{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T07:44:35Z","timestamp":1777880675016,"version":"3.51.4"},"reference-count":29,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2024,4,1]],"date-time":"2024-04-01T00:00:00Z","timestamp":1711929600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Journal of Sports Medicine"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Cohort study; Level of evidence, 3<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>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\u2014including 30 days, 1 season, and 3 seasons before and after concussion\u2014were compared for both groups. Return to play, total concussion cost, and association of return to play with cost were investigated using regression analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      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 ( R\n                      <jats:sup>2<\/jats:sup>\n                      = 0.33; P = .005), and the mean return to play time was positively associated with cost R\n                      <jats:sup>2<\/jats:sup>\n                      = 0.215; P = .030).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23259671241231757","type":"journal-article","created":{"date-parts":[[2024,4,24]],"date-time":"2024-04-24T10:12:16Z","timestamp":1713953536000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Analysis of Player Performance and Financial Costs Associated With Implementation of an Updated National Hockey League Concussion Protocol: A Retrospective Comparative Study"],"prefix":"10.1177","volume":"12","author":[{"given":"Michael A.","family":"Gaudiani","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Henry Ford Health, Detroit, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joshua P.","family":"Castle","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Henry Ford Health, Detroit, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Trevor D.","family":"Wolterink","sequence":"additional","affiliation":[{"name":"School of Medicine, Wayne State University, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas J.","family":"Sprys-Tellner","sequence":"additional","affiliation":[{"name":"School of Medicine, Wayne State University, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jager W.","family":"Haan","sequence":"additional","affiliation":[{"name":"College of Human Medicine, Michigan State University, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T.","family":"Sean Lynch","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Henry Ford Health, Detroit, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2024,4,24]]},"reference":[{"issue":"10","key":"bibr1-23259671241231757","volume":"10","author":"Adams R","year":"2018","journal-title":"Cureus"},{"issue":"1","key":"bibr2-23259671241231757","doi-asserted-by":"crossref","DOI":"10.1177\/23259671211052069","volume":"10","author":"Andrews E","year":"2022","journal-title":"Orthop J Sports Med"},{"key":"bibr3-23259671241231757","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.092190"},{"key":"bibr4-23259671241231757","unstructured":"Centers for Disease Control and Prevention. What is a concussion? Last updated February 12, 2019. Accessed May 2023. https:\/\/www.cdc.gov\/headsup\/basics\/concussion_whatis.html"},{"issue":"2","key":"bibr5-23259671241231757","doi-asserted-by":"crossref","DOI":"10.1177\/2325967119825502","volume":"7","author":"Chatha K","year":"2019","journal-title":"Orthop J Sports Med"},{"key":"bibr6-23259671241231757","doi-asserted-by":"publisher","DOI":"10.1016\/j.csm.2010.08.006"},{"key":"bibr7-23259671241231757","doi-asserted-by":"publisher","DOI":"10.1136\/injuryprev-2013-041016"},{"key":"bibr8-23259671241231757","volume-title":"StatPearls","volume":"9","author":"Ferry B","year":"2023"},{"key":"bibr9-23259671241231757","unstructured":"Hockey-Reference.com. 2022-23 NHL skater advanced statistics Accessed May 2023. https:\/\/www.hockey-reference.com\/leagues\/NHL_2023_skaters-advanced.html"},{"key":"bibr10-23259671241231757","doi-asserted-by":"publisher","DOI":"10.1007\/s40279-022-01645-8"},{"key":"bibr11-23259671241231757","doi-asserted-by":"publisher","DOI":"10.2217\/cnc.15.1"},{"key":"bibr12-23259671241231757","doi-asserted-by":"publisher","DOI":"10.1177\/0363546516638327"},{"key":"bibr13-23259671241231757","doi-asserted-by":"publisher","DOI":"10.3389\/fnins.2020.00761"},{"key":"bibr14-23259671241231757","doi-asserted-by":"publisher","DOI":"10.4085\/1062-6050-52.1.14"},{"key":"bibr15-23259671241231757","doi-asserted-by":"publisher","DOI":"10.1177\/2325967115622621"},{"key":"bibr16-23259671241231757","unstructured":"National Hockey League and National Hockey League Players Association. Concussion evaluation and management protocol: 2022\/23 season. Accessed June 1, 2022. https:\/\/cdn.nhlpa.com\/misc\/files\/2022-23-NHL-NHLPA-Concussion-Protocol.pdf"},{"key":"bibr17-23259671241231757","unstructured":"National Hockey League Players Association. Concussion protocol and education. Accessed May 2023. https:\/\/www.nhlpa.com\/the-pa\/pa-programs-and-partnerships\/concussion-protocol-and-education"},{"key":"bibr18-23259671241231757","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2017.5611"},{"key":"bibr19-23259671241231757","doi-asserted-by":"publisher","DOI":"10.1177\/2325967117740847"},{"key":"bibr20-23259671241231757","doi-asserted-by":"publisher","DOI":"10.4085\/1062-6050-126.20"},{"key":"bibr21-23259671241231757","doi-asserted-by":"publisher","DOI":"10.1177\/2325967119854199"},{"issue":"4","key":"bibr22-23259671241231757","doi-asserted-by":"crossref","DOI":"10.1177\/2325967120913020","volume":"8","author":"Peterson JG","year":"2020","journal-title":"Orthop J Sports Med"},{"key":"bibr23-23259671241231757","doi-asserted-by":"publisher","DOI":"10.1016\/j.csm.2020.08.013"},{"key":"bibr24-23259671241231757","doi-asserted-by":"publisher","DOI":"10.1177\/2325967118814238"},{"key":"bibr25-23259671241231757","doi-asserted-by":"publisher","DOI":"10.1016\/j.brainresbull.2020.09.021"},{"key":"bibr26-23259671241231757","doi-asserted-by":"publisher","DOI":"10.2147\/OAJSM.S157433"},{"key":"bibr27-23259671241231757","doi-asserted-by":"publisher","DOI":"10.1017\/S031716710000946X"},{"key":"bibr28-23259671241231757","doi-asserted-by":"publisher","DOI":"10.2217\/cnc-2020-0012"},{"key":"bibr29-23259671241231757","doi-asserted-by":"publisher","DOI":"10.1111\/joim.12863"}],"container-title":["Orthopaedic Journal of Sports Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/23259671241231757","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/23259671241231757","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/23259671241231757","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:18:52Z","timestamp":1777594732000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/23259671241231757"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4]]},"references-count":29,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2024,4]]}},"alternative-id":["10.1177\/23259671241231757"],"URL":"https:\/\/doi.org\/10.1177\/23259671241231757","relation":{},"ISSN":["2325-9671","2325-9671"],"issn-type":[{"value":"2325-9671","type":"print"},{"value":"2325-9671","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4]]},"article-number":"23259671241231757"}}