The Financial Toll of Career-Ending Concussions in Professional Hockey
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Research Article For reprint orders, please contact: [email protected] NA Research Article 2016/01/28 The financial toll of career-ending concussions in professional hockey Aim: Several high-profile professional hockey players have retired due to career-ending Carmen Hiploylee1, Richard concussions sustained in the National Hockey League (NHL). We sought to determine Wennberg1 & Charles H the salary cost of career-ending concussions in the NHL. Methods: Concussion- Tator*,1 1 induced retirements from 1995 to 2015 were identified using public media sources. Canadian Sports Concussion Project, Krembil Neuroscience Centre, The number of missed games due to a player’s final concussion was multiplied by per University of Toronto, Toronto Western game salary to determine cost. Results: In total, 35 players were identified: the total Hospital, 399 Bathurst Street, Toronto, cost to teams and insurers of career-ending concussions was US$135,476,777. Half of ON M5T 2S8, Canada the total consisted of salaries owing three players with contracts still active in 2015. *Author for correspondence: Conclusion: The financial impact of concussion-induced retirements provides another Tel.: +1 416 603 5889 Fax: +1 416 603 5298 reason for professional leagues to take measures to better protect their players from [email protected] concussion. First draft submitted: 29 May 2016; Accepted for publication: 4 July 2016; Published online: 27 July 2016 Keywords: concussion • cost • hockey • NHL • retirement • salary Concussions suffered in the National Hockey Concussions in professional hockey have League (NHL) and other professional leagues received much public and media attention, leading to postconcussion syndrome (PCS) and it has been stated that a degree of vio- and professional athletes’ premature retire- lence deemed intrinsic to the sport is a major ment have been well recognized [1–4], but contributor to the serious injuries sustained there has been no report of the financial by the players [2,8]. Sociologically, it has been implications for teams in terms of lost sal- argued that this ‘risk culture’ perpetuates an Concussion ary costs. To our knowledge, the sole journal atmosphere in which pain and injury inflicted report on NHL career-ending concussions on an athlete may be valued and respected consisted of interviews with five NHL play- over the athlete’s safety and health [9–11] . ers who sustained concussions during their More recently, this injurious behavior has 2016 NHL careers [5]. The report revealed the been increasingly viewed from the perspec- emotional distress, difficulty in transitioning tive of concussions placing athletes at risk to retirement life and strain on their personal of chronic traumatic encephalopathy, a pro- relationships [5]. Although definitions vary, gressive degenerative tauopathy of the brain PCS is generally accepted to mean persisting manifested as dementia and other mental symptoms (somatic, affective or cognitive) and neurological symptomatology [12] . due to a concussion that do not resolve within In 1997, the NHL and the NHL Players’ a certain timeframe (10 days to 3 months or Association (NHLPA) initiated the NHL- more, depending on the definition used) [6,7]. NHLPA Concussion Program and began These postconcussive symptoms can be to collect statistics on concussions in the debilitating and can permanently impact the league. During the seasons 1997–1998 to part of quality of life and health of players [5]. 2003–2004, 559 physician-diagnosed con- 10.2217/cnc-2016-0008 © Charles Tator et al. Concussion (2016) 1(4), CNC20 eISSN 2056-3299 Research Article Hiploylee, Wennberg & Tator cussions were tallied during regular season games [13] . cal record based analysis of NHL concussions over the Among the 559 reported concussions, 10.6% were seven seasons from 1997 to 2004 by Benson et al. [13] diagnosed retrospectively and never evaluated during with the data obtained from public records in Wenn- the game, allowing players to immediately return to berg and Tator [4] shows nearly identical numbers. Spe- play (RTP). Additionally, 8.3% of concussions were cifically, Benson et al. [13] identified 559 total concus- evaluated during the game but players were nonethe- sions, and ≤534 concussions with missed playing time less cleared for RTP in the same game. For every suc- (30/559 cases were without medical record informa- cessive concussion sustained, NHL players took more tion on missed playing time [13]), whereas Wennberg time to RTP and suffered more symptoms [13] . and Tator [4] identified 523 concussions with missed It is evident that concussions are a problem in the playing time over the same time period, a difference in NHL, and this is further exemplified by the number concussion identification of <2%, using the game time of players who have prematurely ended their play- loss definition. ing careers because they were unable to recover from PCS [4]. It is important to explore whether the league Identification of retired players, inclusion and the players have taken sufficient measures to miti- & exclusion criteria gate the problem. One approach to focus attention on A number of NHL player retirements in the mid- the importance of this issue is to investigate the finan- late 1990s, publicly attributed to the effects of PCS, cial implications of career-ending concussions in the began to attract attention to the career-ending possi- NHL. Noncareer-ending concussions can be a signifi- bilities of PCS, perhaps most notably the premature cant financial burden as shown by Donaldson et al. [14] retirement of Brett Lindros [1,4,22]. In 2007, the late who found that the total salaries lost from concussions Randy Starkman, a well-respected sports journalist was US$42.8 million a year. Our goal in the present for Canada’s largest daily newspaper, The Toronto Star, study is novel and involved calculation of the financial brought increased attention to this issue with the pub- loss to the teams and their insurers arising from career- lication of a list of professional hockey players whose ending concussions in the NHL in the 20-year period careers were ended by concussion [3]. For this study, from 1995 to 2015. we verified, narrowed down (excluding players whose career-ending concussions did not occur in the NHL), Methods and further populated this list through an exhaustive Identification of concussions search of all players reported to have had a concussion Media reports of concussions sustained in the NHL in the NHL (as defined above), to identify all player that led to time lost from play were identified for each retirements and, if reported, the reason(s) for retire- player. ‘Game time loss’ has been found to be the most ment, looking for evidence that a player’s retirement reliable and accurate injury definition to compare had been publicly attributed to the persistent effects injury rates between games, seasons and teams (com- of PCS. pared with attempts to identify all injuries, i.e., includ- We used the following inclusion and exclusion crite- ing those without missed playing time) [15], and the ria. To be included, NHL players must have had their present authors have used this methodology in previ- career-ending concussion in the NHL. A career-ending ous reports [1,4]. Concussions were identified through concussion was defined as a concussion and ensuing examination of injury reports published in print or PCS (identified in media reports as persisting debilitat- online in The Hockey News (Transcontinental Publica- ing symptoms, most frequently headache and cognitive tions, Montreal, QC, Canada) [16], The Sporting News symptoms) that ultimately caused the player to retire Hockey Register (Sporting News Books, Vulcan Sports from play in the NHL. Two individuals that had not Media, MO, USA) [17], and The Sports Network [18], returned to play for years after a concussion compli- occasionally supplemented by examination of contem- cated by PCS, but who had not publicly announced poraneous print or online newspaper or other news their retirement from professional hockey and were media articles, as previously described in detail [1,4]. still under contract, were considered as retired for Since the first paper of Wennberg and Tator [1] other the purposes of this study. NHL players meeting our studies have used similar methods to identify NHL inclusion criteria were identified from 1995 to 2015. injuries [4,14,19–21] . Using these methods, it is important to note that concussions that were either overlooked or Retirement & salary cost data collection did not lead to time lost from play were rarely publicly All player retirement information and salary data were reported and so the total number of concussions identi- collected and multiply checked for verification wher- fied for this report is an underestimation [1,4]. Nonethe- ever possible from publicly available, hockey-related less, a comparison of the data in the prospective, medi- news sources and websites such as The Hockey News [16], 10.2217/cnc-2016-0008 Concussion (2016) 1(4) future science group The financial toll of career-ending concussions in professional hockey Research Article The Sports Network [18], NHL.com [23], CapGeek [24], related to his career-ending concussion [30]), nor does it Blackhawk Zone [25], HockeyZonePlus [26], as well as include the costs of disability insurance or the costs of Wikipedia [27] and other print or online newspaper injury treatment and management. sources. One might speculate that some of the players Player name, total number of reported concussions included in our study, due to their concussion his- sustained as an NHL player and information allowing tories, may have been perceived as ‘less valuable’ or us to calculate the total salary cost due were obtained. ‘higher risk’ by the time of their career-ending concus- The team played for, the player’s age and the year at the sion, although this cannot be proven. It might explain time of the last concussion were also recorded.