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ObjectiveTo review the incidence of brain injuries sustained while playing ice hockey.Data SourceMEDLINE was searched for articles from 1966 to 1997 relating to ice hockey and injuries. Additional references were reviewed from the bibliographies of the retrieved articles.Study SelectionAll clinical study designs were included.Data Extraction and SynthesisIn reviewing the literature, particular attention was paid to the relative strengths of the different study designs. Rates of head injuries were recorded (or calculated if possible) from the data.Main ResultsThe most common brain injury was concussion. The incidence of concussion (per 1000 player-hours) ranged from 0.0 to 2.8 for players aged 5 to 14 years, from 0.0 to 2.7 for high school players, from 0.2 to 4.2 for university players, and from 0.0 to 6.6 for players on elite teams. The incidence of concussion increases with higher levels of play, is higher in game play than practice for elite players, is reduced by appropriate helmets, and is showing a downward trend for players aged 5 to 14 years. Other brain injuries included rare epidural and subdural hematomas that can be lethal. Recommendations for the further reduction of brain injuries and guidelines for future studies of the incidence of head injuries in hockey are provided.