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.

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 (n2008-2009 = 16; 510 players) and after (n2013-2014 = 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.

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BackgroundA 2015, Hockey Calgary body checking (BC) policy change disallowed BC from non-elite Bantam (ages 13–14, lower 60% of divisions). This was informed by evidence that disallowing BC in Pee Wee (ages 11–12) reduced the risk of injury, specifically concussion, by >3-fold.ObjectiveTo compare the frequency of type and intensity of player-to-player contacts (PC) and head contact in non-elite Bantam ice hockey games in leagues allowing BC (2014–15) compared with leagues disallowing BC (2015–16).DesignCohort study.SettingIce-hockey arenas in Calgary, Canada.ParticipantsNon-elite Bantam players in 2014–15 (n=348 players) and 2015–16 (n=309 players) seasons.InterventionsIn the 2014–15 season, non-elite Bantam leagues allowed BC. In 2015–2016, BC was disallowed.Main Outcome MeasurementsThirteen games pre-policy change (2014–2015) and 13 post-policy change were video recorded. Analysis using validated methodology was used to compare the frequency, type (i.e., trunk, head and other types of PC with limb/head/stick), and intensity (trunk contacts level 1–5 with increasing intensity) of PCs. Incidence rate ratios (IRR) were estimated using Poisson regression (controlling for cluster by team, offset by player minutes).ResultsThere were a total of 3485 trunk contacts and 1395 other contacts in 26 games. The overall risk of trunk PCs was lower post-policy change (IRR=0.50, 95% CI; 0.45–0.56). Post-policy change, high intensity (body checking - level 4,5) contacts decreased (IRR4=0.19, 95% CI; 0.13–0.26 IRR5=0.11, 95% CI; 0.03–0.51), lower intensity (level 2,3) PCs were less frequent (IRR2=0.45, 95% CI; 0.40–0.50 and IRR3=0.47, 95% CI; 0.35–0.63), and other contacts made with the limb/stick also decreased (IRR=0.60, 95% CI; 0.48–0.73). Head contact decreased (IRR=0.40, 95% CI; 0.25–0.61).ConclusionsPost-policy change disallowing BC in non-elite Bantam, incidence of high intensity (level 4,5) PCs decreased 82%. Head contact decreased 60% and stick/limbs contact decreased 40%. These findings inform the mechanisms of injury explaining concussion risk reduction post-BC policy change.

To compare physical contacts (PCs) and head contacts (HCs) in nonelite U15 (ages 13-14) and U18 (ages 15-17) ice hockey players in body checking (BC) and non-BC leagues. Design: Cohort video analysis study. Setting: Ice hockey arenas in Calgary, Canada. Participants: Players from 13 BC and 13 non-BC games at the nonelite U15 and U18 levels (n 5 52 total games). Assessment of Risk Factors: Games were videotaped and analyzed to compare PC variables between leagues allowing and prohibiting BC. Main Outcome Measures: Validated methodology for PC type (trunk PC and other types of PC with limb/stick/head), intensity (low and high intensity), and HC. Incidence rate ratios (IRRs) were estimated using Poisson regression (controlling for cluster by team game and offset by player minutes) to compare the incidence of PCs in BC and non-BC games. Results: The rate of trunk PCs was lower in the non-BC leagues for both U15 (IRR 5 0.50, 99% confidence interval [CI]: 0.43-0.58) and U18 (IRR 5 0.56, 99%