Converging evidence for the under-reporting of concussions in youth ice hockey

Background: Concussions are potentially serious injuries. The few investigations of prevalence or incidence in youth ice hockey have typically relied on prospective reports from physicians or trainers and did not survey players, despite the knowledge that many athletes do not report probable concussions. Objective: This study sought to compare concussion rates in youth ice hockey that were estimated from a variety of reporting strategies. Methods: Rates were calculated from British Columbia Amateur Hockey Association (BCAHA) official injury reports, from direct game observation by minor hockey volunteers (such as coaches and managers), as well as from retrospective surveys of both elite and non-elite youth players. All research was conducted within the BCAHA. Results: Estimates from official injury reports for male players were between 0.25 and 0.61 concussions per 1000 player game hours (PGH). Concussion estimates from volunteer reports were between 4.44 and 7.94 per 1000 PGH. Player survey estimates were between 6.65 and 8.32 per 1000 PGH, and 9.72 and 24.30 per 1000 PGH for elite and non-elite male youth hockey, respectively. Conclusion: It was found that concussions are considerably under-reported to the BCAHA by youth hockey players and team personnel.