Claude Goulet

Risk of Injury Associated With Body Checking Among Youth Ice Hockey Players

CONTEXT Ice hockey has one of the highest sport participation and injury rates in youth in Canada. Body checking is the predominant mechanism of injury in leagues in which it is permitted. OBJECTIVE To determine if risk of injury and concussion differ for Pee Wee (ages 11-12 years) ice hockey players in a league in which body checking is permitted (Alberta, Canada) vs a league in which body checking is not permitted (Quebec, Canada). DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study conducted in Alberta and Quebec during the 2007-2008 Pee Wee ice hockey season. Participants (N = 2154) were players from teams in the top 60% of divisions of play. MAIN OUTCOME MEASURES Incidence rate ratios adjusted for cluster based on Poisson regression for game- and practice-related injury and concussion. RESULTS Seventy-four Pee Wee teams from Alberta (n = 1108 players) and 76 Pee Wee teams from Quebec (n = 1046 players) completed the study. In total, there were 241 injuries (78 concussions) reported in Alberta (85 077 exposure-hours) and 91 injuries (23 concussions) reported in Quebec (82 099 exposure-hours). For game-related injuries, the Alberta vs Quebec incidence rate ratio was 3.26 (95% confidence interval [CI], 2.31-4.60 [n = 209 and n = 70 for Alberta and Quebec, respectively]) for all injuries, 3.88 (95% CI, 1.91-7.89 [n = 73 and n = 20]) for concussion, 3.30 (95% CI, 1.77-6.17 [n = 51 and n = 16]) for severe injury (time loss, >7 days), and 3.61 (95% CI, 1.16-11.23 [n=14 and n=4]) for severe concussion (time loss, >10 days). The estimated absolute risk reduction (injuries per 1000 player-hours) that would be achieved if body checking were not permitted in Alberta was 2.84 (95% CI, 2.18-3.49) for all game-related injuries, 0.72 (95% CI, 0.40-1.04) for severe injuries, 1.08 (95% CI, 0.70-1.46) for concussion, and 0.20 (95% CI, 0.04-0.37) for severe concussion. There was no difference between provinces for practice-related injuries. CONCLUSION Among 11- to 12-year-old ice hockey players, playing in a league in which body checking is permitted compared with playing in a league in which body checking is not permitted was associated with a 3-fold increased risk of all game-related injuries and the categories of concussion, severe injury, and severe concussion.

Effectiveness of helmets in skiers and snowboarders: case-control and case crossover study

Abstract Objective To determine the effect of helmets on the risk of head and neck injuries in skiers and snowboarders. Design Matched case-control and case crossover study. Setting 19 ski areas in Quebec, Canada, November 2001 to April 2002. Participants 1082 skiers and snowboarders (cases) with head and neck injuries reported by the ski patrol and 3295 skiers and snowboarders (controls) with non-head or non-neck injuries matched to cases at each hill. Main outcome measures Estimates of matched odds ratios for the effect of helmet use on the risk of any head or neck injury and for people requiring evacuation by ambulance. Results The adjusted odds ratio for helmet use in participants with any head injury was 0.71 (95% confidence interval 0.55 to 0.92), indicating a 29% reduction in the risk of head injury. For participants who required evacuation by ambulance for head injuries, the adjusted odds ratio for helmet use was 0.44 (0.24 to 0.81). Similar results occurred with the case crossover design (odds ratio 0.43, 0.09 to 1.83). The adjusted odds ratio for helmet use for participants with any neck injury was 0.62 (0.33 to 1.19) and for participants who required evacuation by ambulance for neck injuries it was 1.29 (0.41 to 4.04). Conclusions Helmets protect skiers and snowboarders against head injuries. We cannot rule out the possibility of an increased risk of neck injury with helmet use, but the estimates on which this assumption is based are imprecise.

Risk of injury associated with bodychecking experience among youth hockey players

Background: In a previous prospective study, the risk of concussion and all injury was more than threefold higher among Pee Wee ice hockey players (ages 11–12 years) in a league that allows bodychecking than among those in a league that does not. We examined whether two years of bodychecking experience in Pee Wee influenced the risk of concussion and other injury among players in a Bantam league (ages 13–14) compared with Bantam players introduced to bodychecking for the first time at age 13. Methods: We conducted a prospective cohort study involving hockey players aged 13–14 years in the top 30% of divisions of play in their leagues. Sixty-eight teams from the province of Alberta (n = 995), whose players had two years of bodychecking experience in Pee Wee, and 62 teams from the province of Quebec (n = 976), whose players had no bodychecking experience in Pee Wee, participated. We estimated incidence rate ratios (IRRs) for injury and for concussion. Results: There were 272 injuries (51 concussions) among the Bantam hockey players who had bodychecking experience in Pee Wee and 244 injuries (49 concussions) among those without such experience. The adjusted IRRs for game-related injuries and concussion overall between players with bodychecking experience in Pee Wee and those without it were as follows: injury overall 0.85 (95% confidence interval [CI] 0.63 to 1.16); concussion overall 0.84 (95% CI 0.48 to 1.48); and injury resulting in more than seven days of time loss (i.e., time between injury and return to play) 0.67 (95% CI 0.46 to 0.99). The unadjusted IRR for concussion resulting in more than 10 days of time loss was 0.60 (95% CI 0.26 to 1.41). Interpretation: The risk of injury resulting in more than seven days of time loss from play was reduced by 33% among Bantam hockey players in a league where bodychecking was allowed two years earlier in Pee Wee compared with Bantam players introduced to bodychecking for the first time at age 13. In light of the increased risk of concussion and other injury among Pee Wee players in a league where bodychecking is permitted, policy regarding the age at which hockey players are introduced to bodychecking requires further consideration.

Injuries among skiers and snowboarders in Quebec.

Background: Snow sports such as skiing and snowboarding are recognized as hazardous, but population-based injury rates or specific risk factors have been difficult to estimate as a result of a lack of complete data for both numerator and denominator. Methods: We used data from 3 surveys to estimate the number of participants and annual number of outings in Quebec by age, sex, activity, and calendar year. Injuries reported by ski patrollers were used to estimate injury rates among skiers and snowboarders for the head and neck, trunk, upper extremity, and lower extremity. Results: Head–neck and trunk injury rates increased over time from 1995–1996 to 1999–2000. There was a steady increase in the rate of injury with younger age for all body regions. The rate of head–neck injury was 50% higher in snowboarders than in skiers (adjusted rate ratio [ARR] = 1.5; 95% confidence interval = 1.3–1.8). Women and girls had a lower rate of head–neck injury (0.73; 0.62–0.87). Snowboarders were twice as likely as skiers to have injuries of the trunk (2.1; 1.7–2.6), and more than 3 times as likely to have injuries of the upper extremities (3.4; 2.9–4.1). Snowboarders had a lower rate of injury only of the lower extremities (0.79; 0.66–0.95). Snowboarder collision-related injury rates increased substantially over time. Conclusions: Except for lower extremity injuries, snowboarders have a higher rate of injuries than skiers. Furthermore, collision-related injury rates have increased over time for snowboarders. Targeted injury prevention strategies in this group seem justified.

Risk factors associated with alpine skiing injuries in children. A case-control study.

We investigated the relative contribution of four risk factors to the occurrence of injuries among alpine skiers aged 12 years and younger (3 to 12 years old; mean age, 9.43 years). The risk factors selected were deficient binding adjustment, absence of formal training, low skill level, and use of rented equipment. A group of injured skiers (N 41) and a control group of uninjured skiers (N 313) were recruited among young skiers at one major alpine ski center in the Québec City, Canada, area during the 1995 to 1996 season. No significant group differences were found for mean age or sex distribution. The adjusted odds ratios for injury were 7.54 (95% confidence interval [2.57, 22.15]) for skiers in the low level of skill category relative to highly skilled skiers, 7.14 (2.59, 19.87) for skiers who rented their ski equipment compared with skiers who owned their equipment, and 2.11 (1.02, 4.33) for skiers with ill-adjusted bindings compared with skiers with better-adjusted bindings. Only formal training did not meet the 0.05 significance level for entry into the model; this is probably because of methodologic limitations. Implications of these results for the development of a prevention program aimed at young skiers are discussed.

Promoting respect for the rules and injury prevention in ice hockey: evaluation of the Fair-Play program

OBJECTIVE To reduce the number of transgressions to the rule, the occurrence of violent acts and to prevent injuries, Hockey Québec adopted the Fair-Play Program (FPP). The objective of the present study was to evaluate the effectiveness of the FPP. METHODS 52 Bantam (14-15 years) teams participated in this cohort study. In total, 49 games (13 with the FPP, 36 without FPP) were systematically assessed for transgressions to the rule. Body checking was allowed in all games. Transgressions to the rule data were obtained using a real time observation system in a natural setting, while injury data were collected through a self-administered questionnaire. Data were analysed using generalised linear models with generalised estimating equations accounting for potential team effect. RESULTS The number of penalties per game was significantly lower (p < 0.01) for games played with the FPP. Overall, no difference was noted in the number of transgressions observed during games played with or without the FPP. Players in leagues where the FPP was used held their opponents more frequently (p < 0.0001). On the other hand, players in leagues without the FPP shoved and hit more (p = 0.05). No difference was noted in the injury rate for games played with or without the FPP. CONCLUSIONS This study showed that the FPP is one of the tools available to help those in the hockey world promote fair play values. Moreover, this project clearly showed the importance of program evaluation and the value of direct observation in a natural setting.

Helmet Use and Risk of Neck Injury in Skiers and Snowboarders

In a case-control study, the authors examined the relation between helmet use and neck injury among Québec, Canada, skiers and snowboarders using 10 years of ski patrol data (1995-1996 to 2004-2005). Cases were defined as persons with any neck injury (n = 2,986), an isolated neck injury requiring ambulance evacuation (n = 522), or a cervical spine fracture or dislocation (n = 318). The control group included persons with non-head, non-neck injuries (n = 97,408) in an unmatched analysis. The authors also matched cases with controls injured at the same ski area, during the same activity (skiing vs. snowboarding), and during the same season. Helmet use was the primary exposure variable. For the unmatched analysis, the authors used unconditional logistic regression and adjusted for clustering by ski area and other covariates. They used conditional logistic regression for the matched analysis. Multiple imputation was used to address missing values. The adjusted odds ratio was 1.09 (95% confidence interval (CI): 0.95, 1.25) for any neck injury, 1.28 (95% CI: 0.96, 1.71) for isolated ambulance-evacuated neck injuries, and 1.02 (95% CI: 0.79, 1.31) for cervical spine fractures or dislocations. Similar results were found in the conditional logistic regression analysis and in analyses restricted to children under age 11 years. These results do not suggest that helmets increase the risk of neck injuries among skiers and snowboarders.

Meeting the Global Demand of Sports Safety : The Intersection of Science and Policy in Sports Safety

Sports and physical activity are transforming, and being transformed by, the societies in which they are practised. From the perspectives of both competitive and non-competitive sports, the complexity of their integration into today’s society has led to neither sports federations nor governments being able to manage the safety problem alone. In other words, these agencies, whilst promoting sport and physical activity, deliver policy and practices in an uncoordinated way that largely ignores the need for a concurrent overall policy for sports safety.This article reviews and analyses the possibility of developing an overall sports safety policy from a global viewpoint. Firstly, we describe the role of sports in today’s societies and the context within which much sport is delivered. We then discuss global issues related to injury prevention and safety in sports, with practical relevance to this important sector, including an analysis of critical policy issues necessary for the future development of the area and significant safety gains for all. We argue that there is a need to establish the sports injury problem as a critical component of general global health policy agendas, and to introduce sports safety as a mandatory component of all sustainable sports organizations.We conclude that the establishment of an explicit intersection between science and policy making is necessary for the future development of sports and the necessary safety gains required for all participants around the world. The Safe Sports International safety promotion programme is outlined as an example of an international organization active within this arena.

Characteristics of injuries sustained by snowboarders in a terrain park

Objective:To determine injured body regions and injury type resulting from snowboarding on aerial and nonaerial terrain park features and the accuracy of ski patrol assessments compared with physician diagnoses. Design:Case series study. Setting:An Alberta terrain park during the 2008-2009 and 2009-2010 seasons. Patients:There were 333 snowboarders injured on features (379 injuries). Assessment of Risk Factors:Aerial or nonaerial terrain park feature used at injury, injured body region, injury type, and additional risk factors were recorded from ski patrol Accident Report Forms, emergency department medical records, and telephone interviews. Measures:Odds of injury to body regions and injury types on aerial versus nonaerial features were calculated using multinomial logistic regression. Accuracy of ski patrol injury assessments was examined through sensitivity, specificity, and kappa (&kgr;) statistics. Results:The wrist was the most commonly injured body region (20%), and fracture was the most common injury type (36%). Compared with the upper extremity, the odds of head/neck [odds ratio (OR), 2.58; 95% confidence interval (CI), 1.37-4.85] and trunk (OR, 3.65; 95% CI, 1.68-7.95) injuries were significantly greater on aerial features. There was no significant association between aerial versus nonaerial feature and injury type. The accuracy of ski patrol injury assessment was higher for injured body region (&kgr; = 0.65; 95% CI, 0.54-0.75) than for injury type (&kgr; = 0.29; 95% CI, 0.22-0.37). Conclusions:Snowboarders were significantly more likely to sustain head/neck or trunk injuries than upper extremity injuries on aerial features. Investigators should acknowledge potential misclassification when using ski patrol injury assessments.

COGNITIVE STYLES OF FRENCH CANADIAN ATHLETES

The purpose of this study was to assess field-dependence/independence of 192 French Canadian athletes involved in a university athletic program. Field-dependence refers to one who is strongly influenced by his immediate environment, while a field-independent is individually oriented and much less influenced by environment. Analysis of variance showed that for these athletes there were no significant differences for the embedded figures test scores on age, sex, level of competition, and sports. The highest mean score of 13.86 was obtained by athletes older than 18 yr. of age.