Most sports-related brain injuries occur in hockey, study finds

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Hockey is the biggest contributor to sports-related brain injuries in children and teens, a finding that is prompting neurosurgeons, sports-medicine specialists and brain-injury advocates to call for major changes to how the game is played.

A study published in the journal PLOS One on Thursday by researchers at Toronto's St. Michael's Hospital found that hockey accounted for 44 per cent of the sports-related brain injuries that sent people five to 19 years old to 15 Canadian emergency departments from 1990 to 2009. About 10 per cent of the hockey-related brain injuries resulted from hits from behind, which are banned.

"If you extrapolate from our study, where it's only 15 hospitals, that translates into thousands of brain injuries every year from checking from behind," said Dr. Michael Cusimano, lead author of the study and a neurosurgeon at St. Michael's Hospital. "We need to change the culture to say, 'Let's make this thing safer for kids.' "

The findings throw fresh fuel on the debate over whether hockey and other organized sports are simply too dangerous for children and teens to play. A key concern is the potential long-term harm caused by concussions.

"We want our kids to be active, we want them to play games, we want them to play hockey," Dr. Paul Echlin, a sports-medicine physician based in Burlington, Ont., and a leading authority on concussions. "[There are] too many concussions occurring. Hockey can be modified or changed to continue the great game it is. Currently, there's a lot of resistance to keep it the way it is."

Something must be done to change the game because the dangers and perceived risks of hockey are doing considerable harm to participation in the game, said Dr. Charles Tator, a neurosurgeon at the Krembil Neuroscience Centre at Toronto Western Hospital and project leader of the Canadian Sports Concussion Project.

"We are witnessing parents turning away from the game," said Tator, who is also a volunteer and board member at Parachute Canada, an injury-prevention advocacy organization. "Hockey is a great game and it should be safer. Let's save the hockey game."

While sports-related brain injuries are a concern, they make up only about 20 per cent of the brain injuries that affect young people, according to the Ontario Brain Injury Association. Falls, such as down the stairs or off a bike, are a much more common cause of concussions, skull fractures and other brain injuries, said Katie Muirhead, an advocacy specialist at the association.

"Anyone can get a head injury from any activity," she said.

But so much attention is being paid to sports-related brain injuries because they should not be occurring, Tator said. They are preventable incidents that are causing potentially irreparable damage to thousands of young Canadians every year, he said.

The question many are asking is how broad those changes need to be and what can be considered an acceptable level of risk for parents who want to enroll their child in hockey. "We're having some real big issues about what are we doing, how far do we go?" said Martin Mrazik, associate professor in the department of education psychology at the University of Alberta and a neuropsychologist.

Calls for an end to fighting or a ban on head shots may sound good, but the issues involving brain injuries and hockey are much more complicated, Tator said. For instance, at what age is bodychecking appropriate? What can be done about hard plastic shoulder and elbow pads that can do serious damage during a bodycheck? And what about the role of injury prevention and education?

Most experts agree that there is no simple solution.

The new study used data from the Canadian Hospitals Injury Reporting and Prevention Program to figure out the causes of brain injuries that are sending young people to the hospital. The database collects information from 11 pediatric and four general emergency rooms at Canadian hospitals.

From 1990 to 2009, the database recorded 12,799 brain injuries related to organized and informal sports. Of those, 44 per cent, or 5,675, occurred while playing hockey. The most common cause of hockey-related brain injury was being hit by another player. Soccer accounted for 19 per cent of sports-related brain injuries, the study found.

Echlin noted that current injury tracking is insufficient because it can track only those kids who end up in emergency with a concussion. Better reporting mechanisms are needed to truly understand the scope of the problem and develop tailored solutions, he said.

Many experts who have been following the debate about brain injuries and hockey say some significant progress has been achieved in the past few years, such as stricter rules about hits to the head and a greater emphasis on keeping concussed kids off the ice. One of the biggest wins, Mrazik says, is the fact so many people are now talking about the risks of concussions and the need for better programs and education to prevent injuries.

But there is still a long way to go. "I think the game can be made safer without changing the game that much," Tator said. "We just have to do it very smartly."