ObjectiveTo compare rates of injury and concussion among non-elite (lowest 60% by division of play) Bantam (ages 13–14 years) ice hockey leagues that disallow body checking to non-elite Bantam leagues that allow body checking.MethodsIn this 2-year cohort study, Bantam non-elite ice hockey players were recruited from leagues where policy allowed body checking in games (Calgary/Edmonton 2014–2015, Edmonton 2015–2016) and where policy disallowed body checking (Kelowna/Vancouver 2014–2015, Calgary 2015–2016). All ice hockey game-related injuries resulting in medical attention, inability to complete a session and/or time loss from hockey were identified using valid injury surveillance methodology. Any player suspected of having concussion was referred to a study physician for diagnosis and management.Results49 body checking (608 players) and 33 non-body checking teams (396 players) participated. There were 129 injuries (incidence rate (IR)=7.98/1000 hours) and 54 concussions (IR=3.34/1000 hours) in the body checking teams in games. After policy change, there were 31 injuries (IR=3.66/1000 hours) and 17 concussions (IR=2.01/1000 hours) in games. Policy disallowing body checking was associated with a lower rate of all injury (adjusted incidence rate ratio (IRR)=0.44; 95% CI: 0.27 to 0.74). The point estimate showed a lower rate of concussion (adjusted IRR=0.6; 95% CI: 0.31 to 1.18), but this was not statistically significant.ConclusionPolicy change disallowing body checking in non-elite Bantam ice hockey resulted in a 56% lower rate of injury. There is growing evidence that disallowing body checking in youth ice hockey is associated with fewer injuries.

ObjectivesThe objective of this study is to evaluate the effect of policy change disallowing body checking in adolescent ice hockey leagues (ages 15–17) on reducing rates of injury and concussion.MethodsThis is a prospective cohort study. Players 15–17 years-old were recruited from teams in non-elite divisions of play (lower 40%–70% by division of play depending on year and city of play in leagues where policy permits or prohibit body checking in Alberta and British Columbia, Canada (2015–18). A validated injury surveillance methodology supported baseline, exposure-hours and injury data collection. Any player with a suspected concussion was referred to a study physician. Primary outcomes include game-related injuries, game-related injuries (>7 days time loss), game-related concussions and game-related concussions (>10 days time loss).Results44 teams (453 player-seasons) from non-body checking and 52 teams (674 player-seasons) from body checking leagues participated. In body checking leagues there were 213 injuries (69 concussions) and in non-body checking leagues 40 injuries (18 concussions) during games. Based on multiple multilevel mixed-effects Poisson regression analyses, policy prohibiting body checking was associated with a lower rate of injury (incidence rate ratio (IRR): 0.38 (95% CI 0.24 to 0.6)) and concussion (IRR: 0.49; 95% CI 0.26 to 0.89). This translates to an absolute rate reduction of 7.82 injuries/1000 game-hours (95% CI 2.74 to 12.9) and the prevention of 7326 injuries (95% CI 2570 to 12083) in Canada annually.ConclusionsThe rate of injury was 62% lower (concussion 51% lower) in leagues not permitting body checking in non-elite 15–17 years old leagues highlighting the potential public health impact of policy prohibiting body checking in older adolescent ice hockey players.

Context: Injury surveillance has shown that concussions are the most common injury in youth ice hockey. Research examining criteria to ensure correct fit of protective equipment and its potential relationship with concussion risk is very limited. Objective: To evaluate the association between helmet fit and odds of concussion in youth ice hockey players. Design: Nested case-control in a cohort study. 10 Setting: COUNTRY-XXX. Participants: Data were collected for 72 concussed, 41 non-concussion injured, and 62 uninjured ice hockey players ages 11–18 years. Main Outcome Measures: Helmet fit assessments were conducted across players encompassing helmet specifications, condition, certification, and criteria measuring helmet fit. Using a validated injury surveillance system, cases included players with suspected and/or physician-diagnosed concussion. One control group included players who sustained non-concussion injuries and a second control group included uninjured players. Helmet fit criteria (score/16) were assessed for concussed players and compared with each of two control groups. The primary outcome was dichotomous (>1 helmet fit criteria missing vs. 0 or 1 criteria missing). Logistic and conditional logistic regression were used to investigate the effect of helmet fit on odds of concussion. Results: The primary analysis (54 pairs matched for age, sex, and level of play) suggested that inadequate helmet fit (>1 criterion missing) resulted in greater odds of concussion when comparing concussed and uninjured players [OR: 2.67 (95% CI 1.04–6.81), p=0.040]. However, a secondary unmatched analysis including all participants suggested no significant association between helmet fit and odds of concussion when comparing concussed players with non-concussion injured players [OR: 0.98 (95% CI 0.43–2.24), p=0.961] or uninjured players [OR: 1.66 (95% CI 0.90–3.05), p=0.103]. Conclusion: Inadequate helmet fit may affect the odds of sustaining a concussion in youth ice hockey. Future research with larger sample sizes should continue to evaluate this relationship and inform helmet fit recommendations.

BackgroundHockey Canada’s evidence-based body checking (BC) policy change (2013) was informed by evidence that policy allowing BC in Pee Wee (11–12 year old) ice hockey players resulted in a >3-fold increased risk of injury and concussion compared with leagues where BC was not allowed.ObjectiveTo compare the frequency of type and intensity of physical contacts (PC) and head contact in elite (upper 30%) Pee Wee ice hockey games in leagues not allowing BC (2013–2014) compared with leagues allowing BC (2007–2008) using video analysis.MethodsTen elite games pre-policy change (2007–2008) and 11 elite games post-policy change (2013–2014) were video recorded and analysed using a validated methodology to compare the frequency of type (trunk and other types of PC with limb/head/stick) and intensity (trunk contacts – level 1–5 intensity) of PC and head contact. Incidence rate ratios (IRR) were estimated using Poisson regression controlling for clustering by game) to compare PC before and after the BC policy change.ResultsA total of 4409 trunk PCs and 2623 other PCs were observed. The total number of trunk PCs (IRR = 0.97, 95% CI: 0.83–1.14) and other contacts (IRR = 0.87, 95% CI: 0.59–1.29) did not change post-policy change. High intensity contacts (levels 4 and 5) were less frequent post-policy change (IRR4 = 0.13, 95% CI: 0.09–0.19 and IRR5 = 0.13, 95% CI: 0.07–0.26) and low intensity contacts (level 2) increased (IRR2 = 1.47, 95% CI: 1.21–1.79). Limb PCs decreased in 2013–14 (IRR = 0.48, 95% CI; 0.33–0.71) and there was no difference for head contacts (IRR = 0.81, 95% CI; 0.51–1.30).ConclusionsThere were no significant differences in total number of PC by study year. However, the incidence of high intensity (level 4–5) PCs decreased post -policy change. There was no significant difference in direct head contact or total number of other contacts. This will inform the development and evaluation of injury prevention and skill training strategies in youth ice hockey.

BackgroundFew studies have investigated head impacts in youth ice hockey, none of which have reported impact mechanisms.ObjectiveTo investigate head impact characteristics in youth ice hockey.DesignVideo analysis.Setting2013/2014 Calgary bantam (13–14 years) ice hockey season.MethodsA previously compiled video database of 7260 bantam ice hockey player-to-player contacts from 22 games was searched for head impact cases. Eight games were randomly selected, two elite and six non-elite, from which head impact cases were analysed.ResultsA total of 254 head impact cases were identified, which represented 3.5% of all player-to-player contacts at a rate of 11.5 head contacts per game. A total of 100 head impact cases were analysed. Two-thirds of all cases (67%) occurred in close proximity to the boards and 11% of all cases resulted in a penalty. Over half of all impacts (55%) were to the side of the helmet, followed by the cage (29%), rear (7%), front (6%) and top (2%). The primary impacting object was an opposing player in 69% of all cases with the most common being the shoulder (31%), helmet (12%) and glove (10%). The impacting object was the glass and boards for 17% and 11% of all cases, respectively. A secondary impact occurred in 21% of all cases, which was most commonly to the side of the helmet and impacting the glass. One case involving a tertiary impact was identified, which comprised of two impacts to the shoulder of an opposing player and then an impact against the boards during the subsequent fall.ConclusionsImpacts in youth ice hockey games are typically to the side and cage of helmets by an opposing player. Helmet performance and standards testing should include representative impacts by compliant surfaces to simulate player-to-player contact.