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Is protective equipment useful in preventing concussion? A systematic review of the literature

B W Benson¹, G M Hamilton¹, W H Meeuwisse¹, P McCrory², J Dvorak³

¹ Sport Medicine Centre, Faculty of Kinesiology, and Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
² Centre for Health, Exercise & Sports Medicine, University of Melbourne, Parkville, Australia
³ F-MARC, FIFA Medical Assessment and Research Center, Schulthess Clinic, Zurich, Switzerland

Correspondence to:
Dr B Benson, Sport Medicine Centre, University of Calgary, 2500 University Drive NW, Calgary, Alberta, Canada, T2N 1N4; bbenson{at}ucalgary.ca

Objective: To determine if there is evidence that equipment use reduces sport concussion risk and/or severity.

Data sources: 12 electronic databases were searched using a combination of Medical Subject Headings and text words to identify relevant articles.

Review methods: Specific inclusion and exclusion criteria were used to select studies for review. Data extracted included design, study population, exposure/outcome measures and results. The quality of evidence was assessed based on epidemiologic criteria regarding internal and external validity (ie, strength of design, sample size/power calculation, selection bias, misclassification bias, control of potential confounding and effect modification).

Results: In total, 51 studies were selected for review. A comparison between studies was difficult due to the variability in research designs, definition of concussion, mouthguard/helmet/headgear/face shield types, measurements used to assess exposure and outcomes, and variety of sports assessed. The majority of studies were observational, with 23 analytical epidemiologic designs related to the subject area. Selection bias was a concern in the reviewed studies, as was the lack of measurement and control for potentially confounding variables.

Conclusions: There is evidence that helmet use reduces head injury risk in skiing, snowboarding and bicycling, but the effect on concussion risk is inconclusive. No strong evidence exists for the use of mouthguards or face shields to reduce concussion risk. Evidence is provided to suggest that full facial protection in ice hockey may reduce concussion severity, as measured by time loss from competition.

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