Incidence of Concussion
in Youth Ice Hockey Players

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.

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).

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?

Jane McDevitt, PhD
by: Jeff Driban


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