Sports Medicine Research: In the Lab & In the Field: Should We Check the Checking Age in Youth Ice Hockey? (Sports Med Res)
Monday, February 1, 2016

Should We Check the Checking Age in Youth Ice Hockey?

Incidence of Concussion in Youth Ice Hockey Players

Kontos AP, Elbin RJ, Sufrinko A, Dakan S, Bookwalter K, Price A, Meehan WP, Collins MW. Pediatrics. 2016;137(2):e20151633.

Take Home Message: Concussion rates in youth ice hockey are nearly 3 times higher during games compared to practice, and 12 to 14 year olds have higher incidence rates compared to 15 to 18 year olds.

Ice hockey is consistently one of the sports with the highest concussion incidence rates. Additionally, concussions represent a greater proportion of total injuries among boy’s ice hockey (22%) compared to other sports (13%).  However, much of this data are taken from only games. Therefore, the authors monitored 397 youth ice hockey players (12-18 years) during the 2012-13 and 2013-14 seasons for a total of 23,360 athletic exposures (AE; 12,784 practice & 10,585 game) to determine the incidence of concussion in relation to games versus practices and age. The authors recruited the players from 3 different sites: Western Pennsylvania (343 players), Boston, Massachusetts (31 players), Birmingham, Alabama (27 players), consisting of 31 different teams (27 male and 4 female teams; 11 high schools, 10 midget, 7 bantam, and 3 peewee). The peewee-level teams (37 players) and 4 girls teams (67 players) were the only nonchecking teams included. The proportion of nonchecking players were similar between players 12-14 years and 15-18 years of age. The research team educated a coach or designated parent about concussions and how to collect and report player exposure prior to the start of the season. The research team contacted the team representative 2 to 3 times per week throughout the 2 seasons to determine if any suspected concussions occurred. During games and practices licensed medical professionals were present and assessed all injuries, as well as conducted follow-up evaluations for players with suspected concussions. Overall, a total of 37 (9%) players incurred a medically diagnosed concussion during the study period. Eleven (30%) players sustained the concussion during practice and 26 (70%) players suffered concussions during games. No player sustained multiple concussions during the study. All identified mechanisms of injury involved player-to-player contact, including 19 with secondary contact with the boards. Additionally, 43% of the concussion injury mechanisms involved illegal contact resulting in a penalty. The combined incidence rate for games and practices was 1.59 concussion per 1000 AEs. The incidence rate was 2.9 times higher for games (2.5 per 1000 AEs) compared with practices (1.0 per 1000 AEs). Concussion incidence rates were higher in 12-14 year olds (2.8 per 1000) compared to 15-18 year olds (1.2 per 1000 AEs).

The authors of this study found that players had nearly 3 times more concussions per game compared with practice. Game situations are typically played at a higher intensity; therefore, it is intuitive that more concussion would be sustained during game situations. What was alarming was the significant percentage (43%) of concussion causing impacts that were a result of illegal contact. This finding supports the need for more stringent enforcement of penalties for illegal contact in youth ice hockey to mitigate this behavior.  It was also interesting to note that concussion incidence rate for 12-14 year olds was 2.4 times higher than for 15-18 years olds. This disparity may be due to decreased size and strength, and the introduction of checking at age 13 for males may result in poor checking technique and lack of ice awareness, which could lead to more collisions. It would be helpful to know if concussion rates differed between teams with or without checking in each age group. Future research should compare younger and older adolescents to determine concussion risk factors such as game play characteristics to determine if rule changes such as delaying the introduction of checking until age of 15 would be advantageous. In the meantime, medical professionals and coaches should be aware of the high concussion rates during games, and should be educating players on proper techniques to diminish concussions caused by illegal checking.                                                         

Questions for Discussion: Do you feel concussion rates would decrease in the 12-14 age group if checking was not legal? How can we modify contact behavior in youth ice hockey athletes?

Written by: Jane McDevitt, PhD
Reviewed by: Jeff Driban

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Preseason Neck Pain and Headache: Concussion Predictor?



Kontos, A., Elbin, R., Sufrinko, A., Dakan, S., Bookwalter, K., Price, A., Meehan, W., & Collins, M. (2016). Incidence of Concussion in Youth Ice Hockey Players PEDIATRICS DOI: 10.1542/peds.2015-1633

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