- © 2004 Canadian Medical Association or its licensors
There are several problems with the analysis of bodychecking and concussions by Anthony Marchie and Michael Cusimano.1 They quote statistics from the popular media alongside those from peer-reviewed journals, their essay contains some inaccurate numbers, and they are selective in their use of the available data.
For instance, citing Honey's review2 of articles published between 1966 and 1997, they state that there were 2.8 concussions per 1000 player-hours for participants aged 5 to 17; however, the concussion rates reported in the 4 studies reviewed by Honey2 were 0.0, 0.5, 1.5 and 2.8, and only the last of these had data for players 5 to 17 years (the age range was narrower for the other 3 studies). Furthermore, Marchie and Cusimano neglect to share 2 major conclusions of that review:2 that the incidence of concussion increases with the level of play and that it has been decreasing in children 5 to 14 years of age.
Elsewhere, Marchie and Cusimano use injury data from high school, university and elite-level players to support their conclusion that our children, and perhaps Canadian society as a whole, would be better off if there was no more checking at the youth level. However, the data from the cited studies3,4,5 support the concept that injury rates climb along with the size and speed of the players.
The American Academy of Pediatrics also endorses the no-checking concept for children.6 They weight heavily data from a small prospective study of hockey injuries in 150 boys, 9 to 15 years of age, over a season.7 However, most of the 52 injuries (sustained by 44 players) were contusions, sprains and strains. Disability was defined as time away from physical activity, not days missed from school or admission to hospital. Fracture, not concussion or catastrophic injury, is why the American Academy of Pediatrics suggests that checking should be proscribed.
Current data do not support the notion that serious injury is a major risk of ice hockey at the more junior levels. It is only when speed and strength outpace judgement, in mid and late adolescence, that the game becomes hazardous. Rather than banning checking in the younger age groups, a concerted international effort should be made to rid hockey of dangerous behaviours, such as checking from behind. Catastrophic injury in football dropped dramatically when spearing was eliminated in the 1970s.3 Surely similar rule changes could be instituted and enforced for hockey.
Ian B. Ross Associate Professor Department of Neurosurgery University of Mississippi Medical Center Jackson, Miss.