Published online May 2, 2005
PEDIATRICS
Vol. 115
No. 5
May 2005, pp.
1448-1449
(doi:10.1542/peds.2005-0334)
Characteristics of Ice Hockey–Related Injuries Treated in US Emergency Departments, 2001–2002
David Luke, PharmD
Medical Division
Pfizer, Inc
Ledyard, CT 06339
To the Editor.—
In the December 2004 issue of Pediatrics, Hostetler et al1 described the characteristics of hockey-related injuries through review of the National Electronic Injury Surveillance System and concluded that adolescents between the ages of 12 and 17 years had the greatest incidence of injuries. Although the data are limited by collection through emergency-department records and the data are not divided into traditional age-group classifications as established by USA Hockey (eg, Peewee, Bantam, and Midget age groups), we could not agree more with their conclusions. However, there is more to reducing the number of hockey-related injuries than improvement in hockey gear and reduction in body checking, such as enforcement of USA Hockey rules and placing limits on injury-provoking activities. In 1998, realizing that the 15- to 18-year-old age group was at the greatest risk for hockey-related injuries, we formed a league for Midget-aged players (NorthEastern Midget Hockey League; www.nemhl.org) that encompasses 4 Northeastern states (Connecticut, Massachusetts, New York, and Vermont) and established greater restrictions on foul play than those outlined by USA Hockey. For example, after 3 minor penalties in a game, the player sits out the rest of the game. Three major violations, including fighting and those penalties involving the hockey stick, result in automatic expulsion from the league. On-ice officials understand and call these more restrictive rules, and a league disciplinary committee objectively reviews all major violations for adherence to the rules.
To this end, we have significantly reduced the number of hockey-related injuries in our league. In the 2003–2004 season, which encompassed 141 games, 11 of 136 (8.1%) league players had hockey-related injuries requiring treatment. Of these 11 injuries, 4 were upper extremity (according to the definitions outlined by Hostetler et al1), 2 were trunk injuries, 1 was a lower extremity injury, and 2 were cuts to the face. Two players suffered traumatic brain injuries, denoted as concussions.
Although the number of injuries is small, the body-region percentages are in line with those summarized by Hostetler et al. The authors also stated that they could not identify an overall percentage of injuries in specific age groups from the literature. In fact, one needs to report the data in player-hours or athlete exposures to draw comparisons. In our experience, we had a rate of 8.668 injuries per 1000 player-hours, which is far less than the published rates of injuries at the Bantam (ages 13–14 years) and high-school levels.2,3 Similarly, the injury rate of 0.078 injuries per game seen in our league is 10-fold less than those rates reported by others using similar fair-play rules.4,5
Typically, the Midget age group (15–18 years of age) has a significantly higher percentage of injuries relative to any other age group. However, adherence to the league-imposed stiffer rules has resulted in a marked reduction in the rate of injuries. The league is a full-contact, comparably skilled league of athletes who compete for a league championship. The American Academy of Pediatrics' Committee on Sports Medicine and Fitness has questioned the practice of checking or intentional body contact in youth sports and advocates for the banishment of full contact at ages 
17 years.6,7 The American Osteopathic Academy of Sports Medicine has taken a much more reasoned approach by focusing on player and coach education and injury prevention through enforcement of the existing rules for violent behavior.8 Through adherence to rules and regulations by the 4 primary stakeholders of hockey (coaches, parents, officials, and, of course, the players), penalties and associated injuries can be reduced without eliminating body checking.
REFERENCES
- Hostetler SG, Xiang H, Smith GA. Characteristics of ice hockey–related injuries treated in US emergency departments, 2001–2002.
Pediatrics. 2004;114(6)
. Available at: www.pediatrics.org/cgi/content/full/114/6/e661
- Stuart MJ, Smith AM, Nieva JJ, Rock MG. Injuries in youth ice hockey: a pilot surveillance strategy.
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- Marcotte G, Simard D. Fair-play: an approach to hockey for the 1990s. In: Castaldi CR, Bishop PJ, Hoerner ER, eds.
Safety in Ice Hockey. 2nd ed. Philadelphia, PA: American Society for Testing and Materials; 1993:103–108
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- American Academy of Pediatrics, Committee on Sports Medicine and Fitness. Safety in youth ice hockey: the effects of body checking.
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- Canadian Academy of Sports Medicine. Position statement. Violence in ice hockey.
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PEDIATRICS (ISSN 1098-4275). ©2005 by the American Academy of Pediatrics
