Effect of Infraction Type on Head Impact Severity in Youth Ice Hockey

Comparing frequency and maximum principal strain of head impacts for U15 ice hockey leagues with standard and modified body contact rules

Brain trauma in bodychecking ice hockey is of concern for youth participants, as it presents unique risks compared to the non-bodychecking version of the sport. This study compared head impact frequency and magnitude between two ice hockey leagues with different body contact rules in the U15 age division: AAA (standard bodychecking) and M15 Minor (modified body contact rules). Video analysis of 16 games per league revealed no significant overall diference in impact frequency. M15 Minor players sustained significantly more head-to-head (14 to 2) impacts and AAA players sustained significantly more head-to-glass (18 to 7) and punch impacts (4 to 0). Laboratory reconstructions and finite element modeling were used to determine impact magnitude as maximum principal strain (MPS) and categorized from very low to very high. Higher impact frequency of very low MPS head impact events were observed for M15 Minor (61 to 51). The findings from this study highlight that this method of modifying body contact rules in U15 hockey did not result in lower levels of brain trauma, rather it presented unique brain trauma mechanisms compared to bodychecking.

Training and Match-Related Head Acceleration Events in Top Level Domestic Senior Women's and Men's Rugby Union: A Multi-League Instrumented Mouthguard Study

The aim of this study was to investigate the difference in head acceleration event (HAE) incidence between training and match-play in women's and men's players competing at the highest level of domestic rugby union globally. Players from Women's (Premiership Women's Rugby, Farah Palmer Cup) and Men's (Premiership Rugby, Currie Cup) rugby union competitions wore instrumented mouthguards during matches and training sessions during the 2022/2023 seasons. Peak linear (PLA) and angular (PAA) acceleration were calculated from each HAE and included within generalized linear mixed-effects models. The incidence of HAEs was significantly greater in match-play compared to training for all magnitude thresholds in both forwards and backs, despite players spending approximately 1.75-2.5 times more time in training. For all HAEs (PLA > 5 g and PAA > 400 rad/s2), incidence rate ratios (IRRs) for match versus training ranged from 2.80 (95% CI: 2.38-3.30; men's forwards) to 4.00 (3.31-4.84; women's forwards). At higher magnitude thresholds (PLA > 25 g; PAA > 2000 rad/s2), IRRs ranged from 3.64 (2.02-6.55; PAA > 2000 rad/s2 in men's backs) to 11.70 (6.50-21.08; PAA > 2000 rad/s2 in women's forwards). Similar trends were observed in each competition. Players experienced significantly more HAEs during match-play than training, particularly at higher magnitude thresholds. Where feasible, HAE mitigation strategies may have more scope for HAE reduction if targeted at match-play, particularly where higher magnitude HAEs are the primary concern. However, the number of HAEs associated with different training drills requires exploration to understand if HAEs can be reduced in training, alongside optimizing match performance (e.g., enhancing contact technique).

Associations between the circumstances and severity of head impacts in men's university ice hockey

Improved evidence on the most common and severe types of head impacts in ice hockey can guide efforts to preserve brain health through improvements in protective gear, rink design, player training, and rules of play. In this observational cohort study of men's university hockey, we compared video evidence on the circumstances of 234 head impacts to measures of head impact severity (peak linear accelerations and rotational velocities) from helmet-mounted sensors (GForceTracker). Videos were analyzed with a validated questionnaire, and paired with helmet sensor data. Shoulder-to-head impacts were more common than hand- or elbow-, but there were no differences in head impact severity between upper limb contact sites (p ≥ 0.2). Head-to-glass impacts were nearly four times more common, and just as severe as head-to-board impacts (p ≥ 0.4). Head impacts resulting in major penalties (versus no penalty), or visible signs of concussion (versus no signs), involved greater head rotational velocities (p = 0.038 and 0.049, respectively). Head impacts occurred most often to the side of the head, along the boards to players in their offensive zone without puck possession. Head impact severity did not differ between cases where the head was (versus was not) the primary site of contact (p ≥ 0.6). Furthermore, penalties were called in only 4% of cases where the head was the initial point of contact. Accordingly, rules that focus on primary targeting of the head, while important and in need of improved enforcement, offer a limited solution.

Head Kinematics in Youth Ice Hockey by Player Speed and Impact Direction

Hockey is a fast-paced sport known for body checking, or intentional collisions used to separate opponents from the puck. Exposure to these impacts is concerning, as evidence suggests head impact exposure (HIE), even if noninjurious, can cause long-term brain changes. Currently, there is limited understanding of the effect of impact direction and collision speed on HIE. Video analysis was used to determine speed and direction for 162 collisions from 13 youth athletes. These data were paired with head kinematic data collected with an instrumented mouthpiece. Relationships between peak resultant head kinematics and speeds were evaluated with linear regression. Mean athlete speeds and relative velocity between athletes ranged from 2.05 to 2.76 m/s. Mean peak resultant linear acceleration, rotational velocity, and rotational acceleration were 13.1 g, 10.5 rad/s, and 1112 rad/s2, respectively. Significant relationships between speeds and head kinematics emerged when stratified by contact characteristics. HIE also varied by direction of collision; most collisions occurred in the forward-oblique (ie, offset from center) direction; frontal collisions had the greatest magnitude peak kinematics. These findings indicate that HIE in youth hockey is influenced by speed and direction of impact. This study may inform future strategies to reduce the severity of HIE in hockey.

Characterization of head impact exposure in boys' youth ice hockey

Ice hockey has one of the highest concussion rates among youth sports. Sensor technology has been implemented in contact and collision sports to inform the frequency and severity of head impacts experienced on-ice. However, existing studies have utilized helmet-mounted sensors with limited accuracy. The objective of this study was to characterize head kinematics of contact events in a sample of youth boys' hockey players using a validated instrumented mouthpiece with improved accuracy. Head kinematics from 892 video-verified events were recorded from 18 athletes across 127 sessions. Median peak resultant linear acceleration, rotational velocity, and rotational acceleration of video-verified events were 7.4 g, 7.7 rad/s, and 576 rad/s², respectively. Contact events occurred at a higher rate in games (2.48 per game) than practices (1.30 per practice). Scenarios involving head contact had higher peak kinematics than those without head contact. This study improves our understanding of head kinematics in boys' youth hockey.

Head Impact Research Using Inertial Sensors in Sport: A Systematic Review of Methods, Demographics, and Factors Contributing to Exposure

BACKGROUND

The number and magnitude of head impacts have been assessed in-vivo using inertial sensors to characterise the exposure in various sports and to help understand their potential relationship to concussion.

OBJECTIVES

We aimed to provide a comprehensive review of the field of in-vivo sensor acceleration event research in sports via the summary of data collection and processing methods, population demographics and factors contributing to an athlete's exposure to sensor acceleration events.

METHODS

The systematic search resulted in 185 cohort or cross-sectional studies that recorded sensor acceleration events in-vivo during sport participation.

RESULTS

Approximately 5800 participants were studied in 20 sports using 18 devices that included instrumented helmets, headbands, skin patches, mouthguards and earplugs. Female and youth participants were under-represented and ambiguous results were reported for these populations. The number and magnitude of sensor acceleration events were affected by a variety of contributing factors, suggesting sport-specific analyses are needed. For collision sports, being male, being older, and playing in a game (as opposed to a practice), all contributed to being exposed to more sensor acceleration events.

DISCUSSION

Several issues were identified across the various sensor technologies, and efforts should focus on harmonising research methods and improving the accuracy of kinematic measurements and impact classification. While the research is more mature for high-school and collegiate male American football players, it is still in its early stages in many other sports and for female and youth populations. The information reported in the summarised work has improved our understanding of the exposure to sport-related head impacts and has enabled the development of prevention strategies, such as rule changes.

CONCLUSIONS

Head impact research can help improve our understanding of the acute and chronic effects of head impacts on neurological impairments and brain injury. The field is still growing in many sports, but technological improvements and standardisation of processes are needed.

On-field Characteristics and Head Impact Magnitude in Youth Tackle Football

BACKGROUND

This study determined the effect of video-verified collision characteristics on head impact magnitudes in male youth tackle football.

METHODS

Participants (n = 23, age = 10.9 ± 0.3 years, height = 150.0 ± 8.3 cm, mass = 41.6 ± 8.4 kg) wore Triax Sim-G sensors throughout the fall 2019 season. Ten filmed games were used to identify nine different collision characteristics: mechanism, preparedness, head direction, struck versus striking activity, stance, play type, closing distance, penalty, and quarter. Random-effects general linear models and Cohen d effect sizes were used to examine differences in log-transformed peak linear (PLA; g) and rotational (PRA; rad/s²) accelerations across characteristics. The 10 games produced 533 total video-verified impacts and 23.2 ± 7.2 impacts per athlete.

RESULTS

PLA (P range: 0.107 to 0.923) and PRA (P range: 0.057 to 0.768) did not differ across characteristics. Struck players (3370 rads/s^2, 95% confidence interval [CI] = 2986 to 3808) had a small effect for higher PRA compared with striking players (3037 rads/s^2, 95% CI = 2713 to 3404, d = 0.251), but negligible effect for simultaneous struck-striking players (3340 rad/s^2, 95% CI = 2945 to 3792, d = 0.018). Fourth quarter impacts (3490 rads/s^2, 95% CI = 3083 to 3951) had a small effect for higher PRA compared with first (2945 rads/s^2, 95% CI = 2596 to 3337, d = 0.404), second (3196 rads/s^2, 95% CI = 2832 to 3604, d = 0.219), and third quarters (3241 rads/s^2, 95% CI = 2841 to 3699, d = 0.144).

CONCLUSION

Youth tackle football characteristics did not significantly affect head impact magnitudes during games. More research is needed to explore additional factors that could be modified for sport safety rather than mitigating impact mechanism.

Differences in Head Impact Exposures Between Youth Tackle and Flag Football Games and Practices: Potential Implications for Prevention Strategies

BACKGROUND

Interventions designed to reduce the risk for head impacts and concussion in youth football have increased over the past decade; however, understanding of the role of regular game play on head impact exposure among youth tackle and flag football athletes is currently limited.

PURPOSE

To explore head impact exposure among youth tackle and flag football athletes (age range, 6-14 years) during both practices and games.

STUDY DESIGN

Cohort study; Level of evidence, 2.

METHODS

Using the Vector MouthGuard sensor, the authors collected head impact data from 524 tackle and flag youth football athletes over the course of a football season. Quantities of interest were estimated from regression models using Bayesian methods.

RESULTS

For impacts ≥10g, a tackle football athlete had an estimated 17.55 (95% CI, 10.78-28.96) times more head impacts per practice compared with a flag football athlete (6.85 [95% CI, 6.05-7.76] and 0.39 [95% CI, 0.24-0.62] head impacts, respectively). Additionally, a tackle football athlete had an estimated 19.48 (95% CI, 12.74-29.98) times more head impacts per game compared with a flag football athlete (13.59 [95% CI, 11.97-15.41] and 0.70 [95% CI, 0.46-1.05] head impacts, respectively). Among tackle football athletes, the estimated average impact rate was 6.51 (95% CI, 5.75-7.37) head impacts during a practice and 12.97 (95% CI, 11.36-14.73) impacts during a game, resulting in 2.00 (95% CI, 1.74-2.29) times more ≥10g head impacts in games versus practices. Tackle football athletes had 2.06 (95% CI, 1.80-2.34) times more high-magnitude head impacts (≥40g) during a game than during a practice. On average, flag football athletes experienced an estimated 0.37 (95% CI, 0.20-0.60) head impacts during a practice and 0.77 (95% CI, 0.53-1.06) impacts during a game, resulting in 2.06 (95% CI, 1.29-3.58) times more ≥10g head impacts in games versus practices. Because of model instability caused by a large number of zero impacts for flag football athletes, a comparison of high-magnitude head impacts is not reported for practices or games.

CONCLUSION

This study provides a characterization of the head impact exposure of practices and games among a large population of youth tackle and flag football athletes aged 6 to 14 years. These findings suggest that a greater focus on game-based interventions, such as fair play interventions and strict officiating, may be beneficial to reduce head impact exposures for youth football athletes.

Incidence of Head Contacts, Penalties, and Player Contact Behaviors in Youth Ice Hockey: Evaluating the “Zero Tolerance for Head Contact” Policy Change

Background:

To reduce the risk of concussion in youth ice hockey, Hockey Canada implemented a national “zero tolerance for head contact” (HC) policy in 2011. A previous cohort study revealed higher concussion rates after this implementation in players aged 11 to 14 years. However, it is unknown whether the elevated risk was due to higher HC rates or factors such as increased concussion awareness and reporting.

Purpose:

To compare the rates of primary and secondary HCs and HC policy enforcement in elite U15 ice hockey leagues (players <15 years) before (2008-2009) and after (2013-2014) the zero-tolerance policy change.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

A total of 32 elite U15 games before (n_2008-2009 = 16; 510 players) and after (n_2013-2014 = 16; 486 players) HC policy implementation were video recorded. Videos were analyzed with validated criteria for identifying HC types (primary/direct contact by players [HC1], secondary/indirect contact via boards, glass, or ice surface [HC2]) and other player-to-player contact behavior. Referee-assessed penalties were cross-referenced with the official Hockey Canada casebook, and penalty types were displayed using proportions. Univariate Poisson regression (adjusted for cluster by team game, offset by game length [minutes]) was used to estimate HC incidence rates (IRs) and incidence rate ratios (IRRs) between cohorts.

Results:

A total of 506 HCs were analyzed, 261 before HC policy implementation (IR, 16.6/100 team minutes) and 245 after implementation (IR, 15.5/100 team minutes). The HC1 rate (IRR, 1.05; 95% CI, 0.86-1.28) and HC2 rate (IRR, 0.74; 95% CI, 0.50-1.11) did not significantly differ before versus after implementation. Only 12.0% and 13.6% of HC1s were penalized pre- and postimplementation, respectively. Before implementation, HC1s were commonly penalized as roughing or elbowing penalties (59%), while after implementation, HC1s were penalized with the HC penalty (76%), and only 8% as roughing or elbowing.

Conclusion:

Despite implementation of the “zero tolerance for HC” policy, there was no difference in the rate of HC1s and HC2s or the proportion of HC1 penalized from before to after implementation. This research is instrumental in informing Hockey Canada’s future referee training and rule enforcement modifications.

Biomechanics of Sport-Related Neurological Injury

As awareness on the short-term and long-term consequences of sports-related concussions and repetitive head impacts continues to grow, so too does the necessity to establish biomechanical measures of risk that inform public policy and risk mitigation strategies. A more precise exposure metric is central to establishing relationships among the traumatic experience, risk, and ultimately clinical outcomes. Accurate exposure metrics provide a means to support evidence-informed decisions accelerating public policy mandating brain trauma management through sport modification and safer play.

Head Impact Biomechanics Differ Between Girls and Boys Youth Ice Hockey Players

The influence of sex on head impact biomechanics is unknown for youth ice hockey. We sought to determine sex differences in head impact severity and frequency in youth ice hockey players. Male (n = 110) and female (n = 25) players (13-16 years old) were recruited from a local hockey organization. Players wore helmets instrumented with the Head Impact Telemetry System for all competitions and practices throughout the season. Seven team-seasons were captured. Random intercepts general mixed linear models determined whether linear acceleration and rotational acceleration differed by sex. Linear regression models evaluated the relationship between sex and impact frequency. All head impact biomechanics were natural log-transformed as their distributions were right-skewed. Females sustained fewer impacts per player than males (27 fewer impacts per player-season, p < 0.0001) even when analysis was limited to games only (21 fewer impacts per player-season, p < 0.0001). The linear acceleration was higher among females (1.07 g; 95% CI 1.00, 1.13; p = 0.04). There were no other meaningful sex differences in head impact severity. Female players are not permitted to body check, and this likely explains why they sustain fewer head impacts than males. However, as a result, females likely sustain a higher proportion of head impacts through illegal or unintentional head contact, and these impacts may result in more force being delivered to the head.

The Socioecological Framework: A Multifaceted Approach to Preventing Sport-Related Deaths in High School Sports

The socioecological framework is a multilevel conceptualization of health that includes intrapersonal, interpersonal, organizational, environmental, and public policy factors. The socioecological framework emphasizes multiple levels of influence and supports the idea that behaviors both affect and are affected by various contexts. At present, the sports medicine community's understanding and application of the socioecological framework are limited. In this article, we use the socioecological framework to describe potential avenues for interventions to reduce sport-related deaths among adolescent participants.

Evaluating the "Threshold Theory": Can Head Impact Indicators Help?

PURPOSE

This study aimed to determine the clinical utility of biomechanical head impact indicators by measuring the sensitivity, specificity, positive predictive value (PV+), and negative predictive value (PV-) of multiple thresholds.

METHODS

Head impact biomechanics (n = 283,348) from 185 football players in one Division I program were collected. A multidisciplinary clinical team independently made concussion diagnoses (n = 24). We dichotomized each impact using diagnosis (yes = 24, no = 283,324) and across a range of plausible impact indicator thresholds (10g increments beginning with a resultant linear head acceleration of 50g and ending with 120g).

RESULTS

Some thresholds had adequate sensitivity, specificity, and PV-. All thresholds had low PV+, with the best recorded PV+ less than 0.4% when accounting for all head impacts sustained by our sample. Even when conservatively adjusting the frequency of diagnosed concussions by a factor of 5 to account for unreported/undiagnosed injuries, the PV+ of head impact indicators at any threshold was no greater than 1.94%.

CONCLUSIONS

Although specificity and PV- appear high, the low PV+ would generate many unnecessary evaluations if these indicators were the sole diagnostic criteria. The clinical diagnostic value of head impact indicators is considerably questioned by these data. Notwithstanding, valid sensor technologies continue to offer objective data that have been used to improve player safety and reduce injury risk.

Anthropometrics and maturity status: A preliminary study of youth football head impact biomechanics

CONTEXT

There is a paucity of head impact biomechanics research focusing on youth athletes. Little is known about how youth subconcussive head impact tolerances are related to physical size and maturation.

OBJECTIVE

To examine the effects of age, anthropometric and maturational status variability on head impact biomechanics.

DESIGN

Cross-sectional.

SETTING

Outdoor youth football facilities in South Carolina.

PARTICIPANTS

Thirty-four male recreational youth football players, 8 to 13yrs.

INTERVENTIONS

Categorized by CDC standards, independent variables were: age, height, mass, BMI, and estimated peak height velocity (PHV). Participants wore a designated head impact sensor (xPatch) on their mastoid process during practices and games.

MAIN OUTCOME MEASURES

Linear acceleration (g) and rotational acceleration (rad/s²).

RESULTS

Boys in the older age category had a greater linear (F=17.72; P<0.001) and rotational acceleration (F=10.74; P<0.001) than those in the younger category. Post-PHV boys had higher linear (F=9.09, P=0.002) and rotational (F=5.57, P=0.018) accelerations than those who were pre-PHV. Rotational, but not linear acceleration differed by height category with lowest impacts found for the tallest category, whereas both linear and rotational accelerations by mass differences favored average and heavy categories. BMI overweight boys, had the greatest linear (F=5.25; P=0.011) and rotational acceleration (F=4.13; P=0.260) means.

CONCLUSION

Post-PHV boys who were older, taller and had longer legs, but who were not heavier, had higher impacts perhaps due to the type of impacts sustained. Taller boys' heads are above their peers possibly encouraging hits in the torso region resulting in lower impact accelerations. Obese boys did not have sequential results compared to boys in the other BMI categories probably due to league rules, player position, and lack of momentum produced.

Concussion in Ice Hockey: Current Gaps and Future Directions in an Objective Diagnosis

OBJECTIVE

This review provides an update on sport-related concussion (SRC) in ice hockey and makes a case for changes in clinical concussion evaluation. Standard practice should require that concussions be objectively diagnosed and provide quantitative measures of the concussion injury that will serve as a platform for future evidence-based treatment.

METHODS

The literature was surveyed to address several concussion-related topics: research in ice hockey-related head trauma, current subjective diagnosis, promising components of an objective diagnosis, and current and potential treatments.

MAIN RESULTS

Sport-related head trauma has marked physiologic, pathologic, and psychological consequences for athletes. Although animal models have been used to simulate head trauma for pharmacologic testing, the current diagnosis and subsequent treatment in athletes still rely on an athlete's motivation to report or deny symptoms. Bias-free, objective diagnostic measures are needed to guide quantification of concussion severity and assessment of treatment effects. Most of the knowledge and management guidelines of concussion in ice hockey are generalizable to other contact sports.

CONCLUSIONS

There is a need for an objective diagnosis of SRC that will quantify severity, establish a prognosis, and provide effective evidence-based treatment. Potential methods to improve concussion diagnosis by health care providers include a standardized concussion survey, the King-Devick test, a quantified electroencephalogram, and blood analysis for brain cell-specific biomarkers.

Head Impact Measurement Devices

Context:

Concussive injuries are at the forefront of sports medicine research. Recently, researchers have used a variety of head- and helmet-based impact-monitoring devices to quantify impacts sustained during contact sport participation. This review provides an up-to-date collection of head accelerometer use at the youth, high school, and collegiate levels.

Evidence Acquisition:

PubMed was searched for articles published between 1980 and 2015 using the terms accelerometer and concussion, impact sensor and concussion, head impact telemetry system, head impact telemetry, and linear acceleration and concussion. An additional Google search was performed to capture devices without publications.

Study Design:

Clinical review.

Level of Evidence:

Level 4.

Results:

Twenty-four products track and/or record head impact for clinical or research use. Ten of these head impact devices have publications supporting their utility.

Conclusion:

Head impact measuring devices can describe athlete exposure in terms of magnitude and/or frequency, highlighting their utility within a multimodal approach for concussion assessment and diagnosis.

The Effect of the "Zero Tolerance for Head Contact" Rule Change on the Risk of Concussions in Youth Ice Hockey Players

BACKGROUND

Ice hockey is a popular winter sport in Canada. Concussions account for the greatest proportion of all injuries in youth ice hockey. In 2011, a policy change enforcing "zero tolerance for head contact" was implemented in all leagues in Canada.

PURPOSE

To determine if the risk of game-related concussions and more severe concussions (ie, resulting in >10 days of time loss) and the mechanisms of a concussion differed for Pee Wee class (ages 11-12 years) and Bantam class (ages 13-14 years) players after the 2011 "zero tolerance for head contact" policy change compared with players in similar divisions before the policy change.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

The retrospective cohort included Pee Wee (most elite 70%, 2007-2008; n = 891) and Bantam (most elite 30%, 2008-2009; n = 378) players before the rule change and Pee Wee (2011-2012; n = 588) and Bantam (2011-2012; n = 242) players in the same levels of play after the policy change. Suspected concussions were identified by a team designate and referred to a sport medicine physician for diagnosis. Incidence rate ratios (IRRs) were estimated based on multiple Poisson regression analysis, controlling for clustering by team and other important covariates and offset by game-exposure hours. Incidence rates based on the mechanisms of a concussion were estimated based on univariate Poisson regression analysis.

RESULTS

The risk of game-related concussions increased after the head contact rule in Pee Wee (IRR, 1.85; 95% CI, 1.20-2.86) and Bantam (IRR, 2.48; 95% CI, 1.17-5.24) players. The risk of more severe concussions increased after the head contact rule in Pee Wee (IRR, 4.12; 95% CI, 2.00-8.50) and Bantam (IRR, 7.91; 95% CI, 3.13-19.94) players. The rates of concussions due to body checking and direct head contact increased after the rule change.

CONCLUSION

The "zero tolerance for head contact" policy change did not reduce the risk of game-related concussions in Pee Wee or Bantam class ice hockey players. Increased concussion awareness and education after the policy change may have contributed to the increased risk of concussions found after the policy change.

The Influence of Head Impact Threshold for Reporting Data in Contact and Collision Sports: Systematic Review and Original Data Analysis

BACKGROUND

Head impacts and resulting head accelerations cause concussive injuries. There is no standard for reporting head impact data in sports to enable comparison between studies.

OBJECTIVE

The aim was to outline methods for reporting head impact acceleration data in sport and the effect of the acceleration thresholds on the number of impacts reported.

METHODS

A systematic review of accelerometer systems utilised to report head impact data in sport was conducted. The effect of using different thresholds on a set of impact data from 38 amateur senior rugby players in New Zealand over a competition season was calculated.

RESULTS

Of the 52 studies identified, 42% reported impacts using a >10-g threshold, where g is the acceleration of gravity. Studies reported descriptive statistics as mean ± standard deviation, median, 25th to 75th interquartile range, and 95th percentile. Application of the varied impact thresholds to the New Zealand data set resulted in 20,687 impacts of >10 g, 11,459 (45% less) impacts of >15 g, and 4024 (81% less) impacts of >30 g.

DISCUSSION

Linear and angular raw data were most frequently reported. Metrics combining raw data may be more useful; however, validity of the metrics has not been adequately addressed for sport. Differing data collection methods and descriptive statistics for reporting head impacts in sports limit inter-study comparisons. Consensus on data analysis methods for sports impact assessment is needed, including thresholds. Based on the available data, the 10-g threshold is the most commonly reported impact threshold and should be reported as the median with 25th and 75th interquartile ranges as the data are non-normally distributed. Validation studies are required to determine the best threshold and metrics for impact acceleration data collection in sport.

CONCLUSION

Until in-field validation studies are completed, it is recommended that head impact data should be reported as median and interquartile ranges using the 10-g impact threshold.

Safe-Play Knowledge, Aggression, and Head-Impact Biomechanics in Adolescent Ice Hockey Players

CONTEXT

Addressing safe-play knowledge and player aggression could potentially improve ice hockey sport safety.

OBJECTIVES

To compare (1) safe-play knowledge and aggression between male and female adolescent ice hockey players and (2) head-impact frequency and severity between players with high and low levels of safe-play knowledge and aggression during practices and games.

DESIGN

Cohort study.

SETTING

On field.

PATIENTS OR OTHER PARTICIPANTS

Forty-one male (n = 29) and female (n = 12) adolescent ice hockey players.

INTERVENTION(S)

Players completed the Safe Play Questionnaire (0 = less knowledge, 7 = most knowledge) and Competitive Aggressiveness and Anger Scale (12 = less aggressive, 60 = most aggressive) at midseason. Aggressive penalty minutes were recorded throughout the season. The Head Impact Telemetry System was used to capture head-impact frequency and severity (linear acceleration [g], rotational acceleration [rad/s(2)], Head Impact Technology severity profile) at practices and games.

MAIN OUTCOME MEASURE(S)

One-way analyses of variance were used to compare safe play knowledge and aggression between sexes. Players were categorized as having high or low safe-play knowledge and aggression using a median split. A 2 × 2 mixed-model analysis of variance was used to compare head-impact frequency, and random-intercept general linear models were used to compare head-impact severity between groups (high, low) and event types (practice, game).

RESULTS

Boys (5.8 of 7 total; 95% confidence interval [CI] = 5.3, 6.3) had a trend toward better safe-play knowledge compared with girls (4.9 of 7 total; 95% CI = 3.9, 5.9; F1,36 = 3.40, P = .073). Less aggressive male players sustained significantly lower head rotational accelerations during practices (1512.8 rad/s (2) , 95% CI = 1397.3, 1637.6 rad/s(2)) versus games (1754.8 rad/s (2) , 95% CI = 1623.9, 1896.2 rad/s(2)) and versus high-aggression players during practices (1773.5 rad/s (2) , 95% CI = 1607.9, 1956.3 rad/s (2) ; F1,26 = 6.04, P = .021).

CONCLUSIONS

Coaches and sports medicine professionals should ensure that athletes of all levels, ages, and sexes have full knowledge of safe play and should consider aggression interventions for reducing head-impact severity among aggressive players during practice.

Does Visual Performance Influence Head Impact Severity Among High School Football Athletes?

OBJECTIVE

To compare the odds of sustaining moderate and severe head impacts, rather than mild, between high school football players with high and low visual performance.

DESIGN

Prospective quasi-experimental.

SETTING

Clinical Research Center/On-field.

PARTICIPANTS

Thirty-seven high school varsity football players.

INTERVENTIONS

Athletes completed the Nike SPARQ Sensory Station visual assessment before the season. Head impact biomechanics were captured at all practices and games using the Head Impact Telemetry System.

MAIN OUTCOME MEASURES

Each player was classified as either a high or low performer using a median split for each of the following visual performance measures: visual clarity, contrast sensitivity, depth perception, near-far quickness, target capture, perception span, eye-hand coordination, go/no go, and reaction time. We computed the odds of sustaining moderate and severe head impacts against the reference odds of sustaining mild head impacts across groups of high and low performers for each of the visual performance measures.

RESULTS

Players with better near-far quickness had increased odds of sustaining moderate [odds ratios (ORs), 1.27; 95% confidence intervals (CIs), 1.04-1.56] and severe head impacts (OR, 1.45; 95% CI, 1.05-2.01) as measured by Head Impact Technology severity profile. High and low performers were at equal odds on all other measures.

CONCLUSIONS

Better visual performance did not reduce the odds of sustaining higher magnitude head impacts. Visual performance may play less of a role than expected for protecting against higher magnitude head impacts among high school football players. Further research is needed to determine whether visual performance influences concussion risk.

CLINICAL RELEVANCE

Based on our results, we do not recommend using visual training programs at the high school level for the purpose of reducing the odds of sustaining higher magnitude head impacts.

Concussion: key stakeholders and multidisciplinary participation in making sports safe

As unstructured play declines, organized sports leagues have become a highly popular form of physical activity in young people. As concussive injuries are garnering increased media attention and public awareness, there is a growing concern for athlete safety. Although athletic trainers and physicians play a large role in keeping athletes healthy and safe, this article investigates nontraditional, multidisciplinary teams that are involved in promoting athlete safety, including the role of equipment makers, coaches, referees, governing bodies of sport, lawmakers, and fans. As opposed to a focus on diagnosing or managing concussive injuries, this article seeks to promote injury prevention strategies.

Ice Hockey Summit II: zero tolerance for head hits and fighting

OBJECTIVE

To present currently known basic science and on-ice influences of sport-related concussion (SRC) in hockey, building on the Ice Hockey Summit I action plan (2011) to reduce SRC.

METHODS

The prior summit proceedings included an action plan intended to reduce SRC. As such, the proceedings from Summit I served as a point of departure, for the science and discussion held during Summit II (Mayo Clinic, Rochester MN, October 2013). Summit II focused on (1) Basic Science of Concussions in Ice Hockey: Taking Science Forward; (2) Acute and Chronic Concussion Care: Making a Difference; (3) Preventing Concussions via Behavior, Rules, Education and Measuring Effectiveness; (4) Updates in Equipment: their Relationship to Industry Standards; and (5) Policies and Plans at State, National and Federal Levels to reduce SRC. Action strategies derived from the presentations and discussion described in these sectors were subsequently voted on for purposes of prioritization. The following proceedings include knowledge and research shared by invited faculty, many of whom are health care providers and clinical investigators.

RESULTS

The Summit II evidence-based action plan emphasizes the rapidly evolving scientific content of hockey SRC. It includes the most highly prioritized strategies voted on for implementation to decrease concussion.

CONCLUSIONS

The highest priority action items identified from the Summit includes the following: (1) eliminate head hits from all levels of ice hockey, (2) change body-checking policies, and (3) eliminate fighting in all amateur and professional hockey.

Instrumented mouthguard acceleration analyses for head impacts in amateur rugby union players over a season of matches

BACKGROUND

Direct impacts with the head (linear acceleration or pressure) and inertial loading of the head (rotational acceleration or strain) have been postulated as the 2 major mechanisms of head-related injuries such as concussion. Although data are accumulating for soccer and American football, there are no published data for nonhelmeted collision sports such as rugby union.

PURPOSE

To quantify head impacts via instrumented mouthguard acceleration analyses for rugby union players over a season of matches.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

Data on impact magnitude and frequency were collected with molded instrumented mouthguards worn by 38 premier amateur senior rugby players participating in the 2013 domestic season of matches.

RESULTS

A total of 20,687 impacts >10g (range, 10.0-164.9g) were recorded over the duration of the study. The mean ± SD number of impacts per player over the duration of the season of matches was 564 ± 618, resulting in a mean ± SD of 95 ± 133 impacts to the head per player, per match over the duration of the season of matches. The impact magnitudes for linear accelerations were skewed to the lower values (Sp = 3.7 ± 0.02; P < .001), with a mean linear acceleration of 22.2 ± 16.2g. Rotational accelerations were also skewed to the lower values (Sp = 2.0 ± 0.02; P < .001), with a mean rotational acceleration of 3902.9 ± 3948.8 rad/s(2).

CONCLUSION

The acceleration magnitudes and number of head impacts in amateur rugby union players over a season of matches, measured via instrumented mouthguard accelerations, were higher than for most sports previously reported. Mean linear acceleration measured over a season of matches was similar to the mean linear accelerations previously reported for youth, high school, and collegiate American football players but lower than that for female youth soccer players. Mean rotational acceleration measured over a season of matches was similar to mean rotational accelerations for youth, high school, and collegiate American football players but less than those for female youth soccer players, concussed American collegiate players, collegiate American football players, and professional American football players.

Validation of a helmet-based system to measure head impact biomechanics in ice hockey

PURPOSE

This study aimed to quantify differences between head acceleration measured by a helmet-based accelerometer system for ice hockey and an anthropometric test device (ATD) to validate the system's use in measuring on-ice head impacts.

METHODS

A Hybrid III 50th percentile male ATD head and neck was fit with a helmet instrumented with the Head Impact Telemetry (HIT) System for hockey and impacted at various speeds and directions with different interfaces between the head and helmet. Error between the helmet-based and reference peak accelerations was quantified, and the influence of impact direction and helmet-head interface was evaluated. Regression equations were used to reduce error. System-reported impact direction was validated.

RESULTS

Nineteen percent of impacts were removed from the data set by the HIT System processing algorithm and were not eligible for analysis. Errors in peak acceleration between the system and ATD varied from 18% to 31% and from 35% to 64% for linear and rotational acceleration, respectively, but were reduced via regression equations. The relationship between HIT System and reference acceleration varied by direction (P < 0.001) and head-helmet interface (P = 0.005). Errors in impact azimuth were approximately 4%, 10%, and 31% for side, back, and oblique back impacts, respectively.

CONCLUSIONS

This is the first comprehensive evaluation of peak head acceleration measured by the HIT System for hockey. The HIT System processing algorithm removed 19% of the impacts from the data set, the correlation between HIT System and reference peak resultant acceleration was strong and varied by head surface and impact direction, and the system error was larger than reported for the 6-degree-of-freedom HIT System for football but could be reduced via calibration factors. These findings must be considered when interpreting on-ice data.

Head-impact mechanisms in men's and women's collegiate ice hockey

CONTEXT

Concussion injury rates in men's and women's ice hockey are reported to be among the highest of all collegiate sports. Quantification of the frequency of head impacts and the magnitude of head acceleration as a function of the different impact mechanisms (eg, head contact with the ice) that occur in ice hockey could provide a better understanding of this high injury rate.

OBJECTIVE

To quantify and compare the per-game frequency and magnitude of head impacts associated with various impact mechanisms in men's and women's collegiate ice hockey players.

DESIGN

Cohort study.

SETTING

Collegiate ice hockey rink.

PATIENTS OR OTHER PARTICIPANTS

Twenty-three men and 31 women from 2 National Collegiate Athletic Association Division I ice hockey teams.

MAIN OUTCOME MEASURE(S)

We analyzed magnitude and frequency (per game) of head impacts per player among impact mechanisms and between sexes using generalized mixed linear models and generalized estimating equations to account for repeated measures within players.

INTERVENTION(S)

Participants wore helmets instrumented with accelerometers to allow us to collect biomechanical measures of head impacts sustained during play. Video footage from 53 games was synchronized with the biomechanical data. Head impacts were classified into 8 categories: contact with another player; the ice, boards or glass, stick, puck, or goal; indirect contact; and contact from celebrating.

RESULTS

For men and women, contact with another player was the most frequent impact mechanism, and contact with the ice generated the greatest-magnitude head accelerations. The men had higher per-game frequencies of head impacts from contact with another player and contact with the boards than did the women (P < .001), and these impacts were greater in peak rotational acceleration (P = .027).

CONCLUSIONS

Identifying the impact mechanisms in collegiate ice hockey that result in frequent and high-magnitude head impacts will provide us with data that may improve our understanding of the high rate of concussion in the sport and inform injury-prevention strategies.

Subconcussive head impact biomechanics: comparing differing offensive schemes

PURPOSE

Recent literature suggests that subconcussive impacts may influence cognitive functioning across the life span. These effects are suggested to manifest as functional and possibly structural changes. Head impact biomechanics during American football have been characterized from the high school to professional level, but style of play has not been considered. The aim of this investigation was to quantify and compare head impact frequencies and magnitudes between two different offensive schemes.

METHODS

We investigated the frequencies and magnitudes (linear acceleration [g], rotational acceleration [rad·s], and HITsp) of head impacts sustained by 83 high school football athletes, playing for schools using two different offensive schemes. The two schemes comprised a run-first offense (42 athletes) and a pass-first offense (41 athletes). The Head Impact Telemetry System was used to record head impact measures.

RESULTS

A total of 35,620 impacts were recorded across two seasons. Athletes in the run-first offense sustained an average of 456 head impacts per season (41 practices and 9 games), whereas the pass-first offense athletes sustained an average of 304 head impacts per season (44 practices and 9 games). The pass-first offense, however, sustained significantly higher impact magnitudes (P values < 0.05; 28.56g, 1777.58 rad·s, and 16.24) than the run-first offense (25.67g, 1675.36 rad·s, and 15.48) across a season.

CONCLUSIONS

These data provide a first look at how different offensive strategies may influence head impact exposure in football athletes. In the study population, a run-first offense was associated with more frequent head impacts, of smaller magnitude, than a pass-first offense.

Head impact exposure in male and female collegiate ice hockey players

The purpose of this study was to quantify head impact exposure (frequency, location and magnitude of head impacts) for individual male and female collegiate ice hockey players and to investigate differences in exposure by sex, player position, session type, and team. Ninety-nine (41 male, 58 female) players were enrolled and 37,411 impacts were recorded over three seasons. Frequency of impacts varied significantly by sex (males: 287 per season, females: 170, p<0.001) and helmet impact location (p<0.001), but not by player position (p=0.088). Head impact frequency also varied by session type; both male and female players sustained more impacts in games than in practices (p<0.001), however the magnitude of impacts did not differ between session types. There was no difference in 95th percentile peak linear acceleration between sexes (males: 41.6 g, females: 40.8 g), but 95th percentile peak rotational acceleration and HITsp (a composite severity measure) were greater for males than females (4424, 3409 rad/s(2), and 25.6, 22.3, respectively). Impacts to the back of the helmet resulted in the greatest 95th percentile peak linear accelerations for males (45.2 g) and females (50.4 g), while impacts to the side and back of the head were associated with the greatest 95th percentile peak rotational accelerations (males: 4719, 4256 rad/sec(2), females: 3567, 3784 rad/sec(2) respectively). It has been proposed that reducing an individual's head impact exposure is a practical approach for reducing the risk of brain injuries. Strategies to decrease an individual athlete's exposure need to be sport and gender specific, with considerations for team and session type.

Cumulative head impact burden in high school football

Impacts to the head are common in collision sports such as football. Emerging research has begun to elucidate concussion tolerance levels, but sub-concussive impacts that do not result in clinical signs or symptoms of concussion are much more common, and are speculated to lead to alterations in cerebral structure and function later in life. We investigated the cumulative number of head impacts and their associated acceleration burden in 95 high school football players across four seasons of play using the Head Impact Telemetry System (HITS). The 4-year investigation resulted in 101,994 impacts collected across 190 practice sessions and 50 games. The number of impacts per 14-week season varied by playing position and starting status, with the average player sustaining 652 impacts. Linemen sustained the highest number of impacts per season (868); followed by tight ends, running backs, and linebackers (619); then quarterbacks (467); and receivers, cornerbacks, and safeties (372). Post-impact accelerations of the head also varied by playing position and starting status, with a seasonal linear acceleration burden of 16,746.1g, while the rotational acceleration and HIT severity profile burdens were 1,090,697.7 rad/sec(2) and 10,021, respectively. The adolescent athletes in this study clearly sustained a large number of impacts to the head, with an impressive associated acceleration burden as a direct result of football participation. These findings raise concern about the relationship between sub-concussive head impacts incurred during football participation and late-life cerebral pathogenesis, and justify consideration of ways to best minimize impacts and mitigate cognitive declines.

Proceedings from the Ice Hockey Summit on concussion: a call to action

OBJECTIVE

The objective of this proceeding is to integrate the concussion in sport literature and sport science research on safety in ice hockey to develop an action plan to reduce the risk, incidence, severity, and consequences of concussion in ice hockey.

METHODS

A rationale paper outlining a collaborative action plan to address concussions in hockey was posted for review 2 months before the Ice Hockey Summit: Action on Concussion. Focused presentations devoted specifically to concussion in ice hockey were presented during the Summit, and breakout sessions were used to develop strategies to reduce concussion in the sport. This proceedings and a detailed scientific review (a matrix of solutions) were written to disseminate the evidence-based information and resulting concussion reduction strategies. The manuscripts were reviewed by the authors, advisers, and contributors to ensure that the opinions and recommendations reflect the current level of knowledge on concussion in hockey.

RESULTS

Six components of a potential solution were articulated in the Rationale paper and became the topics for breakout groups that followed the professional, scientific lectures. Topics that formed the core of the action plan were metrics and databases; recognizing, managing, and returning to play; hockey equipment and ice arenas; prevention and education; rules and regulations; and expedient communication of the outcomes. The attendees in breakout sessions identified action items for each section. The most highly ranked action items were brought to a vote in the open assembly by using an Audience Response System. The strategic planning process was conducted to assess the following: Where are we at? Where must we get to? What strategies are necessary to make progress on the prioritized action items?

CONCLUSIONS

Three prioritized action items for each component of the solution and the percentage of the votes received are listed in the body of this proceeding.

Pediatric sports-related concussion

This article aims to examine pediatric concussion literature with respect to epidemiology, etiology, return to play, and recurrent concussions, and to provide recommendations for future research. We conducted a review of pediatric concussion literature regarding incidence, etiology, return to play, and recurrent concussive injury by using MEDLINE, CINAHL, Sport-Discus, and PsychInfo databases from 1995-2010. A review of reference lists in the aforementioned articles was also performed. We discovered that the research on sports-related concussion specific to children and adolescents is rather limited. Results of existing studies of concussion incidence in this population indicate that concussion is relatively rare compared with most musculoskeletal injuries; however, the potential consequences of mismanagement and of subsequent injury warrant significant attention regarding injury recognition and recovery, and the challenge of determining readiness to return to play. Evidence exists that children and adolescents take longer to recover than adults after a concussion, which underscores the need for a more conservative approach to management and return to physical and cognitive activities. Concussion in the young athlete is of specific concern because of the continuing cognitive maturation, therefore, the recovery may be more difficult to track when using the standard assessment tools currently available. Until future studies can better delineate the mechanisms of, response to, and recovery from concussion in the young athlete, it is prudent to act in a conservative manner when dealing with pediatric athletes with concussion.

Proceedings from the Ice Hockey Summit on concussion: a call to action

The objective of this proceedings is to integrate the concussion in sport literature and sport science research on safety in ice hockey to develop an action plan to reduce the risk, incidence, severity, and consequences of concussion in ice hockey. A rationale paper outlining a collaborative action plan to address concussions in hockey was posted for review two months prior to the Ice Hockey Summit: Action on Concussion. Focused presentations devoted specifically to concussion in ice hockey were presented during the Summit and breakout sessions were used to develop strategies to reduce concussion in the sport. This proceedings and a detailed scientific review (a matrix of solutions) were written to disseminate the evidence-based information and resulting concussion reduction strategies. The manuscripts were reviewed by the authors, advisors and contributors to ensure that the opinions and recommendations reflect the current level of knowledge on concussion in hockey. Six components of a potential solution were articulated in the Rationale paper and became the topics for breakout groups that followed the professional, scientific lectures. Topics that formed the core of the action plan were: metrics and databases; recognizing, managing and return to play; hockey equipment and ice arenas; prevention and education; rules and regulations; and expedient communication of the outcomes. The attendees in breakout sessions identified action items for each section. The most highly ranked action items were brought to a vote in the open assembly, using an Audience Response System (ARS). The strategic planning process was conducted to assess: Where are we at?; Where must we get to?; and What strategies are necessary to make progress on the prioritized action items? Three prioritized action items for each component of the solution and the percentage of the votes received are listed in the body of this proceedings.

No evidence for a cumulative impact effect on concussion injury threshold

Recent studies using a helmet-based accelerometer system (Head Impact Telemetry System [HITS]) have demonstrated that concussions result from a wide range of head impact magnitudes. Variability in concussion thresholds has been proposed to result from the cumulative effect of non-concussive head impacts prior to injury. We used the HITS to collect biomechanical data representing >100,000 head impacts in 95 high school football players over 4 years. The cumulative impact histories prior to 20 concussive impacts in 19 athletes were compared to the cumulative impact histories prior to the three largest magnitude non-concussive head impacts in the same athletes. No differences were present in any impact history variable between the concussive and non-concussive high magnitude impacts. These analyses included the number of head impacts, cumulative HIT severity profile value, cumulative linear acceleration, and cumulative rotational acceleration during the same practice or game session, as well as over the 30 min and 1 week preceding these impacts. Our data do not support the proposal that impact volume or intensity influence concussion threshold in high school football athletes.

Does cervical muscle strength in youth ice hockey players affect head impact biomechanics?

OBJECTIVE

To evaluate the effect of cervical muscle strength on head impact biomechanics.

DESIGN

Prospective cohort.

SETTING

Field setting.

PARTICIPANTS

Thirty-seven volunteer ice hockey players (age = 15.0 ± 1.0 years, height = 173.5 ± 6.2 cm, mass = 66.6 ± 9.0 kg, playing experience = 2.9 ± 3.7 years).

INTERVENTIONS

Participants were equipped with accelerometer-instrumented helmets to collect head impact biomechanics (linear and rotational acceleration) throughout an entire playing season. Before the season, isometric cervical muscle strength was measured for the anterior neck flexors, anterolateral neck flexors, cervical rotators, posterolateral neck extensors, and upper trapezius. Data were analyzed using random intercept general mixed linear models, with each individual player as a repeating factor/cluster.

MAIN OUTCOME MEASURES

Dependent variables included linear and rotational head accelerations. Cervical strength data were categorized into tertiles, creating groups with high, moderate, and low strength. Strength measures were averaged and normalized to body mass.

RESULTS

Significant differences in cervical muscle strength existed across our strength groups (P < 0.05). No differences were observed in linear or rotational acceleration across strength groups for the anterior neck flexors (PLin = 0.399; PRot = 0.060), anterolateral neck flexors (PLin = 0.987; PRot = 0.579), cervical rotators (PLin = 0.136; PRot = 0.238), posterolateral neck extensors (PLin = 0.883; PRot = 0.101), or upper trapezius (PLin = 0.892; PRot = 0.689).

CONCLUSIONS

Our hypothesis that players with greater static neck strength would experience lower resultant head accelerations was not supported. This contradicts the notion that cervical muscle strength mitigates head impact acceleration. Because we evaluated cervical strength isometrically, future studies should consider dynamic (ie, isokinetic) methods in the context of head impact biomechanics.

Proceedings from the Ice Hockey Summit on Concussion: a call to action

OBJECTIVE

: The objective of this proceeding was to integrate the concussion in sport literature and sport science research on safety in ice hockey to develop an action plan to reduce the risk, incidence, severity, and consequences of concussion in ice hockey.

DESIGN

: A rationale paper outlining a collaborative action plan to address concussions in hockey was posted for review 2 mos before the "Ice Hockey Summit: Action on Concussion." Focused presentations devoted specifically to concussion in ice hockey were presented during the summit, and breakout sessions were used to develop strategies to reduce concussion in the sport. The proceedings and a detailed scientific review (a matrix of solutions) were written to disseminate the evidence-based information and resulting concussion reduction strategies. The manuscripts were reviewed by the authors, advisors, and contributors to ensure that the opinions and recommendations reflect the current level of knowledge on concussion in hockey.

RESULTS

: Six components of a potential solution were articulated in the "Rationale" paper and became the topics for breakout groups that followed the professional scientific lectures. Topics that formed the core of the action plan were metrics and databases; recognizing, managing, and return to play; hockey equipment and ice arenas; prevention and education; rules and regulations; and expedient communication of the outcomes. The attendees in the breakout sessions identified the action items for each section. The most highly ranked action items were brought to a vote in the open assembly, using an Audience Response System. The strategic planning process was conducted to assess the following: "Where are we at?" "Where must we get to?" "What strategies are necessary to make progress on the prioritized action items?"

CONCLUSIONS

: Three prioritized action items for each component of the solution and the percentage of the votes received are listed in the body of this proceeding.

Proceedings from the ice hockey summit on concussion: a call to action

OBJECTIVE

The objective of this proceeding is to integrate the concussion in sport literature and sport science research on safety in ice hockey to develop an action plan to reduce the risk, incidence,severity, and consequences of concussion in ice hockey. methods: A rationale paper outlining a collaborative action plan to address concussions in hockey was posted for review two months prior to the Ice Hockey Summit: Action on Concussion. Focused presentations devoted specifically to concussion in ice hockey were presented during the Summit and break out sessions were used to develop strategies to reduce concussion in the sport. This proceedings and a detailed scientific review (a matrix of solutions) were written to disseminate the evidence based information and resulting concussion reduction strategies. The manuscripts were reviewed by the authors, advisors and contributors to ensure that the opinions and recommendations reflect the current level of knowledge on concussion in hockey.

RESULTS

Six components of a potential solution were articulated in the Rationale paper and became the topics for breakout groups that followed the professional, scientific lectures. Topics that formed the core of the action plan were: metrics and databases; recognizing,managing, and return to play; hockey equipment and ice arenas;prevention and education; rules and regulations; and expedient communication of the outcomes. The attendees in breakout sessions identified action items for each section. The most highly ranked action items were brought to a vote in the open assembly, using an Audience Response System (ARS). The strategic planning process was conducted to assess: Where are we at?; Where must we get to?; and What strategies are necessary to make progress on the prioritized action items?

CONCLUSIONS

Three prioritized action items for each component of the solution and the percentage of the votes received are listed in the body of this proceeding.

Proceedings from the Ice Hockey Summit on Concussion: a call to action

OBJECTIVE

The objective of this proceeding is to integrate the concussion in sport literature and sport science research on safety in ice hockey to develop an action plan to reduce the risk, incidence, severity, and consequences of concussion in ice hockey.

METHODS

A rationale paper outlining a collaborative action plan to address concussions in hockey was posted for review two months prior to the Ice Hockey Summit: Action on Concussion. Focused presentations devoted specifically to concussion in ice hockey were presented during the Summit and breakout sessions were used to develop strategies to reduce concussion in the sport. This proceedings and a detailed scientific review (a matrix of solutions) were written to disseminate the evidence-based information and resulting concussion reduction strategies. The manuscripts were reviewed by the authors, advisors and contributors to ensure that the opinions and recommendations reflect the current level of knowledge on concussion in hockey.

RESULTS

Six components of a potential solution were articulated in the Rationale paper and became the topics for breakout groups that followed the professional, scientific lectures. Topics that formed the core of the action plan were: metrics and databases; recognizing, managing and return to play; hockey equipment and ice arenas; prevention and education; rules and regulations; and expedient communication of the outcomes. The attendees in breakout sessions identified action items for each section. The most highly ranked action items were brought to a vote in the open assembly, using an Audience Response System (ARS). The strategic planning process was conducted to assess: Where are we at?; Where must we get to?; and What strategies are necessary to make progress on the prioritized action items?

CONCLUSIONS

Three prioritized action items for each component of the solution and the percentage of the votes received are listed in the body of this proceeding.