Preseason Reports of Neck Pain, Dizziness, and Headache as Risk Factors for Concussion in Male Youth Ice Hockey Players

Objective: The objective of this study was to determine the risk of concussion in youth male hockey players with preseason reports of neck pain, headaches, and/or dizziness. Design: Secondary data analysis of pooled data from 2 prospective cohort studies. Setting: Ice hockey rinks in Alberta and Quebec, Canada. Participants: A total of 3832 male ice hockey players aged 11 to 14 years (280 teams) participated. Assessment of Risk Factors: Participants recorded baseline preseason symptoms of dizziness, neck pain, and headaches on the Sport Concussion Assessment Tool. Incidence rate ratios (IRR) were estimated using Poisson regression, adjusted for cluster by team, hours of exposure, and other covariates. Main Outcome Measures: Concussions that occurred during the season were recorded using a validated prospective injury surveillance system. Results: Preseason reports of neck pain and headache were risk factors for concussion (IRR = 1.67; 95% confidence interval [CI], 1.15-2.41 and IRR = 1.47; 95% CI, 1.01-2.13). Dizziness was a risk factor for concussion in the Pee Wee nonbody checking cohort (IRR = 3.11; 95% CI, 1.33-7.26). A combination of any 2 symptoms was a risk factor in the Pee Wee nonbody checking cohort (IRR = 3.65; 95% CI, 1.20-11.05) and the Bantam cohort (IRR = 2.40; 95% CI, 1.15-4.97). Conclusions: Male youth athletes reporting headache and neck pain at baseline were at an increased risk of concussion during the season. The risk associated with dizziness and any 2 of dizziness, neck pain, or headaches depended on age group and body checking. Clinical Relevance: Baseline testing may be of benefit to identify individuals with symptoms of dizziness, neck pain, and headaches who may be at a higher risk of concussion during the season.