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. 2006 Oct-Dec;41(4):441–449.

Injuries Sustained by Pediatric Ice Hockey, Lacrosse, and Field Hockey Athletes Presenting to United States Emergency Departments, 1990–2003

Ellen Elizabeth Yard *, R Dawn Comstock *,†
PMCID: PMC1748420  PMID: 17273471

Abstract

Context: Ice hockey, lacrosse, and field hockey are increasingly popular sports among US youth athletes, but no authors to date have compared injuries in male and female pediatric (ages 2 through 18 years) participants.

Objective: To compare patterns of injury among pediatric ice hockey, lacrosse, and field hockey players.

Design: A descriptive analysis of all pediatric (ages 2 through 18 years) ice hockey, lacrosse, and field hockey injuries captured by the US Consumer Product Safety Commission's National Electronic Injury Surveillance System.

Setting: US Consumer Product Safety Commission's National Electronic Injury Surveillance System.

Patients or Other Participants: Children with ice hockey, lacrosse, or field hockey injuries presenting to emergency departments participating in the National Electronic Injury Surveillance System.

Main Outcome Measure(s): We reviewed all ice hockey, lacrosse, and field hockey injuries captured by the National Electronic Injury Surveillance System and categorized them by sex, age, injury site, and injury diagnosis.

Results: An estimated 321 237 pediatric participants in ice hockey, lacrosse, and field hockey presented to US emergency departments from 1990 through 2003. The injured were primarily male (74.4%) and aged 10 through 18 years (95.4%). Ice hockey accounted for more injuries (53.6%) than lacrosse (26.5%) or field hockey (19.9%). Children aged 2 through 9 years sustained twice the proportion of head and face injuries (53.1%) as children aged 10 through 18 years (23.2%) (incidence rate ratio [IRR] = 2.25, 95% confidence interval [CI] = 1.94 to 2.62). Males incurred a higher proportion of shoulder and upper arm injuries (14.1%) than females (3.1%) (IRR = 4.51, 95% CI = 3.07 to 6.62). The proportion of concussion was higher in ice hockey players (3.9%) than in field hockey players (1.4%) (IRR = 2.75, 95% CI = 1.17 to 6.46). Females in lacrosse had twice the proportion of facial injuries (20.9%) as males (10.5%) (IRR = 1.95, 95% CI = 1.46 to 2.60). In all sports, the ball or puck caused a greater proportion of face injuries in females than in males (IRR = 2.48, 95% CI = 2.03 to 3.05). Facial injuries from falls occurred in higher proportions in ice hockey players (10.6%) than in lacrosse (2.4%) (IRR = 4.32, 95% CI = 1.53 to 12.18) and field hockey (0.4%) players (IRR = 28.38, 95% CI = 6.71 to 120.01).

Conclusions: Pediatric ice hockey, lacrosse, and field hockey injuries differed by age and sport and, within each sport, by sex. An understanding of sport-specific patterns of injury should assist coaches and certified athletic trainers in developing targeted preventive interventions.

Keywords: epidemiology, athletic injuries, protective equipment

Ice hockey, lacrosse, and field hockey are increasingly popular sports among US youth. In 2004, more than 370 000 registered youth played ice hockey, 1 an estimated 275 000 played lacrosse, 2 and an estimated 60 000 played field hockey. 3 From 1990 to 2004, ice hockey participation at the high school level has increased 87%, lacrosse participation has increased 254%, and field hockey participation has increased 28%. 4 Although these 3 sports are distinct, participants in each sport move at high speeds and use a stick to swing at a ball or puck, a combination that places players at risk of injury. The amount of required protective equipment in each sport correlates with the level of permitted player-to-player contact: participants in ice hockey and men's lacrosse wear the most equipment, whereas those in field hockey and women's lacrosse don little ( Table 1).

Table 1. Required Protective Equipment and Permitted Player-to-Player Contact for Pediatric Ice Hockey, Lacrosse, and Field Hockey by Sex, United States, 1990–2003.

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To date, no authors have compared male and female pediatric (ages 2 through 18 years) ice hockey, lacrosse, and field hockey injuries. Prior studies of pediatric injuries in these sports were uncommon and tended to be sex specific. Ice hockey has received the most attention, 5–13 with several studies focused specifically on children. 10–13 Research in lacrosse, which has primarily focused on head, face, and neck injuries, 14–17 includes one study of high school lacrosse players 18 and another study of all age groups using nationally representative data. 19 The few investigations of field hockey injuries include studies focused on adult players at the international level 20 as well as one study of female high school field hockey players. 21

Effectiveness of protective gear has been assessed in various sports; although its use is generally recommended, 10, 16, 19, 22, 23 some researchers have mixed views. 18, 24, 25 Proponents assert that protective equipment lowers injury rates. 16, 22, 23 Others have found that protective gear either makes no difference 24 or encourages participants to play more dangerously, leading to higher injury rates to protected regions 18 or elsewhere. 25 Our objective was to compare the patterns of injuries sustained by pediatric athletes in ice hockey, lacrosse, and field hockey presenting to US emergency departments (EDs). The use of sticks and fast-moving projectiles in these 3 sports places athletes at risk of injury, although each sport has distinct rules regarding player-to-player contact and the use of protective equipment ( Table 1). Knowing more about these sport-related injury patterns may enable coaches and certified athletic trainers to develop interventions such as specific drills or equipment policies that maximize athletic performance while reducing the risk of injury.

METHODS

The US Consumer Product Safety Commission's (CPSC) National Electronic Injury Surveillance System (NEISS) collects information from a network of 100 US hospitals. At NEISS hospitals (a stratified probability sample of all hospitals in the nation with at least 6 beds and a 24-hour ED), trained coders review all ED records daily and enter demographic, injury, and treatment information into the NEISS database. 26 Coders also assign 1 or 2 CPSC-specific product codes to each case. These codes designate the products being used and the activities being engaged in at the time of injury.

We evaluated all cases of children aged 2 through 18 years presenting to EDs in NEISS hospitals that were coded as ice hockey, lacrosse, or field hockey injuries (codes 1279, 1215, and 1295, respectively) between January 1, 1990, and December 31, 2003. As an example of the coding mechanism, any ED admission resulting from playing ice hockey or resulting from an ice hockey skate, stick, or puck should have received a code of 1279.

To be included in this study, the injury had to occur during active participation in 1 of these 3 sports. No differentiation was made between structured (formal practice or competition) or unstructured (school yard, home, etc) activity. Cases involving spectators or injuries from equipment that were sustained while not playing were excluded. For example, a hockey spectator hit by the puck and an individual who cut his hand while taping a lacrosse stick were removed. The variables analyzed include sport, sex, and age and injury region, diagnosis, and mechanism. The 26 injury regions recorded by NEISS were, for the purposes of this study, grouped into head, face, neck, shoulder/upper arm, elbow/lower arm, hand/wrist, upper leg/knee, lower leg/foot/ankle, and other. With newer rules mandating eye goggles in women's lacrosse and the large number of facial injuries typically seen in EDs, we thought additional attention to this detail might be interesting to the readership and might possibly inform prevention initiatives. However, providing this detailed of a breakdown for all types or sites of injury would be too much to accomplish in this article. Injury diagnoses were categorized into contusion/abrasion, strain/sprain, fracture, laceration, concussion, and other. Injury mechanism was ascertained by reading through the NEISS narrative of every case and coding the injury mechanism as stick, ball/puck, player collision, fall, and other (eg, noncontact, overuse). The institutional review board at Columbus Children's Research Institute approved this study.

Statistical Analysis

We used SPSS (version 14.0; SPSS Inc, Chicago, IL) for data analysis. Unless otherwise stated, data presented represent national estimates calculated through the use of statistical weights provided by the CPSC to account for the complex sample design of NEISS. Sport-specific and sex-specific injury rates using the national estimate of those injured in the numerator and the estimated US census population of those aged 2 through 18 years in the denominator 27 were calculated to compare injury magnitude by sport; linear regression was used to calculate slopes for these injury rates and to analyze trend significance, with P values of less than .05 considered significant.

Categorical variables were assessed through injury proportion ratios (IPRs) with 95% confidence intervals (CIs); the SPSS Complex Samples module was used to account for the stratum, primary sampling unit, and weights of the complex survey design, with P values of less than .05 considered significant. As an example of IPR calculation, the formula for comparing the proportion of fractures between males and females is as follows:

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RESULTS

Demographics

An estimated 321 237 children aged 2 through 18 years were treated in US EDs from 1990 through 2003 for injuries sustained while participating in ice hockey, lacrosse, or field hockey. This number corresponds to an estimated 23 059 injured children each year. Demographic information is presented in Table 2. Ice hockey resulted in more injuries than lacrosse and field hockey combined, and males represented three quarters of all cases. Fewer than 5% of the injured were aged 9 years or younger. Disposition was similar among all cases, with most (98.5%) patients being treated and released. No fatalities were reported among any cases during this study period.

Table 2. Characteristics of Pediatric Ice Hockey, Lacrosse, and Field Hockey Injuries in Athletes Presenting to Emergency Departments, United States, 1990–2003.

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General Epidemiology

Injuries in male ice hockey players peaked in 1993 and were lowest in 1990 and 2002 ( Figure 1). The injury rates in male lacrosse and female field hockey players decreased during the study period (β 1 = −.55, P = .035; and β 1 = −.41, P = .011, respectively), whereas the rate in female lacrosse players increased (β 1 = .21, P = .006). No other trends were significant. Overall, 3.5 per 10 000 US children were treated in EDs yearly for ice hockey, lacrosse, and field hockey injuries.

Figure 1. Pediatric ice hockey, lacrosse, and field hockey athletes with injuries presenting to emergency departments by sport, United States, 1990–2003. Calculated using statistical weights provided by the Consumer Product Safety Commission National Electronic Injury Surveillance System 26 and US Census age group population estimates. 27 The trends for male field hockey, female ice hockey, and female lacrosse players contain fewer than 25 cases in some years and, thus, may be unstable .

Figure 1

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For all 3 sports combined, children aged 2 through 9 years sustained double the proportion (53.2%) of head and face injuries as children aged 10 through 18 years (23.5%) (IPR = 2.25, 95% CI = 1.94 to 2.62). Males incurred a larger proportion of shoulder/upper arm injuries (14.1%) than females (3.1%) (IPR = 4.51, 95% CI = 3.07 to 6.62) and a larger proportion of fractures (19.3%) than females (13.4%) (IPR = 1.44, 95% CI = 1.25 to 1.67). Females incurred larger proportions of facial injuries (20.4%) than males (14.4%) (IPR = 1.40, 95% CI = 1.15 to 1.72), larger proportions of hand/wrist injuries (30.2%) than males (18.2%) (IPR = 1.66, 95% CI = 1.44 to 1.90), larger proportions of lower leg/foot/ankle injuries (19.8%) than males (11.8%) (IPR = 1.63, 95% CI = 1.37 to 1.95), and larger proportions of strains/sprains (27.1%) than males (19.4%) (IPR = 1.40, 95% CI = 1.20 to 1.63).

Most lacerations among all sport participants occurred to the face (57.5%). Contusion/abrasion occurred most frequently to the finger (11.6%), followed by the shoulder (10.2%). Strain/sprain was diagnosed most commonly in the ankle (29.0%) and knee (16.2%). Fractures occurred most frequently to the finger (22.3%) and shoulder (16.2%).

Patterns of Injury by Sport and Sex

Ice Hockey

Ice hockey accounted for an estimated 172 128 injuries from 1990 through 2003. Body region injured for all subjects by sport is presented in Figure 2. Males injured their hand/wrist, face, and shoulder/upper arm most often, whereas females most frequently injured the face, hand/wrist, and head ( Figure 3). Males sustained nearly double the proportion of shoulder/upper arm injuries (IPR = 1.82, 95% CI = 1.15 to 2.91). Although females tended to injure the head in greater proportions (IPR = 1.33), this difference was insignificant ( Figure 3).

Figure 2. Injury sites of pediatric ice hockey, lacrosse, and field hockey athletes presenting to emergency departments by sport, United States, 1990–2003. Calculated using statistical weights provided by the Consumer Product Safety Commission National Electronic Injury Surveillance System. 26 Population numbers represent national yearly estimates calculated via 3-year rolling averages .

Figure 2

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Figure 3. Regions of pediatric athletes' ice hockey, lacrosse, and field hockey injuries in athletes presenting to emergency departments by sport and sex, United States, 1990–2003. A, Males, n = 17 109. B, Females, n = 5949. Calculated using statistical weights provided by the Consumer Product Safety Commission National Electronic Injury Surveillance System. 26 Population numbers represent national yearly estimates calculated via 3-year rolling averages .

Figure 3

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The most common diagnoses among males were contusion/ abrasion, laceration, fracture, and strain/sprain ( Figure 4). The most common diagnoses among females were contusion/abrasion, strain/sprain, and laceration. Males had double the proportion of fractures compared with females (IPR = 2.14, 95% CI = 1.40 to 3.30; Figure 4).

Figure 4. Diagnoses of pediatric athletes with ice hockey, lacrosse, and field hockey injuries presenting to emergency departments by sport and sex, United States, 1990–2003. A, Males, n = 17 109. B, Females, n = 5949. Calculated using statistical weights provided by the Consumer Product Safety Commission National Electronic Injury Surveillance System. 26 Population numbers represent national yearly estimates calculated via 3-year rolling averages .

Figure 4

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Lacrosse

An estimated 85 039 US children were treated for lacrosse injuries from 1990 through 2003. The most commonly injured regions among males were hand/wrist, shoulder/upper arm, and lower leg/foot/ankle ( Figure 3). Females were most likely to injure their lower leg/foot/ankle, hand/wrist, and face. Males sustained almost 5 times the proportion of shoulder injuries compared with females (IPR = 4.80, 95% CI = 2.64 to 8.73) and more than twice the proportion of elbow injuries compared with females (IPR = 2.29, 95% CI = 1.36 to 3.86). Females had almost twice the proportion of lower leg/foot/ankle injuries compared with males (IPR = 1.80, 95% CI = 1.34 to 2.42) and double the proportion of face injuries (IPR = 1.95, 95% CI = 1.46 to 2.60).

The most common diagnoses in males were contusion/abrasion, strain/sprain, and fracture ( Figure 4). In females, the most common diagnoses were strain/sprain, contusion/abrasion, and fracture. Males sustained a larger proportion of fractures than females (IPR = 1.45, 95% CI = 1.13 to 1.87).

Field Hockey

From 1990 through 2003, approximately 64 070 US children sustained injuries requiring a visit to the ED while playing field hockey. The hand/wrist was injured most frequently, followed by the face and the lower leg/foot/ ankle ( Figure 3). Males sustained a greater proportion of elbow/lower arm injuries (IPR = 2.31, 95% CI = 1.10 to 4.84).

The most frequent diagnoses among males were contusion/ abrasion, strain/sprain, and laceration, whereas in females the most frequent diagnoses were contusion/abrasion, strain/ sprain, fracture, and laceration ( Figure 4). Males sustained a higher proportion of lacerations (IPR = 1.56, 95% CI = 1.09 to 2.24).

Comparison Among Sports

Male field hockey players sustained a larger proportion of facial injuries than male ice hockey (IPR = 1.57, 95% CI = 1.15 to 2.14) and male lacrosse players (IPR = 2.29, 95% CI = 1.60 to 3.26; Figure 3). Females experienced a similar proportion of facial injuries in ice hockey, lacrosse, and field hockey. Table 3 shows the site and diagnosis of facial injuries by sport and sex. Ice hockey and female field hockey players with facial injuries sustained lower proportions of eye injuries than lacrosse and male field hockey players. Females in lacrosse tended to sustain a higher, but nonsignificant, proportion of facial fractures compared with those in all other sports (IPR = 1.76).

Table 3. Site and Diagnosis of Facial Injuries for Pediatric Ice Hockey, Lacrosse, and Field Hockey Injuries in Athletes Presenting to Emergency Departments by Sport and Sex, United States, 1990–2003 [No. (%)]*.

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Shoulder/upper arm injuries among males occurred in greater proportions during ice hockey than during field hockey (IPR = 3.41, 95% CI = 1.47 to 7.90) and during lacrosse than during field hockey (IPR = 3.45, 95% CI = 1.47 to 8.10; Figure 3). In females, shoulder/upper arm injuries occurred in greater proportions during ice hockey than during either lacrosse (IPR = 2.60, 95% CI = 1.22 to 5.54) or field hockey (IPR = 3.52, 95% CI = 1.57 to 7.90). Field hockey players sustained greater proportions of hand/wrist injuries than ice hockey (IPR = 2.15, 95% CI = 1.85 to 2.50) or lacrosse players (IPR = 1.49, 95% CI = 1.31 to 1.69). Among women, lacrosse players injured the lower leg/foot/ankle in greater proportions than ice hockey players (IPR = 2.52, 95% CI = 1.60 to 3.97; Figure 3).

Concussion was more prevalent among youth playing ice hockey than among those playing field hockey (IPR = 2.75, 95% CI = 1.17 to 6.46). Ice hockey and field hockey players were diagnosed with lacerations in greater proportions than lacrosse players (IPR = 2.41, 95% CI = 1.87 to 3.10, and IPR = 1.72, 95% CI = 1.30 to 2.28, respectively; Figure 4). Lacrosse and field hockey players were diagnosed with strain/ sprain in greater proportions than ice hockey players (IPR = 1.56, 95% CI = 1.40 to 1.74).

Mechanism of Injury

Overall, only 65.4% of all ED narratives included enough information to categorize the injury mechanism. This information was present more often when the injury was to the face (81.4%) or head (80.3%) than when injury was to the upper (61.3%) or lower extremities (50.9%). Of all coded mechanisms, contact with another player was the most common (30.5%), followed by stick (27.2%), fall (18.0%), ball/ puck (15.3%), and other (8.9%).

Common mechanisms of facial injuries by sport and sex are shown in Figure 5. Overall, male facial injuries most often resulted from the stick (45.5%), ball/puck (21.2%), and player contact (15.8%). Most female facial injuries resulted from the ball/puck (46.3%) and stick (44.7%). The ball/puck caused a higher proportion of facial injuries among females than males (IPR = 2.18, 95% CI = 1.80 to 2.66). Sticks accounted for twice the proportion of facial injuries among male field hockey players compared with all other male and female sports combined (IPR = 2.17, 95% CI = 1.74 to 2.70). Male facial injuries from falls occurred in higher proportions in ice hockey players (13.8%) than in lacrosse players (3.0%) (IPR = 4.56, 95% CI = 1.62 to 12.58) and field hockey players (0.4%) (IPR = 32.99, 95% CI = 7.60 to 143.17).

Figure 5. Mechanisms of pediatric athletes' ice hockey, lacrosse, and field hockey facial injuries in athletes presenting to emergency departments by sport and sex, United States, 1990–2003. A, Males, n = 2459. B, Females, n = 1214. Calculated using statistical weights provided by the Consumer Product Safety Commission National Electronic Injury Surveillance System. 26 Population numbers represent national yearly estimates calculated via 3-year rolling averages .

Figure 5

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DISCUSSION

In our study, the first to compare injuries among pediatric ice hockey, lacrosse, and field hockey players, we found an estimated 3.5 per 10 000 US children were treated in EDs annually for injuries sustained while participating in these sports from 1990 through 2003. Pediatric ice hockey, lacrosse, and field hockey injuries differed by age and sport and, within each sport, by sex. An understanding of sport-specific patterns of injury should assist coaches and certified athletic trainers in developing targeted preventive interventions. For example, because males in ice hockey and lacrosse sustained higher proportions of shoulder/upper arm injuries, additional or improved equipment and strength training may be useful. Meanwhile, full headgear use may decrease the high proportion of females and male field hockey players sustaining facial injuries. Ongoing sport surveillance data to collect participation information is needed to more accurately assess the burden of injuries in these sports, to monitor trends over time, to develop preventive interventions, and to determine intervention effectiveness.

As the amount of required protective equipment and permitted contact increases (ie, from field hockey to lacrosse to ice hockey), pediatric injury rates appear to increase in males and decrease in females ( Figure 1). Previous researchers 28, 29 found that sports with more contact have higher injury rates. Although our rates are not directly comparable with previously reported injury rates as a result of the use of census population estimates for our rate denominators, as opposed to athlete-exposures, our finding for male athletes supports prior assertions that sports containing higher levels of physical contact do have higher injury rates. Our opposing findings for female athletes may be due, in part, to more females participating in field hockey, a sport with fewer injuries than lacrosse or ice hockey. 30 Alternatively, these results also indicate that the type of protective equipment worn in ice hockey may be more effective when protecting against the incidental contact that occurs in the female game. The effectiveness of this equipment may decrease when body checking is introduced, as exemplified by the higher injury rate in male ice hockey compared with any other sport in this study.

Injuries to the shoulder/upper arm region increased as the level of contact and the amount of protective equipment worn increased, with ice hockey and male lacrosse having the highest proportions of shoulder/upper arm injuries. This result is consistent with that of previous researchers in lacrosse, 18 who found that high school males had more shoulder/upper arm injuries than females. Because shoulder pads are worn in ice hockey and male lacrosse, this finding indicates that shoulder pads may not fully protect against the increased amount of player-to-player contact in these sports. Reid and Losek 11 suggested that there may be a false sense of security among youth that shoulder pads will protect them from any injury, making them more likely to engage in dangerous checks.

Our finding that younger children (aged 2 through 9 years) were more than twice as likely to sustain an injury to the head or face than children aged 10 through 18 years supports previous lacrosse research. 19 Younger children may be more likely to play these sports in an unstructured environment, such as at home or on the playground, where headgear usage goes unregulated. Also, younger participants likely have lower skill levels and, thus, may not be as proficient in game fundamentals, such as passing and catching, which can be particularly dangerous in lacrosse, with a catching target zone adjacent to the head, 19 or in stick control, which is important in each of these sports.

Females in all 3 sports and male field hockey players sustained greater proportions of facial injuries than males playing ice hockey and lacrosse. This finding supports previous findings reporting the face as one of the most commonly injured regions in field hockey 21 and female lacrosse, 18, 19 and this finding is likely due in part to the lack of required protective headgear in these sports. 14–16, 19 Although field hockey participants are permitted to wear mouth guards, the goalie is the only player currently required to wear facial protection. In addition, the high proportion of facial injuries occurring away from the mouth indicates that the increased facial protection provided by face masks in conjunction with mouth guards would help to decrease facial injuries in field hockey players.

Compared with male lacrosse players, the greater dependence on cradling the ball in female lacrosse players causes the stick to be held in a more upright position that brings the stick closer to the face, making this area more vulnerable to stick and ball contact. 15 As is the case with field hockey, most facial injuries in female lacrosse players occur away from the eye and mouth, indicating that the January 2005 mandate by the National Federation of High Schools (NFHS) requiring eye goggles may have limited impact. 4 In addition, since more than 20% of female lacrosse facial injuries were fractures, rule changes requiring full facial protection may have much greater injury-prevention potential.

Our study limitations correspond with the limitations of the NEISS data set. Injuries presenting to NEISS EDs represent only the most severe injuries, and only the most serious injury per individual is recorded. The NEISS provides limited information on whether injuries occurred in unstructured or structured environments; therefore, we do not know the percentage of children injured in each. Limited descriptive information is available regarding injury mechanisms, protective equipment used, etc. Also, although it is likely that all injuries included in this study were incident injuries, in rare circumstances the same person may have presented to an ED more than once for treatment of the same injury.

Injury rates based on sport-specific exposures cannot be calculated because accurate, comprehensive estimates for the number of children playing each sport in the United States throughout the study period are not available. Thus, the denominators of the injury rates presented in the text used annual census estimates of the total number of US children aged 2 through 18 years, rather than the number of children aged 2 through 18 years actually participating in these sports. Collecting national age-specific sport exposure data is necessary before accurate sport-specific injury rates can be calculated.

Despite these limitations, this data set is the only nationally representative stratified probability sample of pediatric ice hockey, lacrosse, and field hockey injuries in the United States. Additionally, the data set's stability allows changes over time to be monitored. The patterns of injury regions, diagnoses, and mechanisms in the NEISS data set should be representative of all injuries presenting to US EDs; thus, as has been demonstrated previously, NEISS data can provide important information on sports-related injuries among children. 5, 8, 9, 19 With no ongoing exposure-based surveillance at the national or community level and only sporadic surveillance at the high school level, the NEISS data set is the best source of information we currently have to direct prevention efforts in youth sports.

Implications for Prevention

Our results support recommendations that participants should always wear available sport-specific protective equipment. Although our findings support the NFHS mandate requiring eye goggles in female high school lacrosse players, 14–16 our data indicate that full facial masks along with mouth guards would provide increased injury prevention and, thus, should be required or at least encouraged in female lacrosse and field hockey players. Rule changes in female lacrosse that encourage stricter enforcement for stick checks that hit the body instead of the stick should also be considered. 18 Certified athletic trainers working with pediatric athletes new to a sport should ensure that these children are instructed in the proper uses and limitations of their protective equipment. 5 Prior researchers 11, 12 found that half of young ice hockey players believe that helmets and face masks protect completely against all head and neck injuries. Certified athletic trainers should also encourage young male ice hockey and lacrosse players to develop the necessary upper body strength to better absorb impacts associated with giving and receiving checks. In addition, rule changes that restrict or modify checking among young male ice hockey and lacrosse players should be considered.

Long-term surveillance in conjunction with future case-control and cohort studies is needed to assess the effect of protective equipment use on injury rates in pediatric sports and to monitor the effects of new rule changes. Gaining insight into the patterns of pediatric sport injuries can lead to sport-specific equipment and rule modifications and training interventions that decrease injuries among pediatric athletes, increase their overall enjoyment of the sport, and ultimately contribute to their adoption of physical activity as part of a healthy lifestyle.

Acknowledgments

We thank the Consumer Product Safety Commission for providing the data. This study was not supported by any funding agency.

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