Concussion In Youth Ice Hockey Research Articles

Factors Associated With Concussion Rates in Youth Ice Hockey Players: Data From the Largest Longitudinal Cohort Study in Canadian Youth Ice Hockey.

To examine factors associated with rates of game and practice-related concussion in youth ice hockey. Five-year prospective cohort (Safe2Play). Community arenas (2013-2018). Four thousand eighteen male and 405 female ice hockey players (6584 player-seasons) participating in Under-13 (ages 11-12), Under-15 (ages 13-14), and Under-18 (ages 15-17) age groups. Bodychecking policy, age group, year of play, level of play, previous injury in the previous year, lifetime concussion history, sex, player weight, and playing position. All game-related concussions were identified using validated injury surveillance methodology. Players with a suspected concussion were referred to a study sport medicine physician for diagnosis and management. Multilevel Poisson regression analysis including multiple imputation of missing covariates estimated incidence rate ratios (IRRs). A total of 554 game and 63 practice-related concussions were sustained over the 5 years. Female players (IRR Female/Male = 1.79; 95% CI: 1.26-2.53), playing in lower levels of play (IRR = 1.40; 95% CI: 1.10-1.77), and those with a previous injury (IRR = 1.46; 95% CI: 1.13, 1.88) or lifetime concussion history (IRR = 1.64; 95% CI: 1.34-2.00) had higher rates of game-related concussion. Policy disallowing bodychecking in games (IRR = 0.54; 95% CI: 0.40-0.72) and being a goaltender (IRR Goaltenders/Forwards = 0.57; 95% CI: 0.38-0.87) were protective against game-related concussion. Female sex was also associated with a higher practice-related concussion rate (IRR Female/Male = 2.63; 95% CI: 1.24-5.59). In the largest Canadian youth ice hockey longitudinal cohort to date, female players (despite policy disallowing bodychecking), players participating in lower levels of play, and those with an injury or concussion history had higher rates of concussion. Goalies and players in leagues that disallowed bodychecking had lower rates. Policy prohibiting bodychecking remains an effective concussion prevention strategy in youth ice hockey.

Factors Associated With Clinical Recovery After Concussion in Youth Ice Hockey Players.

Background:The identification of factors associated with clinical recovery in youth after sports-related concussion could improve prognostication regarding return to play (RTP).Purpose:To assess factors associated with clinical recovery after concussion in youth ice hockey players.Study Design:Cohort study; Level of evidence, 2.Methods:Participants were part of a larger longitudinal cohort study (the Safe to Play study; N = 3353). Included were 376 ice hockey players (age range, 11-17 years) from teams in Calgary and Edmonton, Canada, with 425 physician-diagnosed ice hockey–related concussions over 5 seasons (2013-2018). Any player with a suspected concussion was referred to a sports medicine physician for diagnosis, and a Sport Concussion Assessment Tool (SCAT) form was completed. Time to clinical recovery was based on time between concussion and physician clearance to RTP. Two accelerated failure time models were used to estimate days to RTP clearance: model 1 considered symptom severity according to the SCAT3/SCAT5 symptom evaluation score (range, 0-132 points), and model 2 considered responses to individual symptom evaluation items (eg, headache, neck pain, dizziness) of none/mild (0-2 points) versus moderate/severe (3-6 points). Other covariates were time to physician first visit (≤7 and >7 days), age group (11-12, 13-14, and 15-17 years), sex, league type (body checking and no body checking), tandem stance (modified Balance Error Scoring System result ≥4 errors out of 10), and number of previous concussions (0, 1, 2, and ≥3).Results:The complete case analysis (including players without missing covariates) included 329 players (366 diagnosed concussions). The median time to clinical recovery was 18 days. In model 1, longer time to first physician visit (>7 days) (time ratio [TR], 1.637 [95% confidence interval (CI), 1.331-1.996]) and greater symptom severity (TR, 1.016 [95% CI, 1.012-1.020]) were significant predictors of longer clinical recovery. In model 2, longer time to first physician visit (TR, 1.698 [95% CI, 1.399-2.062]), headache (moderate/severe) (TR, 1.319 [95% CI, 1.110-1.568]), and poorer tandem stance (TR, 1.249 [95% CI, 1.052-1.484]) were significant predictors of longer clinical recovery.Conclusion:Medical clearance to RTP was longer for players with >7 days to physician assessment, poorer tandem stance, greater symptom severity, and moderate/severe headache at first visit.

Incidence of Head Contacts, Penalties, and Player Contact Behaviors in Youth Ice Hockey: Evaluating the "Zero Tolerance for Head Contact" Policy Change.

Background:To reduce the risk of concussion in youth ice hockey, Hockey Canada implemented a national “zero tolerance for head contact” (HC) policy in 2011. A previous cohort study revealed higher concussion rates after this implementation in players aged 11 to 14 years. However, it is unknown whether the elevated risk was due to higher HC rates or factors such as increased concussion awareness and reporting.Purpose:To compare the rates of primary and secondary HCs and HC policy enforcement in elite U15 ice hockey leagues (players <15 years) before (2008-2009) and after (2013-2014) the zero-tolerance policy change.Study Design:Cohort study; Level of evidence, 3.Methods:A total of 32 elite U15 games before (n2008-2009 = 16; 510 players) and after (n2013-2014 = 16; 486 players) HC policy implementation were video recorded. Videos were analyzed with validated criteria for identifying HC types (primary/direct contact by players [HC1], secondary/indirect contact via boards, glass, or ice surface [HC2]) and other player-to-player contact behavior. Referee-assessed penalties were cross-referenced with the official Hockey Canada casebook, and penalty types were displayed using proportions. Univariate Poisson regression (adjusted for cluster by team game, offset by game length [minutes]) was used to estimate HC incidence rates (IRs) and incidence rate ratios (IRRs) between cohorts.Results:A total of 506 HCs were analyzed, 261 before HC policy implementation (IR, 16.6/100 team minutes) and 245 after implementation (IR, 15.5/100 team minutes). The HC1 rate (IRR, 1.05; 95% CI, 0.86-1.28) and HC2 rate (IRR, 0.74; 95% CI, 0.50-1.11) did not significantly differ before versus after implementation. Only 12.0% and 13.6% of HC1s were penalized pre- and postimplementation, respectively. Before implementation, HC1s were commonly penalized as roughing or elbowing penalties (59%), while after implementation, HC1s were penalized with the HC penalty (76%), and only 8% as roughing or elbowing.Conclusion:Despite implementation of the “zero tolerance for HC” policy, there was no difference in the rate of HC1s and HC2s or the proportion of HC1 penalized from before to after implementation. This research is instrumental in informing Hockey Canada’s future referee training and rule enforcement modifications.

Youth Ice Hockey Concussions Reported at US Emergency Department’s from 2002-2016: A Peak in 2011 and the Impact of Rule Modifications

Objectives: Ice hockey has one the highest incidences of concussions among youth sports. To combat this, several national campaigns have attempted to increase awareness since the early 2000’s. USA Hockey, the governing body for youth ice hockey in the US, also addressed the issue by instituting new checking rules in 2011. The new rules outlawed contact to the head at all ages and pushed the minimum age for body checking from 11 years old to 13 years old. The purpose of this study was to investigate the incidence of ice hockey-related concussions during a critical 15-year period from 2002-2016. We hypothesized that awareness campaigns would increase concussion reporting during the 2000’s and a 2011 rule change would decrease reporting. Methods: This is a descriptive epidemiological study utilizing the National Electronic Injury Surveillance System (NEISS). The NEISS was queried for all cases of concussion from January 1, 2002 to December 31, 2016 that included the product code 1279. Cases over the age of 18 and females were excluded. We reviewed the narrative text field and categorized each injury by mechanism (e.g. player contact, contact with boards, fall, etc). USA Hockey membership statistics were used to calculate population at risk and incidence. Incidences were reported per 10,000 person-years. Players were grouped by age according to USA Hockey divisions. Results: The national estimate of ice hockey-related concussions increased significantly from 656 in 2007 to 2,042 in 2011 (p&lt;0.01). During the same period, the incidence increased significantly from 21.8 to 66.8 (p&lt;0.05). After 2011, concussion incidence decreased significantly to 40.7 (p&lt;0.05) and overall, the number of concussions decreased from 1,965 in 2012 to 1,292 in 2016 (p=0.055). The 13-14, 15-16, and 17-18 age groups drove both the increase and decrease in concussions over the study period. The gap in concussion incidence between the 11-12 and 13-14 age divisions widened significantly after 2011 (before 2011: 41 vs 49 (p=0.8); after 2011: 45 and 89 (p&lt;0.01)). During the study period, incidence of concussion increased significantly with each successive age division. The incidences of concussion in the 0-8, 9-10, 11-12, 13-14, 15-16 and 17-18 age groups were 6.3, 22, 33.3, 59, 69.4, and 89.2, respectively. The top three mechanisms of concussion were player contact, falls and board contact. The incidence of concussion by player contact increased in each successive age division, especially between the 11-12 and 13-14 age groups (14.4 and 26.6 respectively, p&lt;0.01). Conclusion: Ice hockey went through a monumental shift during the study period. From 2007-2011, concussion reporting increased significantly as players, coaches and parents became more aware and educated. In response, the rules of the game were changed in 2011 to outlaw hitting to the head and push back body checking to older divisions. Immediately after the rule changes in 2011, a significant decrease in concussion incidence occurred. Adding to this effect was the elimination of body checking in the 11-12 age division, which likely mitigated the rise of concussion incidence in that age group. Since we’ve shown that concussion incidence increases with age, it stands to reason that increasing the body checking age further would result in even decreased incidence of concussions. This study lends credence to the theory that rule changes aimed at protecting players can help decrease the incidence of concussions in youth ice hockey.

PRIORITIZING CONCUSSION PREVENTION IN YOUTH ICE HOCKEY: AN ASSESSMENT OF ENGLISH-LANGUAGE CANADIAN NEWSPAPERS AS A VEHICLE FOR EVIDENCE-BASED KNOWLEDGE TRANSLATION

BackgroundThe extent to which evidence-based injury prevention knowledge is conveyed to the public can have considerable impact on the implementation of injury prevention practice and policy change, which requires significant...

DID “ZERO TOLERANCE FOR HEAD CONTACT” RULE ENFORCEMENT CHANGE THE RISK OF GAME RELATED CONCUSSIONS IN YOUTH ICE HOCKEY PLAYERS?

BackgroundIce hockey is a popular winter sport in Canada. Concussion accounts for the greatest proportion of all injuries in youth ice hockey. Research has informed policy change enforcing the no...

Concussion and concurrent cognitive and sport-specific task performance in youth ice hockey players: a pilot study

ObjectiveTo determine the influence of concussion on cognitive performance while completing concurrent sport-specific tasks to further inform return to play protocols for youth athletes.DesignThis descriptive case pilot study compared the...

DOES BODY CHECKING POLICY TO DISALLOW BODY CHECKING REDUCE THE RISK OF INJURY AND CONCUSSION IN 11 AND 12-YEAR-OLD NON-ELITE ICE HOCKEY PLAYERS IN CANADA?

BackgroundIce hockey has high participation and injury rates in youth in Canada. Body checking (BC) is the predominant mechanism of injury. Research has informed policy change disallowing BC in non-elite...

Concussion in youth ice hockey: It's time to break the cycle

The following article describes the methods, materials and techniques used in the long-term management of an anophthalmic patient. Following aggressive surgery to remove a squamous cell carcinoma, the patient had no orbital implant inserted at the time of surgery and remains reticent in regard to further surgery. She presented with a large orbital socket requiring imaginative and innovative ocular rehabilitation. This paper describes the materials and methods of fabricating this new and innovative medical device.

Converging evidence for the under-reporting of concussions in youth ice hockey

Background: Concussions are potentially serious injuries. The few investigations of prevalence or incidence in youth ice hockey have typically relied on prospective reports from physicians or trainers and did not...