Comparative Epidemiology of Craniofacial Injuries Across 4 Hockey Variants: A NEISS-Based Analysis

Hockey is a varied sport. Subtypes, such as ice, field, roller, and street, have different equipment, unique contact rules, and distinct challenges that affect injury patterns. This study examined craniofacial hockey-related injuries using data from the National Electronic Injury Surveillance System. We analyzed emergency department visits in the United States from 2005 to 2024. Over this period, 6160 craniofacial injuries were reported. Ice hockey accounted for 74.5% (n=4592), followed by field hockey at 16.5% (n=1017), street hockey at 6.9% (n=422), and roller hockey at 2.1% (n=129). The following trends were identified. Sex distribution differed significantly (P<0.001). Male players made up the majority in ice, street, and roller hockey at 89.2%, 83.6%, and 91.5%, respectively. Female players were the majority in field hockey at 84.1%. Age distribution also differed significantly (P<0.001), with players aged 10 to 19 being the most frequently injured group across all types. Injury type varied by sport: concussions were most common in ice hockey. Fractures and dental injuries appeared more often in field hockey. Stick and eye injuries were more frequent in street hockey, and fall-related head injuries predominated in roller hockey. Rates of concussions, lacerations, and fractures all differed significantly across types (all P<0.001). Emergency department outcomes did not differ significantly by variant (P=0.335). Hospitalization rates remained low. These findings show that craniofacial injury mechanisms, anatomic distribution, and affected demographics differ by hockey type. Concussion rates from ED cases may not accurately reflect the true number of cases, as many concussions are treated by athletic trainers or at outpatient clinics before reaching the emergency department. This emphasizes the need for sport-specific protective equipment standards, targeted concussion education, and tailored prevention strategies for each variant.