Delayed Concussion Recovery: Youth Hockey

| By Dr. Jennifer Hunnicutt

Ice hockey is considered one of the higher-risk sports for concussions. And youth hockey is no exception.

One of the primary concerns in youth athletics is delayed recovery following concussion. After a head injury, athletes want to get back to their sport as soon as possible, but returning to sport too early could be detrimental.

Given the high rate of concussions in youth hockey, researchers at the University of Calgary sought to determine what factors were associated with delayed recovery. (1)

They considered recovery to be time between the concussion and clearance to return to play by the physician trained in concussion care.

Using the 5-year Safe to Play study of hockey leagues in Calgary and the surrounding areas, the researchers evaluated a cohort of youth (11-17 years) hockey players who were diagnosed with a concussion. Males and females with at least one diagnosed concussion were included in this study. This totaled 366 concussions in 329 hockey players, 86% of which were male and 15% female.

Researchers collected injury reports, balance testing, and the Sport Concussion Assessment Tool (SCAT). The SCAT includes a thorough symptom checklist, (2) which researchers used as variables in this study. Using two different statistical models, researchers determined which factors were associated with delayed recovery.   

The percentage of youth hockey players that experienced prolonged recovery (>28 days to be cleared by physician to return to play) in this study was 25%. The median time to physician clearance to return to play was 18 days.

Concussion Checklist For Parents and Athletes

Results revealed that the following factors affected time to medical clearance consistently across the two statistical models:

  1. Greater than 7 days between injury and first visit with physician
  2. Greater number of symptoms
  3. Decreased balance

Therefore, more symptoms and delayed time to see the physician can affect recovery and increase time to return to play. According to the study procedures, all players with a suspected concussion had the opportunity to see the study physician within 72 hours of injury. As evidenced by the results, not all did. It is intriguing that athletes (and their parents/guardians) did not utilize this opportunity. Perhaps more education should be directed to the parents/guardians of youth sport athletes to seek medical care as early as possible after suspected concussion. It is important, though, that they seek care from healthcare professionals trained in concussion management.

Interestingly, quite a few of the factors that were hypothesized to affect recovery did not in this study. For example, a greater number of previous concussions did not affect recovery. Whereas previous studies have shown females to experience delayed recovery, this study did not.

This study does stress the importance of early evaluation of suspected concussions by healthcare professionals trained in concussion care. Youth hockey provides an interesting sport to study because of the high risk of concussions and demands of the sport (i.e., body checking). Because of this, youth hockey players should be properly evaluated as early as possible after suspected concussion.


  1. Emery CA, Warriyar Kv V, Black AM, Palacios-Derflingher L, Sick S, Debert C, Brooks BL, Yeates KO, Mrazik M, Lebrun C, Hagel BE, Dukelow S, Schneider KJ. Factors Associated With Clinical Recovery After Concussion in Youth Ice Hockey Players. Orthop J Sports Med. 2021 May 5;9(5):23259671211013370. doi: 10.1177/23259671211013370. PMID: 34017881; PMCID: PMC8114271.
  2. McCrory P, Meeuwisse W, Dvorak J, et al. Consensus statement on concussion in sport-the 5th International Conference on Concussion in Sport held in Berlin, October 2016. Br J Sports Med 51(11): 838-847, 2017.
Dr. Jennifer Hunnicutt

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