Concussion rates in youth hockey may be similar to the injury risk with other high-contact sports, though many of the collisions in hockey appear to result from illegal moves on the ice, a U.S. study suggests.

Overall, the players experienced about 1.6 concussions for every 1,000 minutes of participation time, the study found. That amounts to around one injury for roughly every 10 hours of practice and competition.

Players aged 12 to 14 years old were more than twice as likely to get concussions as teens aged 15 to 18, the study also found. This may be due to greater disparities in size, strength and speed among younger athletes as well as less familiarity with checking, or defensive hits designed to capture the puck, said lead author Anthony Kontos, a concussion researcher at the University of Pittsburgh.

The sport might be safer, particularly among the youngest players, if hockey leagues focused on "better enforcement of existing penalties for illegal hits - especially those from behind when players are less able to protect themselves," Kontos said by email.

Another recent study found that of all sports-related injuries that send kids younger than 18 to the emergency room, ice hockey accounts for almost 10 percent of concussions and more than 9 percent of internal organ injuries (see Reuters Health story of January 8, 2016, here: http://reut.rs/1PT0GlT).

To assess concussion rates in youth ice hockey, Kontos and colleagues examined data on 397 young players in western Pennsylvania, Boston and Birmingham, Alabama, over two consecutive seasons running from 2012 through 2014.

They looked at concussion rates per minute of athletic exposure (AE), which includes competitions or practices with the potential for injury.

There were 37 medically diagnosed concussions during a total of more than 23,000 AEs including practices and games. That amounts to an injury rate of 1.58 concussions per 1,000 AEs.

Concussions were much more likely during games, which had an injury rate of 2.49 per 1,000 AEs compared with 1.04 per 1,000 AEs for practices.

For the players aged 12 to 14, the concussion rate was 2.84 per 1,000 AEs, compared with 1.18 for the athletes aged 15 to 18.

Overall, more than 40 percent of the concussions involved illegal contact, and the remainder of these injuries still resulted from players colliding with other players.

Beyond its small size, another limitation of the study is that it only covered three communities and might not be representative of concussion rates or playing styles for all youth leagues, the authors acknowledge. Concussion rates also weren't adjusted to account for playing time of individual athletes.

Kontos, the study's lead author, received grant funding from the National Football League and one co-author got financial support from the National Football League Players Association and philanthropic support from the National Hockey League Alumni Association. Senior author Michael Collins is a co-founder of ImPACT Testing, which sells tools to assess head injuries.

The findings, which relied on reports from coaches and parents about concussions and lacked data on players' symptoms or medical histories, highlights the need for larger trials that can capture more accurate and detailed information about how injuries occur, Dr. Paul Echlin, a researcher at the Elliott Sports Medicine Clinic in Burlington, Ontario, who wasn't involved in the study said by email.

One challenge with hockey is that it may attract young athletes precisely because of the aggressive nature of competition, noted Jason Izraelski, a sports chiropractor and concussion researcher who treats youth hockey players in Toronto.

"Only by teaching ethical concepts of fair play and respect at the grassroots level will athletes help decrease concussion risk," Izraelski, who wasn't involved in the study, said by email.

Player education is particularly vital in hockey when players are allowed to start body checking at age 13, said Tamara Valovich McLeod, co-author of the National Athletic Trainers' Association position statement on management of sport concussions and director of athletic training programs at A.T. Still University in Mesa, Arizona. Checking isn't allowed for younger kids, she said.

"Athletes need to be educated regarding proper techniques to hit/check that are not illegal," McLeod, who wasn't involved in the study, said by email. "Officials need to call penalties and then coaches and athletic trainers need to address with players as a learning moment and work to improve technique so checks are legal."

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