Background The risk of concussion is high in Canadian youth ice hockey. Aiming to reduce this burden, in 2011 Hockey Canada implemented a national `zero tolerance for head contact (HC)` policy mandating the penalization of any player-to-player HC. In 2018-20, Hockey Canada further amended this HC-policy including stricter enforcement of severe HCs. Objective To compare HC rates and HC enforcement pre-policy, post-policy, and following policy amendments in elite U15 Canadian youth ice hockey. Design Prospective cohort. Setting A collection of events recorded with a video-camera located at the highest point near centre-ice in public ice hockey arenas in Calgary, Alberta. Participants A convenience sample of 10 AA (elite) U15 (13-14 year old) games pre-policy (2008-09), 8 games post-policy (2013-14), and 10 games following policy amendments (2020-21). Assessment of Risk Factors An analysis of HC-policy implementation and policy amendments across three cohort years. Main Outcome Measurements Using Dartfish video-analysis software; all player contacts and HCs [direct (HC1), indirect (e.g., boards, ice) (HC2)] were tagged using validated criteria. Univariate Poisson regression [clustering by team-game offset by game-length (minutes)] was used to estimate HC1 and HC2 incidence rates (IR) and incidence rate ratios (IRR) between cohorts. Results A total of 11,427 physical contacts were tagged (n2008-09=3896, n2013-14=3183, n2020-21=4348), with 538 contacts including the head (340 HC1,198 HC2) (n2008-09HC1=125, HC2=66; n2013-14HC1=110, HC2=44; n2020-21HC1=105, HC2=88). With additional rule modifications, a 30% reduction in HC1s emerged (IRR2013-2020=0.70, 95%CI:0.51-0.95). Since the HC-policy implementation, HC1s decreased by 24% (IRR2008-2020=0.76, 95%CI:0.58-0.99). The proportion of HC1s penalized was similar across cohorts (P2008-09=14.4%; P2013-14=15.5%; P2020-21=16.2%). Conclusions The HC-policy amendments and increased policy implementation time have led to a decreased rate of HC1s. However, referee enforcement can further boost the HC-policy effectiveness. These findings can help future referee training and potential rule modifications to increase player safety nationally.
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