Objectives The objective of this study is to evaluate the effect of policy change disallowing body checking in adolescent ice hockey leagues (ages 15–17) on reducing rates of injury and concussion.
Methods This is a prospective cohort study. Players 15–17 years-old were recruited from teams in non-elite divisions of play (lower 40%–70% by division of play depending on year and city of play in leagues where policy permits or prohibit body checking in Alberta and British Columbia, Canada (2015–18). A validated injury surveillance methodology supported baseline, exposure-hours and injury data collection. Any player with a suspected concussion was referred to a study physician. Primary outcomes include game-related injuries, game-related injuries (>7 days time loss), game-related concussions and game-related concussions (>10 days time loss).
Results 44 teams (453 player-seasons) from non-body checking and 52 teams (674 player-seasons) from body checking leagues participated. In body checking leagues there were 213 injuries (69 concussions) and in non-body checking leagues 40 injuries (18 concussions) during games. Based on multiple multilevel mixed-effects Poisson regression analyses, policy prohibiting body checking was associated with a lower rate of injury (incidence rate ratio (IRR): 0.38 (95% CI 0.24 to 0.6)) and concussion (IRR: 0.49; 95% CI 0.26 to 0.89). This translates to an absolute rate reduction of 7.82 injuries/1000 game-hours (95% CI 2.74 to 12.9) and the prevention of 7326 injuries (95% CI 2570 to 12083) in Canada annually.
Conclusions The rate of injury was 62% lower (concussion 51% lower) in leagues not permitting body checking in non-elite 15–17 years old leagues highlighting the potential public health impact of policy prohibiting body checking in older adolescent ice hockey players.
- injury prevention
- ice hockey
- sporting injuries
Data availability statement
Data may be obtained from a third party and are not publicly available.
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Contributors CE, LP-D, AMB, PE, KJS, SB, MM, CL, CG, AM and BEH contributed to the study proposal development. CE, AMB, MK, NS and SK contributed to data collection, entry, and data cleaning. CE, LP-D, AMB, PE, BEH contributed to the data analysis and interpretation of study results. SB, MM and CB contributed to all aspects of data collection at study sites outside of Calgary. CE and BEH contributed to acquisition of funding, study design, and led all aspects of the cohort. All authors critically reviewed and edited the manuscript before submission.
Funding This study was funded by Alberta Innovates Health Solutions (Collaborative Research and Innovation Opportunities Program Grant # 3685), Canadian Institutes of Health Research (Institute of Neuroscience, Mental Health and Addictions Grant #293332), and the Hotchkiss Brain Institute (University of Calgary).
Competing interests None declared.
Patient and public involvement Hockey Canada, BC Hockey, Hockey Calgary and Hockey Edmonton were involved as knowledge brokers in contributing to approval of study design, study recruitment, injury surveillance methods, support of safety designate role and dissemination of research findings within the hockey community. The research questions and outcome measures were developed and informed by the priorities, experience and preferences of Hockey Canada, BC Hockey, Hockey Calgary, and Hockey Edmonton. Hockey players, parents, coaches and administrators in Hockey Canada, BC Hockey, Hockey Calgary and Hockey Edmonton were dedicated to the collection of weekly exposure data, identification of a player with a suspected concussion, and supporting communication with the research team for injury follow-up. A knowledge broker from Hockey Canada and Hockey Calgary informed the methods and time commitment for study participation by players and parents and safety designates. Partners from Hockey Canada, BC Hockey, Hockey Calgary and Hockey Edmonton have received an executive report of the study findings based on preliminary results.
Provenance and peer review Not commissioned; externally peer reviewed.
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