John C Kim and International Adoption Video

Wednesday, September 22, 2010

Body checking, concussion and ice hockey ; anticipatory guidance re checking and the dangers of the sport.

eLetters to:

Lisa L. Bakhos, Gregory R. Lockhart, Richard Myers, and James G. Linakis
Emergency Department Visits for Concussion in Young Child Athletes
Pediatrics 2010; 126: e550-e556 [Abstract] [Full text] [PDF]
* eLetters: Submit a response to this article

eLetters published:

[Read eLetters] Body checking, concussion and ice hockey
Ediriweera Desapriya, Namrata Dutt, Harshani Wijerathne   (2 September 2010)

Body checking, concussion and ice hockey 2 September 2010
Ediriweera Desapriya, 
Research Associate 
Department of Pediatrics
Namrata Dutt, Harshani Wijerathne

Send letter to journal: 
Re: Body checking, concussion and ice hockey

E-mail Ediriweera Desapriya, et al.

When participation rates were accounted for, the rate of concussion was highest in football and ice hockey (1).It is estimated that every year there are 8000-15 000 concussion related to ice hockey minor hockey alone in Canada (2).

Many young hockey players risk the lasting effects of traumatic brain injury by "body checking". Body checking accounts for 86% of all injuries among players aged 9 to 15 years, and this percentage is increasing (2). A recent systematic review and meta analysis by Emery et al (3) have shown that the risk of body-checking policy in youth ice hockey leads to a statistically significant higher risk of concussions (odds ratio, 1.71 [95% CI, 1.2-2.44]). Similar related studies have shown that body checking is significant risk of concussion (4, 5). For all of our attention, recent studies have revealed that one concussion is risk factors for a second one and those who have sustained 3 or more concussions are 9 times more likely to have serious mental illness (6).

In the beginning of the article Bakhos et al (1) clearly shown that football and ice hockey has highest concussion rates compared to other popular sports. Major limitation of Bakhos et al study (1) was that they have not attempted to provide any prevention intervention that could effectively contribute to reduce ice hockey related concussions. They exclusively provide value of helmets on alpine sports and provide some tips to prevent foot ball related concussion. We also believe that well designed and appropriately worn helmets could prevent concussion in ice hockey significantly.

More importantly, we believe that in order to prevent increasing rates of concussion, we need to ban body checking in minor and youth ice hockey. Recently there are two systematic reviews showing strong relationship with body checking and concussion (3, 7). A JAMA article by Emery et al; (8)clearly showed that all injury outcomes, including concussion and severe concussion, were at least three times more common among body checking allowed league players, compared to body checking not allowed league players. These results have obvious implications for the rules of the game in younger ice hockey players and therefore we need to take strong advocacy campaign against body checking in minor ice hockey for the safety of our children.


(1).Bakhos, LL, Lockhart GR, Myers R, James BS, Linakis G. Emergency Department Visits for Concussion in Young Child Athletes. Pediatrics, 2010;126 (3) e550-e556

(2). Marchie A, Cusimano MD. Bodychecking and concussions in ice hockey: Should our youth pay the price? CMAJ. 2003;22;169(2):124-8.

(3). Emery CA, Hagel B, Decloe MD, McKay C. Risk factors for injury and severe injury in youth ice hockey: a systematic review of the literature. Inj Prev. 2010;16(2):113-118

(4). Goodman D, Gaetz M, Meichenbaum D. Concussions in hockey: There is cause for concern. Med Sci Sports Exerc 2001;33:2004-9

(5). Biasca N, Wirth S, Tegner Y. The avoidability of head and neck injuries in ice hockey: an historical review. Br J Sports Med 2002;36:410- 27

(6). Collins MW, Lovell MR, Iverson GL, Cantu RC, Maroon JC, Field M. Cumulative effects of concussion in high school athletes. Neurosurgery 2002; 51:1175-9

(7). Warsh JM, Constantin SA, Howard A, Macpherson A. A systematic review of the association between body checking and injury in youth ice hockey. Clin J Sport Med. 2009;19(2):134-44.

(8). Emery CA, Kang J, Shrier I, Goulet C, Hagel BE, Benson BW, Nettel-Aguirre A, McAllister JR, Hamilton GM, Meeuwisse WH.Risk of injury associated with body checking among youth ice hockey players. JAMA. 2010; 9;303(22):2265-72.

Conflict of Interest:

None declared

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Personal Web site for John C Kim: KIDDOC.ORG

I am a pediatrician specializing in General Pediatrics, International Adoption Medicine, and in the diagnosis and coaching of families pursuing joy.