Conditional recommendations are made supporting preventive interventions concussion education and rules prohibiting high-risk activity for both pediatric and adult amateur athletes and neck strengthening exercise in adult amateur athletes .
Strong recommendations are supported for head protective equipment in both pediatric and adult amateur athletes .
Strong recommendations regarding newer football helmet technology in adult amateur athletes and rules governing the implementation of body-checking in youth ice hockey are supported .
Background Awareness of the magnitude of contact sports-related concussions has risen exponentially in recent years .
Our objective is to conduct a prospect ively registered systematic review of the scientific evidence regarding interventions to prevent contact sports-related concussions .
Risk of injury associated with bodychecking experience among youth hockey players
Background : In a previous prospect i ve study , the risk of concussion and all injury was more than threefold higher among Pee Wee ice hockey players ( ages 11–12 years ) in a league that allows  bodychecking than among those in a league that does not . We examined whether two years of bodychecking experience in Pee Wee influenced the risk of concussion and other injury among players in a Bantam league ( ages 13–14 ) compared with Bantam players introduced to bodychecking for the first time at age 13 . Methods : We conducted a prospect i ve cohort study involving hockey players aged 13–14 years in the top 30 % of divisions of play in their leagues . Sixty-eight teams from the province of Alberta ( n = 995 ) , whose players had two years of bodychecking experience in Pee Wee , and 62 teams from the province of Quebec ( n = 976 ) , whose players had no bodychecking experience in Pee Wee , participated . We estimated incidence rate ratios ( IRRs ) for injury and for concussion . Results : There were 272 injuries ( 51 concussions ) among the Bantam hockey players who had bodychecking experience in Pee Wee and 244 injuries ( 49 concussions ) among those without such experience . The adjusted IRRs for game-related injuries and concussion overall between players with bodychecking experience in Pee Wee and those without it were as follows : injury overall 0.85 ( 95 % confidence interval [ CI ] 0.63 to 1.16 ) ; concussion overall 0.84 ( 95 % CI 0.48 to 1.48 ) ; and injury result ing in more than seven days of time loss ( i.e. , time between injury and return to play ) 0.67 ( 95 % CI 0.46 to 0.99 ) . The unadjusted IRR for concussion result ing in more than 10 days of time loss was 0.60 ( 95 % CI 0.26 to 1.41 ) . Interpretation : The risk of injury result ing in more than seven days of time loss from play was reduced by 33 % among Bantam hockey players in a league where bodychecking was allowed two years earlier in Pee Wee compared with Bantam players introduced to bodychecking for the first time at age 13 . In light of the increased risk of concussion and other injury among Pee Wee players in a league where bodychecking is permitted , policy regarding the age at which hockey players are introduced to bodychecking requires further consideration
Conditional recommendations are made supporting preventive interventions concussion education and rules prohibiting high-risk activity for both pediatric and adult amateur athletes and neck strengthening exercise in adult amateur athletes .
Strong recommendations are supported for head protective equipment in both pediatric and adult amateur athletes .
Strong recommendations regarding newer football helmet technology in adult amateur athletes and rules governing the implementation of body-checking in youth ice hockey are supported .
Background Awareness of the magnitude of contact sports-related concussions has risen exponentially in recent years .
Our objective is to conduct a prospect ively registered systematic review of the scientific evidence regarding interventions to prevent contact sports-related concussions .