PONE-D-21-34814Injury patterns of non-fatal accidents related to ice hockey, an analysis of 7 years of admission to a Level-1 Emergency Centre in SwitzerlandPLOS ONE

Dear Dr. Klukowska-Rötzler,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Ice hockey is the preferred team sport of the academic editor. Therefore I would be extremely happy to get your revised manuscript. Three reviewers very familiar with ice hockey injuries made useful recommendations to revise the manuscript. Please, follow their ideas. I am convinced that the impact of your study can be much improved.

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We look forward to receiving your revised manuscript.

Kind regards,

Hans-Peter Simmen, M.D., Professor of Surgery

Academic Editor

PLOS ONE

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Reviewers' comments:

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Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: No

Reviewer #2: Yes

Reviewer #3: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: No

Reviewer #2: Yes

Reviewer #3: I Don't Know

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Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: No

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Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: No

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: You have a done a good study. Your discussion is well done, and you have also found where we have to increase our investigations in order to ameliorate the safety of the ice hockey players not only in the professional but also in the amateur leagues.

However, there are some points which have to be ameliorates in order to publish such a study.

Concerning „facial region and prevention measures”, Lines 463-465

In order to analyze the relationship between an injury and the protective equipment it is not only mandatory to know if the players were wearing the equipment at all, but also if it was wearied correctly, otherwise we are making wrong conclusion.

Concerning “facial protection”, Lines 481-483

The precise analyze of the relationship between facial protection and injury is one of the most important requirements in the prevention of these injuries and it should be done very precisely! Your opinion is not completely supported by our data.

Concerning “Body checking is related to an increased risk of injury at different age levels”, Line 503-506

Here it would be better if you’d have done an analyze between the players ages differently, first of between U17/U18 and NL/SL and SWHL A, and if you’d have done an analyze between the role of body weight and large size differentials between players in some age groups.

Concerning “more restrictions should be imposed on body checking”, Lines 507-509

You are comparing four different group of players’ ages, which make the result and first of the discussion and conclusions concerning the problems of body checking very difficult.

Concerning “professional and amateur players”, Line 511-520

Your definition of professional and non-professional is not optimal to make such conclusions.

Concerning “concussion”, Lines 522-532

Here, we are missing a clear definition of concussion. In order to analyze the problems of concussions, you should use the most internationally recognized definition of concussion such as the definition of the “Sport Concussion Assessment Tool”, which has been published by the Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016, McCrory P, et al. Br J Sports Med 2017.

Reviewer #2: The study shows a nice overview of injuries in ice hockey. On the other hand, however, the data are mostly only listed in a very general and tabular way. There is a lack of linkage with each other.

Examples: Which diagnoses are correlated with which body parts (e.g., upper extremity fractures, facial lacerations, etc.). Which diagnoses are associated with which treatment (e.g., how many fractures were treated conservatively and which were treated surgically?). The question of severity and outcome arises: who had to be hospitalized with which diagnoses and for how long. The socio-economic aspect is mentioned, but only applied to the direct treatment costs; this study lacks data on hospitalization/duration, loss of work and long-term problems in relation to specific injuries and mechanisms (example: cruciate ligament injuries with months of absence versus banal laceration, see also Fig. 6 with illustration of facial injuries (skin and bone structure) 69.4%: while skin injuries are mostly uncomplicated here, facial fractures are nevertheless associated with considerably more morbidity).

This survey also does not indicate whether there are specific ice hockey injuries that are disproportionately represented in this specific sport because the data are so general. The bias between center function for professional players and general medical care for amateur players is discussed, but is not evident in the overview because no specific information on diagnoses and treatments is available.

Reviewer #3: The present study focuses on non-fatal injury patterns in ice hockey players. Within the framework of a retrospective, descriptive database evaluation, the injury patterns in ice hockey players who were treated at a level 1 trauma center over a period of 7 years are analyzed.The design of the study is highly susceptible to bias, not only due to its retrospective nature. As part of the evaluation, the injuries of professional and amateur ice hockey players are evaluated. It can be assumed that both the physical conditions, due to the different intensity of training sessions, and the protective equipment will be significantly different between these two groups. The authors marginally address this point of criticism, but a corresponding conclusion regarding the adaptation of the study design is missing. Also, the almost exclusive inclusion of male ice hockey players (male percentage 97%) should lead to an adjustment of the study design. The Introduction, and here in particular the first and third paragraphs, consists predominantly of well-known lexicon knowledge and prose and should be clearly shortened to the essentials. On page 4, lines 95-96, the authors state that in most of the studies published on the topic under investigation, the study population consisted primarily of young subjects. In the present study, however, the study population also consists of just under 55% adolescent subjects. This raises the question of what new scientific findings can be derived from the present study.

Generally:

- The sport meant on page 3 line 66 should be called "soccer" and not (American) "football".

- Also on page 3 line 79 there is a spelling mistake: it should read "definitions".

- Overall, the manuscript should be revised for spelling and English grammar.

Suggestion:

The authors should revise their analysis to focus on one study population. They should also explain what new scientific evidence the results of their study provide compared with the existing literature on sports injuries in ice hockey.

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Reviewer #1: No

Reviewer #2: Yes: Walter Kistler

Reviewer #3: No

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Injury patterns of non-fatal accidents related to ice hockey, an analysis of 7 years of admission to a Level-1 Emergency Centre in Switzerland

PONE-D-21-34814R1

Dear Dr. Klukowska-Rötzler,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Hans-Peter Simmen, M.D., Professor of Surgery

Academic Editor

PLOS ONE

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