National Hockey League Players Research Articles

Analysis of Player Performance and Financial Costs Associated With Implementation of an Updated National Hockey League Concussion Protocol: A Retrospective Comparative Study.

An updated National Hockey League (NHL) concussion protocol (NHLCP) was established in the 2016-2017 season to mitigate the negative outcomes of sport-related concussions. However, few studies on the effects of implementing the NHLCP have been performed. To define concussion incidence and investigate differences in NHL player performance after a concussion during periods before and after NHLCP implementation and assess the financial impact on NHL teams associated with NHLCP implementation. Cohort study; Level of evidence, 3. This was a retrospective review of NHL players who sustained a concussion before (2000-2001 to 2015-2016 seasons) and after (2016-2017 to 2020-2021 seasons) implementing the NHLCP (pre-NHLCP and post-NHLCP groups). For each group, multiple performance metrics-including 30 days, 1 season, and 3 seasons before and after concussion-were compared for both groups. Return to play, total concussion cost, and association of return to play with cost were investigated using regression analysis. A total of 452 players (423 skaters, 29 goalies) sustained concussions during the study period, including 331 players (315 skaters, 16 goalies) in the pre-NHLCP group and 121 players (108 skaters, 13 goalies) in the post-NHLCP group. For both groups, no significant differences in standard performance were observed during the 30-day and 1-season periods before and after concussion. The mean return to play was significantly higher in the pre-NHLCP group than in the post-NHLCP group (20.1 vs 15.7 days; P = .022). The mean adjusted player salary was not different between groups; nonetheless, the mean adjusted replacement player salary was significantly higher in the post-NHLCP group ($744,505 vs $896,942; P = .032). The mean cost of time missed did not differ between groups. The mean return to play time significantly decreased over the entire study period (R2 = 0.33; P = .005), and the mean return to play time was positively associated with cost R2 = 0.215; P = .030). Concussion incidence did not change after implementation of the updated NHLCP; nonetheless, players had significantly less missed time from injury after protocol implementation. Changes in player performance 30 days and 1 year before and after concussion injury were not different before and after NHLCP implementation. No differences were found in the financial cost of concussions between the pre- and post-NHLCP groups, and missed time was significantly correlated with mean cost from missed time.

Strategic behaviours in a labour market with mobility-restricting contractual provisions: evidence from the National Hockey League

Abstract We follow workers’ performance along an unbalanced panel dataset over multiple years and study how performance varies at the end of fixed-term contracts, in a labour market where some people face a mobility-restricting clause (i.e. a noncompete clause). Focusing on the labour market of the National Hockey League, we analyse players’ performance data and contracts with a fixed-effects estimator to address empirical limitations in previous studies. We find that, on average, National Hockey League players’ performance does not vary. However, our estimations detect substantially heterogeneous behaviours, depending on tenure, perceived expected performance, and mobility. Only younger players (i.e. restricted free agents) with high expected mobility but low expected performance tend to behave strategically and perform better. Differently, older players (i.e. unrestricted free agents) with high expected mobility tend to underperform, as the option of moving back to European tournaments is more appealing.

Return to Play, Performance, and Earnings Analysis After Lumbar Disc Herniation in National Hockey League Players

Study Design Retrospective cohort study. Objective Professional hockey players have a high incidence of lumbar disc herniations (LDH). The purpose of this study was to determine the impact of LDH on the performance and financial earnings of National Hockey League (NHL) players. Methods NHL players who sustained a LDH were retrospectively reviewed utilizing an online database and a 2:1 matched control cohort. Player performance and game usage was compared at one- and three-season(s) pre- and post-injury season within the cohorts. Injured and matched players were divided into 3 groups based on the player’s adjusted index season salary. Results A total of 181 players were included, with 62 LDH players matched to 119 healthy controls. Return to play after LDH was 79%. The LDH cohort had fewer seasons played throughout their career compared to the matched group (12.5 ± 4.3 vs 14.2 ± 3.8; P = .031). At 1 season post-index, the LDH cohort had significantly fewer goals per 60 and points per 60 when compared to pre-index. At 3 seasons post-index, the LDH cohort exhibited a significant decline in time-on-ice per game played, goals per 60, and points per 60 compared to pre-index. Conclusion The majority of NHL players who sustained a LDH returned to play (79%) but had shorter careers overall and decreased performance outcomes when compared to matched cohorts at both 1 and 3 seasons post-injury.

Initial versus Subsequent Injury and Illness and Temporal Trends Among Professional Hockey Players.

Research is limited investigating injuries/illness incidence among National Hockey League (NHL) players. This study sought to establish injury/illness incidence, initial versus subsequent injury risk among NHL players, and determine temporal trends of injury and illness incidence. Variations in injury incidence by body region, and initial versus subsequent injury would be observed among positions. Retrospective cohort study. Publicly available data were utilized. NHL players 18 years or older between 2007-2008 to 2018-2019 were included. Injury and illness was stratified by position and body segment. Incidence rate (IR), and initial versus subsequent injury and illness risk ratios were calculated. Temporal trends were reported. Nine thousand, seven-hundred and thirty four injuries and illnesses were recorded. Centers had the highest overall IR at 15.14 per 1000 athlete game exposures (AGEs) (95%CI:15.12-15.15) and were 1.4 times more likely to sustain a subsequent injury compared to other positions. The groin/hip/thigh was the most commonly injured body region with an IR of 1.14 per 1000 AGEs (95%CI:1.06-1.21), followed by the head/neck (0.72 per 1000 AGEs, 95%CI:0.66-0.78). Combined injury and illness IR peaked in 2009-2010 season at 12.01 (95%CI: 11.22-12.79). The groin/hip/thigh demonstrated peak incidence during the 2007-2008 season (2.53, 95%CI:2.17-2.90); head/neck demonstrated a peak incidence in 2010-2011 season (Overall: 1.03, 95%CI:0.81-1.26). Injuries reported as 'lower body' increased over time. Positional differences were observed; centers demonstrated the highest overall IR, and subsequent injury risk. Injury by body region was similar to previous literature. Head/neck and concussion decreased over time supporting rule changes in body checking and visor wear. Clinicians should be aware that 'lower body' injuries increased over time; therefore, injuries to the groin/hip/thigh or knee are likely underreported. Level 3.

Who Reaches the NHL? A 20-Year Retrospective Analysis of Junior and Adult Ice Hockey Success in Relation to Biological Maturation in Male Swedish Players

ObjectivesThis study investigated the relationship between biological maturation and success in adolescence and adulthood in male Swedish ice hockey players.MethodsAnthropometric records of players in certified ice hockey high schools between 1998 and 2017 were retrieved (n = 4787). The database was complemented with records of Swedish junior national teams (U16, U18, U20) and National Hockey League (NHL) appearances. Biological maturation was recorded as a percentage of adult height (%AH), and selection probabilities were estimated using a generalised linear mixed effects model. Biological age was determined by comparing players with age-matched growth reference values. Categories of %AH, standard deviation z-scores and biological age offset describing early, on-time and late maturation were created.ResultsA total of 217 players had played on the U16 national team (junior success), and 96 reached the NHL (adult success). The difference [95% confidence interval (CI)] in baseline %AH between players with junior versus adult success was − 0.75 (− 0.39, − 1.11). Looking at age-offset categories in junior success, 30% of players were early maturing and 19% of players were late maturing, showing a bias towards early maturation (p < 0.01). In contrast, more late-maturing players (40%) achieved adult success than early-maturing players (25%), and NHL players had significantly later maturation [%AH: − 0.48 (− 0.80, − 0.16)] than non-NHL players.ConclusionThis unique 20-year analysis shows that junior success in male ice hockey is positively related to early maturation, while adult success is inversely related to advanced maturation. Ice hockey organisations should implement maturation assessments to optimise the development of both late- and early-matured players.

Concussion Characteristics in the National Hockey League Before and After the Introduction of Rule 48

A rule prohibiting a direct hit to the lateral side of the head (ie, Rule 48-Illegal Check to the Head) was introduced in the National Hockey League (NHL) in the 2010-2011 season and refined in the 2011-2012 season to widen the application to include direct contact to all areas of the head. To compare the incidence and proportion of concussions that occurred following hits to the head before and after the implementation of Rule 48. This retrospective cohort study used a before and after design to evaluate concussions among NHL players in regular season games. Data from the 4 seasons preceding the implementation of Rule 48 (2006-2007 to 2009-2010) were compared with data from 5 seasons following its implementation (2014-2015 to 2018-2019). Data were analyzed from October 31, 2021, to November 30, 2022. The incidence and relative proportion of concussion characteristics and mechanisms before and after the introduction of Rule 48. In the analysis of 688 concussions for NHL seasons spanning 2006 to 2010 (n = 231) and 2014 to 2019 (n = 457), there was an overall increase in the incidence of concussion between the 2 time frames, although the incidence of concussions due to hits to the lateral aspect of the head decreased from 1.6/100 games to 1.0/100 games (estimated difference, 0.6/100 games [90% credible interval (CrI), 0.30/100 games to 0.90/100 games). There was also a reduction of 18.8 (90% CrI, 13.0-23.7) percentage points in the proportion of concussions due to hits to the lateral aspect of the head from 80 of 231 concussions (34.6%) to 61 of 457 concussions (13.3%). The incidence of concussions following hits to the head from body checks using the shoulder, arm, and glove was similar before and following the implementation of Rule 48. However, the proportion was reduced 14.7 percentage points from 113 of 231 concussions (48.9%) before to 149 of 457 concussions (32.6%) after implementation of Rule 48 (90% CrI of the difference, 8.9-20.7 percentage points). The findings of this cohort study of NHL players suggest that after the introduction of Rule 48, the incidence rate and proportion of concussions from contact to the lateral aspect of the head decreased, as did the proportion of concussions following direct hits to the head.

Poster 369: Analysis of National Hockey League Player Performance After Concussion and Financial Costs Associated with Implementation of an Updated Concussion Protocol: A Retrospective Comparative Study

Objectives: Background: An updated National Hockey League (NHL) concussion protocol (NHLCP) was established in the 2016–2017 season to mitigate the negative outcomes of sport-related concussions. However, few studies on the effects of implementing the NHLCP have been performed. Purpose: To define concussion incidence and investigate differences in NHL player performance after a concussion during periods before and after implementation of the NHLCP and to assess the financial impact on NHL teams associated with NHLCP implementation. We hypothesized that concussion incidence would increase and player performance would remain the same after NHLCP implementation. Methods: A retrospective review of NHL players who sustained a concussion before (2000–2001 to 2015–2016 seasons) and after (2016–2017 to 2020–2021 seasons) implementation of the NHLCP (pre- NHLCP and post-NHLCP groups). For each group, multiple performance metrics 30 days, 1 season, and 3 seasons before and after concussion were compared for both groups. Return to play, total concussion cost, and association of return to play with cost were investigated with regression analysis. Results: For both groups, no significant differences in standard performance were observed during the 30-day and 1-season time periods before and after concussion. Mean return to play was significantly higher in the pre-NHLCP than in the post-NHLCP group (20.1 vs 15.7 days; P=0.022). Mean adjusted player salary was not different between groups, but mean adjusted replacement player salary was significantly higher in the post-NHLCP group ($744,505 vs $896,942; P= 0.032). Mean cost of time missed did not differ between groups. Mean return to play time significantly decreased over the entire study period 2000–2021 (R2=0.335, P=0.005), and mean return to play time was positively associated with cost (R2=0.215, P=0.030). Conclusions: Concussion incidence did not change after implementation of the updated NHLCP, but players had significantly less missed time from injury after protocol implementation. Changes in player performance 30 days and 1 year before and after concussion injury were not different before and after NHLCP implementation. [Table: see text][Table: see text]

Use of Fantasy Points in Evaluating Professional Athlete Performance After Anterior Cruciate Ligament (ACL) Reconstruction.

Our aim in performing this study was to evaluate whether fantasy and wins above replacement (WAR) scores of athletes undergoing anterior cruciate ligament (ACL) reconstructive surgery in the National Football League (NFL), National Basketball Association (NBA), National Hockey League (NHL), and Major League Baseball (MLB) could be utilized in evaluating their performance post-surgery. We identified publicly accessible data on professional athletes from 1992 to 2015. Fantasy and WARscores were calculated for each player. A total of 83 professional players met the inclusion criteria for this cross-sectional study. Decreased fantasy scores ranged from 33% to 42% across the four leagues after the index operation. NHL players had the lowest return-to-play (RTP) rate at 11/17 (82%), and MLB players had the highest RTP rate at 14/15 (93%). RTP rates of NBA and NFL players were comparable at 22/26 (85%) and 22/25 (88%), respectively. NFL players had the lowest average career length after surgery at 26 months, while NBA players had the longest average career length at 64 months. MLB players on average required the longest time to return to the pre-surgical level of performance (21 months). NHL players had the shortest average recovery time (eight months), and NBA players had the longest average recovery time (13 months). Approximately, more than half of all the studied players exhibited a decline in fantasy or WAR scores. In addition, NFL players had the lowest average career length, and NBA players enjoyed the longest average career length after surgery. NHL players had the lowest recovery time, while NBA players had the longest recovery time.The strength of this study is the utilization of fantasy points and WAR scores as a single unifying measure of a player's performance, which acts as an objective measure after ACL reconstruction. The average performance of a professional athlete, as evaluated through their fantasy score output, tends to decrease after undergoing ACL reconstruction. There is an overall long-term performance decline after initial spikes in their performance after surgery. Additional largerstudies are needed to fully understand the effects of ACL reconstruction in professional athletes;however, the use of fantasy scores may be an objective tool in measuring the success rate of ACL reconstruction.

The impact of COVID-19 on national hockey league players’ return to play

ABSTRACT Objective Evaluate the on-ice performance and return to play (RTP) rate following COVID-19 for National Hockey League (NHL) players during the 2020–21 season. Methods Players with COVID-19 during the abbreviated 2020–21 season were identified using publicly accessible online sources. Demographics and on-ice metrics were accessed using the NHL’s online statistics website. The length of time, rate of RTP, and games missed due to COVID-19 were analyzed. Primary outcomes included average time on ice (TOI) per game (TOI/G), average TOI per shift (TOI/S), and points per game (PPG) compared at different timepoints including pre- and post-COVID-19. Results A total of 73 players (47 forwards, 18 defensemen, 8 goalies) had a documented COVID-19 diagnosis during the abbreviated 2020–21 season. Players missed an average of 5.6 games (14.7 days) due to COVID-19. The post-COVID-19 RTP rate was 97.3%, including playoffs. No differences were found in TOI/G between the pre- (15.7 ± 3.9 min) and post-COVID-19 (15.8 ± 3.4 min, p = 0.874) or in the first (15.8 ± 4.0 min) and second week (15.9 ± 3.8 min, p = 0.925) returned. TOI/shift did not change from pre- (45.6 ± 5.3 sec) to post-COVID-19 (46.7 ± 4.6 sec, p = 0.035) or in first (46.2 ± 5.4 sec) and second week post-COVID-19 (46.2 ± 4.8 sec, p = .854). No differences were identified for PPG between career, pre-COVID-19, and post-COVID-19 (0.44 vs 0.38 vs 0.41; p = 0.274). Conclusion RTP post-COVID was markedly high for NHL players. While the effects of COVID-19 on specific physiological measures remains to be elucidated, this study found NHL players do not have reduced performance following COVID-19.

Salary disclosure and individual effort: Evidence from the National Hockey League

In late January, 1990, the salary of every National Hockey League (NHL) player was suddenly disclosed, ending a decades-long culture of pay secrecy. I find that underpaid players respond to this new information by reallocating effort from defense to offense, which is more highly compensated within the league. Underpaid players begin scoring more, but allow their teams to get scored on by even more than the additional goals they provide. Asymmetrically, overpaid players do not become more defensive-minded. Consistent with reference-dependent utility theory, I find suggestive evidence that this shift is more pronounced for underpaid players who play for teams with higher overall payrolls, as these players likely have a larger discrepancy between their actual salary and their reference point.

A-22 Neurorehabilitation Improves Emotional Domain Symptoms in Active and Retired NHL Players

Abstract Purpose: The prevalence of concussions in the National Hockey League (NHL) has been identified as approximately 1 concussion per 16.67 games, and the long-term effects of traumatic brain injuries are being highlighted in recent research. These long-term consequences may be due to chronic symptoms, especially neuropsychological symptoms, from unaddressed neurological dysfunction. Methods: A neuro-rehabilitation clinic treated 14 active or retired NHL players with symptoms relating to head injury an average of 2.47 years after their most recent head injury. A 5-day, multi-modal neurorehabilitation program was administered in 10 one-hour treatment sessions. Each session consisted of a combination of photobiomodulation, repetitive peripheral somatosensory stimuli, neuromuscular reeducation, vestibular rehabilitation, orthoptic exercises, cognitive exercises, and/or off-vertical axis rotation utilizing a multi-axis rotational chair. Results: On intake, the average overall symptom severity score of the SCAT5 graded symptom checklist was 31.42, and the average severity of emotional domain symptoms (Nervousness/Anxiety, Irritability, Sadness, More Emotional) was 5.86. Of the 14 players, 12 players reported symptoms in the emotional domain on intake while only 6 players reported emotional domain symptoms on exit. On average, emotional domain symptom severity score decreased by 81.71% compared to the 72.27% decrease in total symptom severity.: Conclusions: This neurorehabilitation program has shown to be beneficial at decreasing overall symptom severity in NHL players with symptoms post-head injury, especially symptoms that may be described as neuropsychological. The authors suggest further research be performed with a larger sample size and a follow-up study be performed to assess progression/regression.

Determining Sport Concussion Assessment Tool fifth Edition (SCAT5) reliable change in male professional hockey players

ObjectivesThe purpose of this paper is to provide reliable change metrics and assess the test–retest psychometrics of the Sport Concussion Assessment Tool fifth Edition (SCAT5) in a multilingual sample of...

"Fantasy Points" associated with Professional Athlete Performance after Lumbar Discectomy or Microdiscectomy.

INTRODUCTIONThe treatment of Lumbar Disc Herniation (LDH) in elite athletes is a debated topic that lacks consensus in the literature due to varying outcome reporting methods. The objective of this study was to quantify the overall performance of a sample of professional athletes before and after receiving a lumbar discectomy or microdiscectomy in a cohort of players in the National Football League (NFL), National Basketball Association (NBA), National Hockey League (NHL) and Major League Baseball (MLB).METHODSThe authors identified publicly accessible data from a cohort of different types of professional players who received either a lumbar discectomy or a microdiscectomy. These records were identified through newspaper archives, injury reports, player profiles and press releases between 1993 through 2015. Fantasy and Wins Above Replacement (WAR) scores were calculated for each player.RESULTSA total of 38 professional players met study inclusion criteria. NFL players had the lowest return-to-play (RTP) at nine of 14 (64%). The RTP for NBA, NHL and MLB players were comparable with 6/7 (86%) vs 8/9 (89%) vs 7/8 (88%). NFL players had the lowest average career length after surgery at 34.8 months, while NBA players had the longest average career length at 48 months. MLB players on average required the longest time to return to presurgical level of performance (24 months) and required the longest average recovery time at 12 months.CONCLUSIONSBased on these results, the average performance of most elite athletes are likely to decrease after undergoing a lumbar discectomy. Although it appears that performance peaks in the initial years after the operation for some players, there was an overall long-term decline in this sample of elite athletes. Study limitations included small sample size, lack of controlling for possible confounding variables (e.g., age, etc.) and use of variable reporting sources. Additional studies with larger sample sizes and age-matched controls are needed to examine the effects of lumbar discectomy more comprehensively in elite athletes.

Reduced Career Longevity but Return to Baseline Performance After Arthroscopic Shoulder Labral Repair in National Hockey League Players

PurposeTo investigate the impact of arthroscopic shoulder labral repair without shoulder instability on career longevity, game use, and performance in National Hockey League (NHL) athletes.MethodsA retrospective review of all NHL players who underwent arthroscopic shoulder labral repair from 2004 to 2020 was performed. A 2:1 matched control group was used for comparison. Controls were matched by age, body mass index, position, and experience prior to the index year. Demographic characteristics, game use, and performance metrics were collected for all athletes. Statistical analysis examined game use and performance both at 1-year and 3-year follow-up compared with one season before injury.ResultsTwenty-nine players who underwent arthroscopic shoulder labral surgery returned to play (100%) and were matched with 55 control players. The operative cohort experienced shorter careers compared with controls (4.4 ± 3.1 vs 6.0 ± 3.6 seasons, P < .05). After one season, injured players experienced significant reductions in goals per 60 (0.6 ± 0.4 vs 0.8 ± 0.5, P = .013), points per 60 (1.5 ± 0.9 vs 2.0 ± 0.9, P = .001), and shooting percentage, (8.5 ± 5.8 vs 10.5 ± 5.2, P = .02) compared with the year prior. The reduction in goals (0.6 ± 0.4 vs 0.8 ± 0.5, P = .01) and shooting % (8.5 ± 4.7 vs 10.5 ± 5.2, P = .04) persisted at 3 years. Compared with controls, the surgical group experienced significant reductions at one season postindex in percentage of goals, assists, points per 60, and shooting percentage. Only the reduction in goals per 60 persisted at 3 seasons postindex.ConclusionsFollowing return to play after arthroscopic shoulder labral repair, NHL players demonstrated reduced career longevity compared with healthy controls. Players exhibited significant reductions in game use and performance at one season after injury but returned closer to baseline after 3 seasons.Level of EvidenceLevel III; retrospective case control.

Concussions in the National Hockey League: Analysis of Incidence, Return to Play, and Performance.

Background:Concussion injuries are common in professional hockey; however, their effect on player performance remains unclear.Purpose:To quantify the effect of concussions on the performance of position players in the National Hockey League (NHL).Study Design:Cohort study; Level of evidence, 3.Methods:Concussion data from the NHL were collected using publicly available databases for the seasons between 2009-2010 and 2015-2016, coinciding with new NHL concussion rules. Age, body mass index, position, number of concussions during a player’s NHL career, games played, and time on ice were recorded. Basic and advanced performance metrics were collected for 1 season pre- and postconcussion (short-term period) and 3 seasons before and after concussion (long-term period) to assess short- and long-term changes in performance. A control group of players without an identified concussion who competed during the study period was assembled for comparison. Wilcoxon signed rank tests were used to evaluate pre- to postconcussion data in the short- and long-term settings as well as to compare the cohorts at each time point.Results:Overall, 48 players were identified as having a concussion during the study period. Players missed 17.2 ± 15.1 days (mean ± standard deviation) and 7.5 ± 6.9 games postconcussion. There were no significant differences in any metric when pre- and postconcussion intraseason performance was assessed. Athletes who were concussed demonstrated significantly deceased performance metrics (assists per 60 minutes, points per 60 minutes, Corsi percentage, and Fenwick percentage) in the 3 years after the concussion as compared with the year before injury (P < .05). However, no difference was found between the concussed group and matched control group in the short- or long-term period. Players with concussion played fewer career games (856.4 ± 287.4 vs 725.7 ± 215.0; P < .05) than did controls.Conclusion:A high rate of NHL players were able to return to play after a concussion injury. Players with concussion did not experience a reduction in performance metrics in the short- or long-term setting when compared with matched controls. The concussed cohort maintained a similar workload up to 3 seasons postconcussion but played in fewer career games when compared with matched controls.

A Cross-Sectional Decision-Making Approach to Inform Neuropsychological Battery Development in Professional Hockey.

Neuropsychologists commonly use a large battery of tests to inform clinical decisions. Decision analysis can be used to determine which individual tests play a role in the decision-making process. The objective of this project was to conduct quantitative and qualitative decision analysis of decisions by team neuropsychologists with professional hockey players being evaluated as part of the National Hockey League (NHL)/NHL Players Association Concussion Protocol. We extracted neuropsychological data from an NHL clinical program database. Team neuropsychologists evaluated concussed players using a hybrid neuropsychological test battery. The neuropsychologists then determined whether players were experiencing concussion-related cognitive difficulties. Logistic regression was used to examine which tests accounted for unique variance in the decision-making process. We also conducted a survey of NHL neuropsychologists, asking them to rate the usefulness of each test in the battery. Five of the fifteen measures accounted for unique variance in team neuropsychologists' decisions, including the ImPACT Verbal Memory Composite, Visual Motor Composite, Reaction Time Composite, Symptom Score, and Brief Visuospatial Memory Test-Revised Delayed Recall. Notable discrepancies were uncovered between quantitative indications of usefulness and self-reported qualitative perceptions of test usefulness when making decisions. Qualitatively, clinicians reported that the Hopkins Verbal Learning Test-Revised, Symbol Digit Modalities Test, ImPACT Reaction Time, and Color Trails 2 were the most useful tests when making decisions. Along with validation studies, decision analysis can be used as part of a comprehensive evaluation process to inform the development of best-practice batteries for use among athletes with sports concussion.

737. Geographic Clustering of Travel-acquired Infections in Ontario, Canada, 2008-2020

BackgroundAs rates of international travel increase, more individuals are at risk of travel-acquired infections (TAIs). We aimed to review all microbiologically confirmed cases of malaria, dengue, chikungunya, and enteric fever (Salmonella enterica serovar Typhi/Paratyphi) in Ontario, Canada between 2008-2020 to identify high-resolution geographical clusters that could be targeted for pre-travel prevention.MethodsRetrospective cohort study of over 174,000 unique tests for the four above TAIs from Public Health Ontario Laboratories. Test-level data were processed to calculate annual case counts and crude population-standardized incidence ratios (SIRs) at the forward sortation area (FSA) level. Moran’s I statistic was used to test for global spatial autocorrelation. Smoothed SIRs and 95% posterior credible intervals (CIs) were estimated using a spatial Bayesian hierarchical model, which accounts for statistical instability and uncertainty in small-area incidence. Posterior CIs were used to identify high- and low-risk areas, which were described using sociodemographic data from the 2016 Census. Finally, a second model was used to estimate the association between drivetime to the nearest travel clinic and risk of TAI within high-risk areas.ResultsThere were 5962 cases of the four TAIs across Ontario over the study period. Smoothed FSA-level SIRs are shown in Figure 1a, with an inset for the Greater Toronto Area (GTA) in 1b. There was spatial clustering of TAIs (Moran’s I=0.61, p< 2.2e-16). Identified high- and low-risk areas are shown in panels c and d. Compared to low-risk areas, high-risk areas were significantly more likely to have higher proportions of immigrants (p< 0.0001), lower household after-tax income (p=0.04), more university education (p< 0.0001), and were less knowledgeable of English/French (p< 0.0001). In the high-risk GTA, each minute increase in drivetime to the closest travel clinic was associated with a 4% reduction in TAI risk (95% CI 2 - 6%). Bayesian hierarchical model (BHM) smoothed standardized incidence ratios (SIRs) for travel-acquired infections (TAIs) and estimated risk levels (a and c) with insets for the Greater Toronto Area (b and d). High-risk areas are defined as those with smoothed SIR 95% CIs greater than 2, and low-risk areas with smoothed SIR 95% CIs less than 0.25.ConclusionUrban neighbourhoods in the GTA had elevated risks of becoming ill with TAIs. However, geographic proximity to a travel clinic was not associated with an area-level risk reduction in TAI, suggesting other barriers to seeking and adhering to pre-travel advice.Disclosures Isaac Bogoch, MD, MSc, BlueDot (Consultant)National Hockey League Players' Association (Consultant) Andrea Boggild, MSc MD DTMH FRCPC, Nothing to disclose Shaun Morris, MD, MPH, DTM&H, FRCPC, FAAP, GSK (Speaker's Bureau)Pfizer (Advisor or Review Panel member)Pfizer (Grant/Research Support)

Do not drop your gloves: “Winning” a fight in the National Hockey League does not improve chances to win the game

Sanctioned fighting has played an integral role in the National Hockey League (NHL) since its early days. Proponents argue that this practice helps teams win games. More specifically, they contend that when a player triumphs decisively in a fight, the outcome creates momentum or a spark for his teammates and thus increases his team’s odds of victory. We used on-line fans’ voting (validated by objective fight data) to assess fight outcome and demonstrated that “winning” the fight did not lead to winning the game when the score was tied. Additionally, in contrast with the “change in momentum” hypothesis, prevailing in a fight did not sway game outcome when the home or away team was one goal behind early enough in the game. Lastly, prevailing in a fight was not associated with scoring the next goal. We discuss the results in light of the strong conviction held by NHL players that fighting boosts momentum and explain possible mechanisms working to preserve this false belief.

An Analysis of Usage of a Multi-Criteria Approach in an Athlete Evaluation: An Evidence of NHL Attackers

The presented research focuses on the commonly used Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS), which is applied to an evaluation of a basic set of 581 national hockey league (NHL) players in the 2018/2019 season. This is used in combination with a number of objective methods for weighting indicators for identifying differences in their usage. A total of 11 indicators with their own testimonial values, including points, hits, blocked shots and more, are selected for this purpose. The selection of a method for weighting indicators has a major influence on the results obtained and the differences between them, and maintains the internal links within the ranked set of players. Of the evaluated methods, we prefer the Mean Weight method, and we recommend that the input indicators be considered equivalent when evaluating athletes.

Performance After Concussion in National Hockey League Players.

Concussions in ice hockey players are an interesting area of study due to the fast-paced and high-impact nature of the sport. Recently, researchers have focused on player performance after return from concussion to evaluate subclinical deficits that were previously missed. To examine National Hockey League (NHL) player performance from 2013 to 2019 and compare performance before a concussion with performance immediately after recovering to assess the current NHL return-to-play protocol. Cross-sectional study. The NHL Injury Viz and sports reporting websites. Players in the NHL who sustained concussions from 2013 to 2019. Goals, assists, points, plus-minus, time on ice (TOI), and hits. When goals, assists, points, plus-minus, TOI, and hits were examined, only TOI was different after the players returned from injury, and this TOI difference was not substantively important. After concussion, NHL player performance did not change.