, occasionally provides expert testimony in matters related to mild traumatic brain injury and sports concussion, and has received funding from the NFL (NFL-Long) through Boston Children's Hospital. W.M. is the chief medical officer for the NHL and an employee of the NHL. P.C. is a member of the NHL/NHLPA Concussion Subcommittee and a paid consultant for the NHLPA. M.G.H. is a member of the NHL/NHLPA Concussion Subcommittee and a paid consultant for the NHLPA. J.S.D. serves as the chief medical consultant for the NHLPA and is the chief medical officer for CF Montreal of Major League Soccer, roles for which he is remunerated. J.M.B. is a part-time employee of the NHL, is a paid consultant for Med-IQ and Sporting KC, and has received grant funding from Genzyme. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
CONSORT (Consolidated Standards of Reporting Trials) diagram of coded events included in the study. NHL, National Hockey League.
See this image and copyright information in PMC

References

    1. Abrahams S, Fie SM, Patricios J, Posthumus M, September AV. Risk factors for sports concussion: an evidence-based systematic review. Br J Sports Med. 2014;48(2):91-97. - PubMed
    1. Asken BM, McCrea MA, Clugston JR, Snyder AR, Houcks ZM, Bauer RM. “Playing through it”: delayed reporting and removal from athletic activity after concussion predicts prolonged recovery. J Athl Train. 2016;51(5):329-335. - PMC - PubMed
    1. Bruce JM, Echemendia RJ, Meeuwisse W, Hutchison MG, Aubry M, Comper P. Development of a risk prediction model among professional hockey players with visible signs of concussion. Br J Sports Med. 2018;52(17):1143-1148. - PubMed
    1. Cerullo E, Quinn TJ, McCleery J, Vounzoulaki E, Cooper NJ, Sutton AJ. Interrater agreement in dementia diagnosis: a systematic review and meta-analysis. Int J Geriatr Psychiatry. 2021;36(8):1127-1147. - PubMed
    1. Cook NE, Karr JE, Iverson GL. Children with ADHD have a greater lifetime history of concussion: results from the ABCD study. J Neurotrauma. 2022;39(1-2):86-92. - PubMed

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