Concussion in Youth Hockey: Prevalence, Risk Factors, and Management across Observation Strategies

Ice hockey ranks among the highest of all sports for rates of concussion, and estimates from youth hockey appear ominously close to estimates from the NHL (23.15 and 29.59 per 1000 player-hours, respectively), yet concussion is seldom studied in the youth setting, particularly in a way that accounts for under-reporting. To maximize the capture of concussions in youth hockey, we used broad injury inclusion criteria and multiple surveillance strategies, including (a) official injury reports, (b) reports from team personnel, and (c) reports from trained hockey observers. The aims were to (a) better elucidate the prevalence and causes of hockey-related concussions, (b) examine how concussions are reportedly managed in youth ice hockey, and (c) speak to the utility of the different surveillance strategies. Contact between players was the most common mechanism across observation strategies and more than half (51 %) of concussions reported by volunteers were caused by illegal acts (32 % hits from behind, 8 % hits to head, and 7 % crosschecks), though few (23 %) resulted in penalties. According to volunteer and observer reports, many young players are returning to play in the same game they sustained a concussion (34 % and 71 %, respectively), which contravenes Hockey Canada guidelines. Contrary to the literature, there were significantly higher odds (p<0.05) of sustaining a concussion in the youngest age division rather than among older players according to volunteer reports. This study sampled approximately 22 400 youth players and is among the broadest investigations of concussion in youth ice hockey.