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Although high rates of injury occur in youth ice hockey, disagreements exist about the risks and benefits of permitting bodychecking. We sought to evaluate associations between experience with bodychecking and rates of injury and concussion among ice hockey players aged 15-17 years.We obtained data from a prospective cohort study of ice hockey players aged 15-17 years in Alberta who played in leagues that permitted bodychecking. We collected data over 3 seasons of play (2015/16-2017/18). We compared players based on experience with bodychecking (≤ 2 v. ≥ 3 yr), estimated using local and national bodychecking policy and region of play. We used validated methodology of ice hockey injury surveillance to identify all injuries related to ice hockey games and defined concussions according to the Consensus Statement on Concussion in Sport.We included 941 players who contributed to 1168 player-seasons, with 205 players participating in more than 1 season. Compared with players with 2 years or less of bodychecking experience, those with 3 or more years of experience had higher rates of all injury (adjusted incidence rate ratio [IRR] 2.55, 95% confidence interval [CI] 1.57-4.14), injury with more than 7 days of time loss (adjusted IRR 2.65, 95% CI 1.50-4.68) and concussion (adjusted IRR 2.69, 95% CI 1.34-5.42).Among ice hockey players aged 15-17 years who participated in leagues permitting bodychecking, more experience with bodychecking did not protect against injury. This provides further support for removing bodychecking from youth ice hockey.

Background Collision sport participation rates among high school youth in Canada are high. While participation is beneficial for physical and mental well-being, the rates of injury in these sports are high. Aims This study aims to compare injury rates and profiles across four common youth collision sports (ice hockey, tackle football, lacrosse, rugby). Methods Data from a cross-sectional questionnaire of 2029 high school youth were used to identify male collision sport participants to be included in this secondary analysis (n = 360). Results Of the 2029 students who completed the questionnaire, 360 participated in collision-based sports [Ages: 14 (5%), 15 (41%), 16 (25%), 17 (26%), 18 (3%)]. The rates of injury ranged from 12.7 injuries/100 participants/year (rugby) to 33.1 injuries/100 participants/year (ice hockey). Concussion rates ranged from 12.4 (football) to 15.8 (ice hockey) concussions/100 participants/year. Similarities existed in the profile of injuries between sports, with most injuries occurring due to contact with another player (range 57.0% to 87.5%). Injuries to the head (33.3%), wrist/hand (16.0%), shoulder (12.8%), and knee (12.0%) were the most prevalent injury type. Substantial differences in previous playing experience existed between sports. Discussion The high rate of injury and concussion reported across each of these sports highlights the need for the introduction of primary prevention strategies in these sports aimed to reduce the risk of injury.

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.

The objective of this study is to examine sport and recreational (SR) activity participation and injury rates (IR) in high school students (ages 14-19).High school students (N = 24 schools, n = 2,029; 958 male, 1,048 female, 23 identified 'other' or missing; ages 14-19) in Alberta completed a web-based survey during class (October 2018-March 2019). Students identified their top three sports for participation in the past year. Primary outcome measures included IR for (a) any SR-related injury, (b) most serious SR-related injury resulting in medical attention, and (c) most serious injury resulting in restriction from SR for at least one day.In total, 1763/2029 (86.89%) respondents [861/958 (89.87%) male, 886/1048 (84.54%) female, 16/23 (69.57%) identifying as 'other' or missing] participated in an SR activity in the past year. Top sports for male participation were basketball (33.08%; 95% CI 27.67-39.00), ice hockey (20.46%; 95% CI 14.87-27.47), and soccer (19.42%; 95% CI 15.67-23.80). Top sports for female participation were dance (22.52%; 95% CI 17.98-27.82), basketball (18.32%; 95% CI 14.32-23.14), and badminton (17.84%; 95% CI 13.35-23.43). Of the 1,971 students completing the SR injury question, 889 reported at least one injury during the past year [(IR = 45.10 injuries/100 students/year (95% CI 39.72-50.61)]. The medical attention IR was 29.09 injuries/100 students/year (95% CI 24.49-34.17) and time loss IR was 36.00 injuries/100 students/year (95% CI 30.47-41.93).High school student SR IRs are high with 29% of adolescents reporting at least one medical attention injury within the past year. Injury prevention strategies targeting youth are necessary. Practical Application: Participation in SR activities has multiple physical, psychological, and health benefits for adolescents, but some SR activities also have greater risks of injury. This study informs the next sports to target for implementation of optimal prospective surveillance and injury prevention strategies among high school aged students.

Policy that disallows body checking (BC) lowers the injury and concussion rate for youth ice hockey players. However, little is known about how disallowing BC influences in-game metrics of performance. This prospective cohort video-analysis study examined offensive performance in Under-15 (ages 13–14) and Under-18 (ages 15–17) youth ice hockey players in leagues allowing and disallowing BC. Fifty-two games were filmed (n = 13 BC, n = 13 non-BC) for Under-15 and Under-18 non-elite (lowest 60% and 45% divisions, respectively) divisions in Calgary, Canada. Footage was analyzed for offensive performance metrics on the puck-carrier using the validated ice hockey adapted team sport assessment procedure. Puck metrics included how the player acquired puck possession (e.g. conquered puck from an opponent, received pass from a teammate) and the outcome (e.g. shot on goal, lost puck to opponent). The puck metrics were used to compute a performance composite score for each player that accounted for the quantity (rate of puck possessions per shift time) and quality (a ratio of positive performance metrics to all metrics) of play. Mean difference's (MD) in performance composite scores were compared using multivariable linear regression (adjusted for player position and cluster by team-game) between leagues allowing and disallowing BC for both age groups. Analyses revealed no significant MD in the performance composite scores between players in BC and non-BC leagues for both age groups (Under-15: MD = 0.02, 95%CI: −0.08, 0.12; Under-18: MD = −0.06, 95%CI: −0.16, 0.03). These findings suggest no differences in offensive performance when BC is disallowed in Under-15 and Under-18 non-elite leagues.

BackgroundConcussion is the most common injury in youth ice hockey. Whether mouthguard use lowers the odds of concussion remains an unanswered question.ObjectiveTo determine the association between concussion and mouthguard use in youth ice hockey.MethodsNested case–control design. Cases and controls were identified from two prospective cohort studies using valid injury surveillance methods. Cases were players concussed during a game or practice; controls were players who sustained a non-concussion injury during a game or practice. The primary exposure was mouthguard use at time of injury; mouthguard type (dental custom fit or off the shelf) was a secondary exposure. Physician-diagnosed or therapist-suspected concussion was the primary outcome. Dental injury was a secondary outcome. Multilevel logistic regression with random effect at a team level was used to obtain ORs for the mouthguard effect, adjusted for level of play, age group, position, concussion history, mechanism of injury, cohort, session type and body checking policy.ResultsAmong cases, 236/315 (75%) were wearing a mouthguard at time of injury, while 224/270 (83%) controls were wearing a mouthguard at time of injury. Any mouthguard use was associated with an adjusted OR for concussion of 0.36 (95% CI 0.17 to 0.73). Off-the-shelf mouthguards were associated with a 69% lower odds of concussion (adjusted OR: 0.31; 95% CI 0.14 to 0.65). Dental custom-fit mouthguards were associated with a non-significant 49% lower odds of concussion (adjusted OR: 0.51; 95% CI 0.22 to 1.10). No dental injuries were identified in either cohort.ConclusionMouthguard use was associated with lower odds of concussion. Players should be required to wear mouthguards in youth ice hockey.

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.

Background Ice hockey is Canada’s most popular winter sport. We have previously demonstrated that injury and concussion risk is reduced >60% in 11–12 year-old players where body checking was disallowed in games nationally in Canada in 2013. Objective: To evaluate the risk of injury and concussion associated with policy change disallowing body checking in games in non-elite Bantam (ages 13–14) ice hockey leagues, compared to body checking leagues. Methods This is a cohort study. Bantam players were recruited from non-elite Bantam teams where policy allowed body checking and following policy change where policy disallowed body checking (2014–2016). A validated injury surveillance system was used to collect preseason, exposure, and injury data. All ice hockey injuries were identified by a team safety designate. Any player with a suspected concussion was referred to a study sport medicine physician. Multivariable Poisson regression analyses controlled for relative age, previous injury, and clustering by team (offset by exposure hours). Findings Forty-nine body checking teams (608 players) and 33 teams non-body checking teams (396 players) participated. There were 123 game injuries [incidence rate (IR)=7.61/1000 hours] and 53 game concussions (IR=3.28/1000 hours). After policy change, there were 27 game injuries (IR=3.19/1000 hours) and 14 game concussions (IR=1.65/hours). Policy disallowing body checking was associated with a reduced rate of all injury [incidence rate ratio (IRR)=0.36 (95% CI; 0.21–0.61)], injury (time-loss >7 days) [IRR=0.35 (95% CI; 0.2–0.62)], concussion [IRR=0.43 (95% CI; 0.21–0.88)], and concussion (time-loss >10 days) [IRR=0.4 (95% CI; 0.18–0.87)]. Conclusion Policy change disallowing body checking in non-elite Bantam ice hockey resulted in a 64% reduction in injury and 57% reduction in concussion rate. Policy implications These findings have important implications for sport policy change informing a reduction in the public health burden of injury.

There is evidence that eye protection, mouth guards, helmets, and face guards are effective in reducing the risk of facial injury; however, such safety practices are not adopted universally by all athletes playing high-risk sports. Underlying beliefs about risk perception, comfort, ineffectiveness, utility, and a lack of awareness or enforcement have been identified as reasons people may not adopt preventive measures. There are several high-risk sports that have not mandated or do not enforce use of protective equipment. Valid evidence can assist with addressing the resistance caused by prevailing beliefs and could be essential in influencing rule changes.

Facial injuries can pose a large health burden for athletes, potentially resulting in time loss and surgery. This article reviews the incidence, common mechanisms, and risk factors of facial injuries in several sports globally. Estimates of facial injury rates are complicated by a lack of, or inconsistent, reporting on specific types of injury. Much of the epidemiologic literature is based on hospital-based injury surveillance and there is a paucity of literature examining sport-specific risk factors. Future research should focus on prospective injury surveillance methodologies with consistent injury definitions examining risk factors and the effectiveness of facial injury prevention efforts.

Background: The Sport Concussion Assessment Tool 5 (SCAT5) is a standardized instrument designed to assist with the clinical and sideline assessment of concussion. Following the 5th International Conference on Concussion in Sport in 2016, the SCAT5 was released. Compared to the previous version (SCAT3), the SCAT5 includes more detailed instructions regarding the symptom checklist and a 10-word list in the immediate memory section to diminish ceiling effects. This study aims to examine the association between having a previous history of concussion and SCAT5 scores in high school rugby players. A second objective is to provide reference values for healthy rugby players for the SCAT5, including typical scores on immediate memory using the 10-word list. Methods: High school rugby players (ages 15-18) from Calgary, Alberta participating in the 2018 high school rugby season (n=388, male=212, female=176) were recruited to a cohort study and asked to complete a baseline SCAT5 assessment administered by trained research assistants at the beginning of the playing season. Outcome measures included baseline symptom evaluation (/22 symptoms)], self-reported rating of percentage of normal (100% perfectly normal) felt at time of testing, immediate memory score using a 10-word list [/30)], digits backward (/4), delayed word memory (/10), and modified Balance Error Scoring System [BESS (/30)]. Players also completed a preseason demographic questionnaire, which assessed their history of concussion. Results: A total of 237/388 (61.08%) rugby players reported no history of concussion (NC) and 151/388 (38.92%) reported at least 1 previous concussion (PC). Ninety of the 212 males (42.45%) and 61 of the 176 females (34.66%) reported a history of previous concussion. Median SCAT5 symptom score was 6 (range; 0-21) for NC and 7 (0-22) for PC groups. At the time of baseline testing, only 30.51% of NC players and 21.85% of PC players reported feeling 100% of normal. Median total scores on the immediate memory score (/30) were 21 (range; 9-28) for NC and 21 (range; 9-29) for PC. Median total score on digits backward (/4) was 3 (range; 0-4) and the delayed memory score (/10) was 7 (range; 0-20), for both NC and PC groups. Median total errors made on the BESS were 4 (range; 0-20) for NC players and 5 (range; 0-17) for PC players. Conclusions: Players with and without a previous history of concussion obtained similar scores on all components of the SCAT5 at baseline. Many high school rugby players did not report feeling 100% of normal during typical baseline testing sessions. The addition of the 10-word list option in the immediate and delayed memory section reduces the likelihood of a ceiling effect. This study informs the use and interpretation of the SCAT5 in high school rugby players.

Objective To determine the association between previous history of concussion and sport-specific skill performance in youth ice hockey players. Design Cross-sectional. Setting Arenas in Calgary, Alberta, Canada over three seasons of play (2012–2015). Participants Five hundred and ninety-six players were recruited from youth hockey teams [525 males and 71 females, aged 11-17, representing elite (upper 30% by division of play) and non-elite (lower 70%)]. Assessment of risk factors Players completed a baseline questionnaire including the number, date of occurrence, and length of recovery following any previous concussions. Outcome measures On-ice skills performance was measured using the Hockey Canada Skills Test (HCST) battery including forward agility weave, forward to backward transition agility, forward/backward speed skate, and a 6-repeat endurance skate Results Previous history of concussion and time since most recent concussion were not associated with any HCST component. Players reporting two or more concussions were faster than those with no history of concussion on forward agility weave with the puck [−7.32 (95% CI: −11.05, −3.59)]. For every additional day of recovery post-concussion, a player’s time was significantly faster on forward agility weave with [−0.11 (95% CI: −0.16, −0.05] and without the puck [−0.08 (95% CI: −0.13, −0.04], transition agility without the puck [−0.01 (95% CI: −0.02, −0.01], and backward speed with [−0.06 (95% CI: −0.1, −0.03)] and without the puck[−0.05 (95% CI: −0.07, −0.03)]. Conclusions Players with a concussion history had similar HCST performance scores to those without. A longer post-concussion recovery was associated with better performance. These results provide reference values which will inform risk assessment and future injury prevention studies. Competing interests None.

Background Policy allowing body checking (BC) increases injury and concussion risk in youth ice hockey players. Hockey Calgary introduced BC policy change in 2015 that disallows BC at the Bantam (ages 13–14) non-elite level (lowest 60% by division of play). Objective To compare game offensive performance (OP) between non-elite Bantam players playing in a league allowing BC and players in a league not allowing BC. Design Prospective cohort. Setting Arenas in Calgary, Alberta. Participants Non-elite Bantam games were videotaped in Calgary, Alberta during the 2014–15 (n=348 players) and 2015–16 (n=309 players) playing seasons. Assessment of Risk Factors Players from the 2014–15 season played in a league allowing BC, while players from 2015–16 season played in a league where BC was not allowed. Main Outcome Measurements Using Dartfish video analysis software, games were analyzed for OP metrics for the puck carrier using the ice hockey adapted Team Sport Assessment Procedure. These metrics included puck possession (conquered puck from an opponent and received pass from a teammate) and puck outcome (successful shot on goal, lost puck to an opponent, and offensive pass to a teammate). Unadjusted incidence rate-ratios (IRRs), clustered by game, were calculated for each puck action per team game between players in Calgary, Alberta 2014–15 (BC allowed) and 2015–16 (BC not allowed). Results No differences were found in puck possession metrics [conquered puck IRR=1.07 (95% CI: 1.00,1.16), received pass IRR=1.05 (95% CI: 0.93,1.18)] or puck outcome [successful shot IRR=0.97 (95% CI: 0.86,1.10), lost puck IRR=1.07 (95% CI: 0.98,1.18), offensive pass IRR=0.98 (95% CI: 0.86,1.12)]. Conclusions There were no differences found across all OP metrics between a non-elite Bantam league allowing BC and a league not allowing BC. There is no evidence to conclude that offensive performance was negatively nor positively affected by Hockey Calgary9s decision to disallow BC at Bantam non-elite levels.