Canada's national winter sport of ice hockey has high youth participation; however, research surrounding female ice hockey is limited and the injury burden remains high. This study compared rates of ...head contact (HC), body checking (BC; high-intensity player-to-player contact), and suspected concussion between female and male youth ice hockey.
Cross-sectional.
Game video-recordings captured in Calgary, Canada.
Ten female (BC prohibited) and 10 male (BC permitted) U15 elite AA (13-14-year-old) game video-recordings collected in the 2021 to 22 seasons and 2020 to 21, respectively.
An analysis of player-to-player physical contact and injury mechanisms using video-analysis.
Videos were analyzed in Dartfish video-analysis software and all physical contacts were coded based on validated criteria, including HCs (direct HC1, indirect HC2), BC (levels 4-5 on a 5-point intensity scale), and video-identified suspected concussions. Univariate Poisson regression clustering by team-game offset by game-length (minutes) were used to estimate incidence rates and incidence rate ratios (IRR, 95% confidence intervals).
The female game had a 13% lower rate of total physical contacts (IRR = 0.87, 0.79-0.96) and 70% lower rate of BC (IRR = 0.30, 0.23-0.39). There were however no differences in the rates of direct HC (IRR = 1.04, 0.77-1.42) or suspected concussion (IRR = 0.42, 0.12-1.42) between the cohorts. Although prohibited in the female game, only 5.4% of HC1s and 18.6% of BC resulted in a penalty.
The rates of HC1s and suspected concussions were similar across youth ice hockey. BC rates were lower in the female game, yet still prevalent despite being prohibited.
Our primary objectives were to identify clinical practice guideline recommendations for children with acute mild traumatic brain injury (mTBI) presenting to an emergency department (ED), appraise ...their overall quality, and synthesize the quality of evidence and the strength of included recommendations.
We searched MEDLINE, EMBASE, Cochrane Central, Web of Science, and medical association websites from January 2012 to May 2023 for clinical practice guidelines with at least 1 recommendation targeting pediatric mTBI populations presenting to the ED within 48 hours of injury for any diagnostic or therapeutic intervention in the acute phase of care (ED and inhospital). Pairs of reviewers independently assessed overall clinical practice guideline quality using the Appraisal of Guidelines Research and Evaluation (AGREE) II tool. The quality of evidence on recommendations was synthesized using a matrix based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Evidence-to-Decision framework.
We included 11 clinical practice guidelines, of which 6 (55%) were rated high quality. These included 101 recommendations, of which 34 (34%) were based on moderate- to high-quality evidence, covering initial assessment, initial diagnostic imaging, monitoring/observation, therapeutic interventions, discharge advice, follow-up, and patient and family support. We did not identify any evidence-based recommendations in high-quality clinical practice guidelines for repeat imaging, neurosurgical consultation, or hospital admission. Lack of strategies and tools to aid implementation and editorial independence were the most common methodological weaknesses.
We identified 34 recommendations based on moderate- to high-quality evidence that may be considered for implementation in clinical settings. Our review highlights important areas for future research. This review also underlines the importance of providing strategies to facilitate the implementation of clinical practice guideline recommendations for pediatric mTBI.
Therapeutic targets have been defined for axial and peripheral spondyloarthritis (SpA) in 2012, but the evidence for these recommendations was only of indirect nature. These recommendations were ...re-evaluated in light of new insights. Based on the results of a systematic literature review and expert opinion, a task force of rheumatologists, dermatologists, patients and a health professional developed an update of the 2012 recommendations. These underwent intensive discussions, on site voting and subsequent anonymous electronic voting on levels of agreement with each item. A set of 5 overarching principles and 11 recommendations were developed and voted on. Some items were present in the previous recommendations, while others were significantly changed or newly formulated. The 2017 task force arrived at a single set of recommendations for axial and peripheral SpA, including psoriatic arthritis (PsA). The most exhaustive discussions related to whether PsA should be assessed using unidimensional composite scores for its different domains or multidimensional scores that comprise multiple domains. This question was not resolved and constitutes an important research agenda. There was broad agreement, now better supported by data than in 2012, that remission/inactive disease and, alternatively, low/minimal disease activity are the principal targets for the treatment of PsA. As instruments to assess the patients on the path to the target, the Ankylosing Spondylitis Disease Activity Score (ASDAS) for axial SpA and the Disease Activity index for PSoriatic Arthritis (DAPSA) and Minimal Disease Activity (MDA) for PsA were recommended, although not supported by all. Shared decision-making between the clinician and the patient was seen as pivotal to the process. The task force defined the treatment target for SpA as remission or low disease activity and developed a large research agenda to further advance the field.
Ringette and female ice hockey are high participation sports in Canada. Despite policies disallowing body checking, both sports have high injury and concussion rates. This study aimed to compare ...physical contact (PC), head contact (HC), and suspected injury and concussion incidence rates (IRs) in female varsity ringette and ice hockey.
Cross-sectional.
Canadian ice arenas.
Eighteen Canadian female university ringette and ice hockey tournament/playoff games in the 2018-2019/2019-2020 seasons.
Game video-recordings were analyzed using Dartfish video-analysis software to compare both sports.
Univariate Poisson regression analyses (adjusted for cluster by team, offset by game-minutes) were used to estimate PC, HC, and suspected injury IRs and incidence rate ratios (IRRs) to compare rates across sports. Proportions of body checks (level 4-5 trunk PC) and direct HC (HC 1 ) penalized were reported.
Analyses of 36 team-games (n = 18 ringette, n = 18 hockey) revealed a 19% lower rate of PCs in ringette than ice hockey {IRR = 0.81 95% confidence interval (CI), 0.73-0.90}, but a 98% higher rate of body checking IRR = 1.98 (95% CI, 1.27-3.09) compared to ice hockey. Ringette had a 40% higher rate of all HC 1 s IRR = 1.40 (95% CI, 1.00-1.96) and a 3-fold higher rate of suspected injury IRR = 3.11 (95% CI, 1.13-8.60) than ice hockey. The proportion of penalized body checks and HC 1 s were low across sports.
Body checking and HC 1 rates were significantly higher in ringette compared to ice hockey, despite rules disallowing both, and very few were penalized. These findings will inform future injury prevention research in ringette and female ice hockey.
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