Background Research in high school and college sports has found high concussion rates in ice hockey. This study describes the epidemiology of concussions in high school boys’ and college men’s ice hockey.

Methods Data originates from High School RIO during the 2008/09-2014/15 academic years (191 team-seasons); and the National Collegiate Athletic Association Injury Surveillance Program (NCAA-ISP) during the 2009/10-2014/15 academic years (148 team-seasons). A reportable concussion occurred as a result of participation in an organised game/practice and required attention from an athletic trainer or physician. Concussion injury rates per 10000 athlete-exposures (AE), injury rate ratios (RR), and 95% confidence intervals (CI) were calculated.

Results Overall, 279 and 309 concussions were reported in high school boys’ and college men’s ice hockey, respectively, for rates of 6.8 and 7.6/10000 AE. Player contact was the most common injury mechanism in boys (46.6%) and men (71.5%). Contact with boards comprised a larger proportion of concussions in boys (31.2%) than men (9.4%). Checking was the activity during which injury occurred for 42.7% of boys’ and 28.5% of men’s concussions. Concussion rates did not differ between boys and men (RR = 0.9; 95% CI: 0.9–1.3). However, the concussion rate due to player contact was higher in men than boys (RR = 1.7, 95% CI: 1.4–2.1). In contrast, concussion rates due to contact with boards (RR = 3.0, 95% CI: 2.0–4.6) and checking (RR = 1.3, 95% CI: 1.0–1.8) were higher in boys than men.

Conclusions Although overall concussion rates did not differ between high school boys’ and college men’s ice hockey players, mechanism- and activity-specific rates varied. Such differences may be associated with physical maturation differences between high school boys’ and college men’s ice hockey athletes, and may indicate a need for continued skill development at lower levels of competition.