Risk of Injury Associated With Body Checking Among Youth Ice Hockey Players

Context Ice hockey has one of the highest sport participation and injury rates in youth in Canada. Body checking is the predominant mechanism of injury in leagues in which it is permitted. Objective To determine if risk of injury and concussion differ for Pee Wee (ages 11-12 years) ice hockey players in a league in which body checking is permitted (Alberta, Canada) vs a league in which body checking is not permitted (Quebec, Canada). Design, Setting, and Participants Prospective cohort study conducted in Alberta and Quebec during the 2007-2008 Pee Wee ice hockey season. Participants (N=2154) were players from teams in the top 60% of divisions of play. Main Outcome Measures Incidence rate ratios adjusted for cluster based on Poisson regression for game-and practice-related injury and concussion. Results Seventy-four Pee Wee teams from Alberta (n=1108 players) and 76 Pee Wee teams from Quebec (n=1046 players) completed the study. In total, there were 241 injuries (78 concussions) reported in Alberta (85 077 exposure-hours) and 91 injuries (23 concussions) reported in Quebec (82 099 exposure-hours). For game-related injuries, the Alberta vs Quebec incidence rate ratio was 3.26 (95% confidence interval [CI], 2.31-4.60 [n=209 and n=70 for Alberta and Quebec, respectively]) for all injuries, 3.88 (95% CI, 1.91-7.89 [n=73 and n=20]) for concussion, 3.30 (95% CI, 1.77-6.17 [n=51 and n=16]) for severe injury (time loss, >7 days), and 3.61 (95% CI, 1.16-11.23 [n=14 and n=4]) for severe concussion (time loss, >10 days). The estimated absolute risk reduction (injuries per 1000 player-hours) that would be achieved if body checking were not permitted in Alberta was 2.84 (95% CI, 2.18-3.49) for all game-related injuries, 0.72 (95% CI, 0.40-1.04) for severe injuries, 1.08 (95% CI, 0.70-1.46) for concussion, and 0.20 (95% CI, 0.04-0.37) for severe concussion. There was no difference between provinces for practice-related injuries. Conclusion Among 11- to 12-year-old ice hockey players, playing in a league in which body checking is permitted compared with playing in a league in which body checking is not permitted was associated with a 3-fold increased risk of all game-related injuries and the categories of concussion, severe injury, and severe concussion. JAMA. 2010; 303(22): 2265-2272