Background In 2013, Hockey Canada introduced an evidence-informed policy change delaying the earliest age of introduction to body checking in ice hockey until Bantam (ages 13–14) nationwide.
Objective To determine if the risk of injury, including concussions, changes for Pee Wee (11–12 years) ice hockey players in the season following a national policy change disallowing body checking.
Methods In a historical cohort study, Pee Wee players were recruited from teams in all divisions of play in 2011–2012 prior to the rule change and in 2013–2014 following the change. Baseline information, injury and exposure data for both cohorts were collected using validated injury surveillance.
Results Pee Wee players were recruited from 59 teams in Calgary, Alberta (n=883) in 2011–2012 and from 73 teams in 2013–2014 (n=618). There were 163 game-related injuries (incidence rate (IR)=4.37/1000 game-hours) and 104 concussions (IR=2.79/1000 game-hours) in Alberta prior to the rule change, and 48 injuries (IR=2.16/1000 game-hours) and 25 concussions (IR=1.12/1000 game-hours) after the rule change. Based on multivariable Poisson regression with exposure hours as an offset, the adjusted incidence rate ratio associated with the national policy change disallowing body checking was 0.50 for all game-related injuries (95% CI 0.33 to 0.75) and 0.36 for concussion specifically (95% CI 0.22 to 0.58).
Conclusions Introduction of the 2013 national body checking policy change disallowing body checking in Pee Wee resulted in a 50% relative reduction in injury rate and a 64% reduction in concussion rate in 11-year-old and 12-year-old hockey players in Alberta.
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Contributors AMB contributed to all research activities and takes responsibility for the integrity of the data and accuracy of the data analysis. She led the analysis and manuscript preparation. BEH and KJS contributed to the design of the study, acquisition of funding, analysis and interpretation of the results and critically reviewed the manuscript. LP-D contributed to the technical aspects of the data analysis, participated in data interpretation and critically reviewed the manuscript. CAE takes responsibility for the integrity of the data and the accuracy of the data analysis. She also led the design, acquisition of funding and all research activities, and critically reviewed the analysis and manuscript preparation.
Funding This study was funded by the Canadian Institutes of Health Research (CIHR), Alberta Children’s Hospital Research Institute and a grant from Alberta Innovates Health Solutions. AMB is supported by the Hotchkiss Brain Institute Dr T Chen Fong Doctoral Scholarship in Neuroscience. CAE is supported by an Alberta Children’s Hospital Foundation Chair in Pediatric Rehabilitation. The University of Calgary Sport Injury Prevention Research Centre is one of the International Research Centres for Prevention of Injury and Protection of Athlete Health supported by the International Olympic Committee. The role of the sponsors and funding bodies was to provide financial support for this research and the translation of the findings to all community partners.
Competing interests None declared.
Ethics approval Ethics approval for both the 2011–2012 and 2013–2014 cohorts was obtained from the Conjoint Health Research Ethics Board at the University of Calgary (Ethics ID# Nos. 20 252 and 14-0348 respectively). All player participants and parents provided written consent to participate.
Provenance and peer review Not commissioned; externally peer reviewed.
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