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220 Does increasing the severity of penalties assessed in association with the ‘zero tolerance for head contact’ policy translate to a reduction in head impact rates in youth ice hockey?
  1. Rylen A Williamson1,
  2. Ash T Kolstad1,
  3. Luc Nadeau6,
  4. Claude Goulet6,
  5. Brent Hagel1,2,3,4,5,
  6. Carolyn A Emery1,2,3,4,5
  1. 1Sport Injury Prevention Research Centre, University of Calgary, Calgary, Canada
  2. 2Alberta Children’s Hospital Research Institute, Calgary, Canada
  3. 3Departments of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
  4. 4Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
  5. 5O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
  6. 6Department of Physical Education, Faculty of Education, Université Laval, Québec City, Canada


Background The risk of concussion is high in Canadian youth ice hockey. Aiming to reduce this burden, in 2011 Hockey Canada implemented a national ‘zero tolerance for head contact (HC)’ policy mandating the penalization of any player-to-player HC. In 2018–20, Hockey Canada further amended this HC-policy including stricter enforcement of severe HCs.

Objective To compare HC rates and HC enforcement pre-policy, post-policy, and following policy amendments in elite U15 Canadian youth ice hockey.

Design Prospective cohort.

Setting A collection of events recorded with a video-camera located at the highest point near centre-ice in public ice hockey arenas in Calgary, Alberta.

Participants A convenience sample of 10 AA (elite) U15 (13–14 year old) games pre-policy (2008–09), 8 games post-policy (2013–14), and 10 games following policy amendments (2020–21).

Assessment of Risk Factors An analysis of HC-policy implementation and policy amendments across three cohort years.

Main Outcome Measurements Using Dartfish video-analysis software; all player contacts and HCs [direct (HC1), indirect (e.g., boards, ice) (HC2)] were tagged using validated criteria. Univariate Poisson regression [clustering by team-game offset by game-length (minutes)] was used to estimate HC1 and HC2 incidence rates (IR) and incidence rate ratios (IRR) between cohorts.

Results A total of 11,427 physical contacts were tagged (n2008–09=3896, n2013–14=3183, n2020–21=4348), with 538 contacts including the head (340 HC1,198 HC2) (n2008–09HC1=125, HC2=66; n2013–14HC1=110, HC2=44; n2020–21HC1=105, HC2=88). With additional rule modifications, a 30% reduction in HC1s emerged (IRR2013–2020=0.70, 95%CI:0.51–0.95). Since the HC-policy implementation, HC1s decreased by 24% (IRR2008–2020=0.76, 95%CI:0.58–0.99). The proportion of HC1s penalized was similar across cohorts (P2008–09=14.4%; P2013–14=15.5%; P2020–21=16.2%).

Conclusions The HC-policy amendments and increased policy implementation time have led to a decreased rate of HC1s. However, referee enforcement can further boost the HC-policy effectiveness. These findings can help future referee training and potential rule modifications to increase player safety nationally.

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