Abstract
RATIONALE: The International Ice Hockey Federation and USA Hockey are ice hockey governing bodies that have made neck guards mandatory beginning August 2024.(1,2) These mandates do not include National Hockey league (NHL) or National Collegiate Athletic Association (NCAA) level players. PURPOSE: To describe life-threatening laceration injuries in ice hockey and identify prevention strategies. METHODS: Case summaries for catastrophic ice hockey laceration injuries from the National Center for Catastrophic Sport Injury Research (NCCSIR) were reviewed to describe the mechanism of injury, use of neck protection, and outcome. A Haddon Matrix informed preventative strategies across pre-event, event, and post-event phases as they relate to the athlete, source (skate, puck, stick), and environment.(3)Results:NCCSIR captured 26 catastrophic ice hockey laceration injuries from 1982 to 2025 (13 professional/semi-professional, 6 high school, 2 select/junior/adult league, 1 college; ages 13-34). Of these 26 injuries, 24 (92%) were caused by skates, and 1 each by puck and stick. The neck was the body part lacerated most commonly (15, 58%), followed by the arm (6), wrist (2,) leg (1), and eye (1). Of 15 athletes with neck lacerations, 7 were reportedly not wearing neck protection; 8 were unknown/unreported. A total of 5 (19%) injuries resulted in death (ages 13-29 years), and 3 of those 5 athletes were reportedly not wearing neck protection. A Haddon Matrix identified prevention strategies by phase and included pre-event: cardiopulmonary resuscitation (CPR) and first-aid training, stop-the-bleed kits, mandated neck protection; during event: equipment inspection, player training; and post-event: secure a safe space for medical personnel to enter/exit ice and provide quick emergency response. DISCUSSION: Ice hockey is an inherently dangerous sport, and lacerations are a common injury type that can result in serious injury or death. This study highlights the Haddon Matrix as a valuable tool for identifying preventive measures for life-threatening lacerations in ice hockey. Further research should investigate the effectiveness of the strategies proposed.