title: The risk of injury associated with body checking among Pee Wee ice hockey players: an evaluation of Hockey Canada's national body checking policy change.
abstract: BACKGROUND
  In 2013, Hockey Canada introduced an evidence-informed policy change delaying the earliest age of introduction to body checking in ice hockey until Bantam (ages 13-14) nationwide.
  
  
  OBJECTIVE
  To determine if the risk of injury, including concussions, changes for Pee Wee (11-12 years) ice hockey players in the season following a national policy change disallowing body checking.
  
  
  METHODS
  In a historical cohort study, Pee Wee players were recruited from teams in all divisions of play in 2011-2012 prior to the rule change and in 2013-2014 following the change. Baseline information, injury and exposure data for both cohorts were collected using validated injury surveillance.
  
  
  RESULTS
  Pee Wee players were recruited from 59 teams in Calgary, Alberta (n=883) in 2011-2012 and from 73 teams in 2013-2014 (n=618). There were 163 game-related injuries (incidence rate (IR)=4.37/1000 game-hours) and 104 concussions (IR=2.79/1000 game-hours) in Alberta prior to the rule change, and 48 injuries (IR=2.16/1000 game-hours) and 25 concussions (IR=1.12/1000 game-hours) after the rule change. Based on multivariable Poisson regression with exposure hours as an offset, the adjusted incidence rate ratio associated with the national policy change disallowing body checking was 0.50 for all game-related injuries (95% CI 0.33 to 0.75) and 0.36 for concussion specifically (95% CI 0.22 to 0.58).
  
  
  CONCLUSIONS
  Introduction of the 2013 national body checking policy change disallowing body checking in Pee Wee resulted in a 50% relative reduction in injury rate and a 64% reduction in concussion rate in 11-year-old and 12-year-old hockey players in Alberta.
authors.affiliation: Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.|Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.|Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Amanda M
authors.initials: AM
authors.lastname: Black
authors.affiliation: Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.|Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.|O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.|Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.|Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Brent E
authors.initials: BE
authors.lastname: Hagel
authors.affiliation: Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.|Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Luz
authors.initials: L
authors.lastname: Palacios-Derflingher
authors.affiliation: Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.|Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.|Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Kathryn J
authors.initials: KJ
authors.lastname: Schneider
authors.affiliation: Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.|Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.|Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.|O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.|Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.|Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Carolyn A
authors.initials: CA
authors.lastname: Emery
mesh_terms: D000416:Alberta; D001265:Athletic Injuries / Q000517:prevention & control*; D001924:Brain Concussion / Q000517:prevention & control*; D002648:Child; D005260:Female; D006688:Hockey / Q000293:injuries* / Q000592:standards; D006801:Humans; D008297:Male; D057766:Policy; D012307:Risk Factors
keywords: Ice hockey; body checking; concussion; injury; policy change