My interest in brain injuries, and most importantly the capacity to prevent them (readers may recall my blog in February regarding Chronic Traumatic Encephalopathy), and injury prevention for children in particular (such as my most recent post regarding hot water scalds) was stimulated again after reading the recent publication “Mechanisms of team-sport-related brain injuries in children 5 to 19 years old: opportunities for prevention” (see http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0058868).  The authors conducted a case series analysis of brain injuries suffered as a consequence of playing ice hockey, soccer, football, basketball, baseball or rugby, and which were recorded in the Canadian Hospitals Reporting and Prevention Program database between 1990 and 2009.

Ice hockey accounted for 44% of the nearly 13,000 brain injuries, and most brain injuries were caused by being struck by another player irrespective of whether the player was wearing a helmet or not, and checking into the boards. Alarmingly, helmet-use was lowest amongst the youngest players. Soccer accounted for 19% of brain injuries, and again being struck by another player was one of the key contributors to brain injury. Whilst the youngest players were more likely to be injured from striking the goal post, brain injuries from kicks to the head increased with player age. Football accounted for 13% of the brain injuries, and the injuries caused by tackles increased as players aged. Consistent with ice hockey, helmet-wearing rates increased with age, and the most common source of injury irrespective of helmet-use was being struck by another player. Basketball accounted for nearly 12% of brain injuries, and brain injuries arising from contact with other players increased as the player aged. Baseball and rugby accounted for roughly 6% each of brain injuries, with the baseball being the most common mechanism of injury for baseball players, and being struck by another player most influential in rugby players.

The authors note that for ice hockey, checking into the boards from behind has been prohibited for two decades, yet the behaviour persists. This suggests that greater enforcement of rules regarding body checking are required. Mandatory wearing of helmets which comply with safety standards may be required in contact sports, whilst after-market padding can reduce negative impacts from collisions with guard posts. Education regarding brain injury risks are important not only for players, but also their parents, the coaches and league officials, particularly  in light of research evidence regarding the relationship between brain injury, brain damage, and early dementia.