Objective To describe the occurrence and trend of concussions during the international ice hockey tournaments.
Design Register study.
Setting The International Ice Hockey Federation (IIHF) World Championships and Olympic Winter Games.
Participants A total of 3293 games were played in the 169 tournaments by 1212 teams (26130 players) comprising 142244 athletic game exposures.
Outcome measures One hundred and sixty concussions were observed.
Main Results The average injury rate (IR) for concussion was 1.1 per 1000 ice hockey player-games for all IIHF World Championship tournaments (WC). The injury rate was highest in men's WC A-pool tournaments and Olympic Winter Games (OWG) (IR 1.6), and lowest in women's WC and OWG (IR 0.9). However, the annual injury rate for concussion in men's tournament has been lower than that in World Junior tournaments since 2012. When concussion occurred in a contact with a flexible board injury rate was 0.2 per 1,000 player games and 1.1 if a board and glass were traditional [RR 6.4, (95% CI 1.50–27.61]. In men's tournaments the trend of concussions caused by illegal hits decreased over a study period. After the 2012 Zurich Consensus Guidelines none of the concussed players returned to a play during a same day in men's WC tournaments.
Conclusions The risk of concussion was significantly lower if games were played on rinks with flexible board and glass. Between 2006 and 2015, the annual risk of concussion in men's WC has been decreasing most likely due to the decreasing number of concussions caused by illegal hits.