Child and Adolescent Athletes at Greatest Risk of Concussions and Closed Head Injuries in Male Ice Hockey: A 20-Year Analysis of National Injury Data

Abstract

Context:

Ice hockey is a fast-paced and physically demanding collision sport that carries a high risk of injury, especially concussions and closed head injuries (CHIs). The purpose of this study was to evaluate the frequency, trends, and mechanisms of injury of concussions and CHIs sustained by male ice hockey players in the United States (US).

Evidence Acquisition:

Concussions and CHIs sustained playing male ice hockey presenting to US emergency departments from January 1, 2004 to December 31, 2023 were queried using the National Electronic Injury Surveillance System (NEISS). For each injury, patient demographics, disposition, and mechanism of injury were recorded. National estimates (NEs) were calculated using the NEISS statistical sample weight. Injury trends were evaluated by linear regression modeling.

Study Design:

Descriptive epidemiology study.

Level of Evidence:

Level 3.

Results:

A total of 62,070 concussions and CHIs occurred during the study period. From 2004 to 2023, overall injury incidence increased (P = 0.06). From 2004 to 2012, there was a significant increase in concussion and CHI incidence (P < 0.001) followed by a plateau after 2013. The age group affected most commonly was adolescents (ages 13-19 years) (52.3%, NE = 32,455). The top 3 mechanisms were head-to-ice contact (28.6%, NE = 17,741), head-to-boards contact (22.8%, NE = 14,123), and head-to-player contact (15.4%, NE = 9575). Head-to-ice contact was the most common mechanism in children (33.6%, NE = 5960). Head-to-player reached its highest rate in young adults (21.3%, NE = 1567). Falls initiated 33.9% of all concussions and CHIs. The hospitalization rate across the study was 3.4%.

Conclusion:

Concussions and CHIs sustained from male ice hockey demonstrated a 290% increase from 2004 to 2023, with the child and adolescent populations at greatest risk and head-to-ice contact representing the most common injury mechanism. Focused injury awareness, educational prevention programs, and potential rule changes are essential to decrease the rising incidence of concussions and CHIs in this at-risk patient population.

Strength-of-Recommendation Taxonomy (SORT):

C-level recommendation.