Article Text

Download PDFPDF
Current state of concussion prevention strategies: a systematic review and meta-analysis of prospective, controlled studies
  1. Daniel K Schneider1,2,
  2. Ravi K Grandhi2,3,
  3. Purnima Bansal4,
  4. George E Kuntz IV2,
  5. Kate E Webster5,
  6. Kelsey Logan1,
  7. Kim D Barber Foss1,6,
  8. Gregory D Myer1,2,3,7,8,9
  1. 1Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  2. 2College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
  3. 3Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
  4. 4Division of Primary Care/Sports Medicine, Jennie Stuart Medical Center, Hopkinsville, Kentucky, USA
  5. 5School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
  6. 6Division of Health Sciences, Mount St. Joseph University, Cincinnati, Ohio, USA
  7. 7Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, Ohio, USA
  8. 8The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
  9. 9Department of Orthopaedics, University of Pennsylvania, Philadelphia, PA, USA
  1. Correspondence to Dr Gregory D Myer, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 10001, Cincinnati, OH 45229, USA; greg.myer{at}


Objective The aim of the current review was to systematically identify, evaluate and synthesise trials that examine concussion prevention via equipment, educational programmes and training programmes.

Data sources PubMed and EBSCO host (CINAHL, MEDLINE, SPORTDiscus).

Eligibility criteria for selecting studies The electronic databases PubMed and EBSCO were searched using the phrases: concussion prevention equipment, concussion prevention training and concussion prevention education. Included studies utilised a prospective study design to evaluate the preventative effect of: (1) equipment, (2) training or (3) educational programmes on the incidence of concussions in comparison to a control group.

Data extraction Demographic data and intervention methods were recorded. Intervention and control group concussion rates and superficial head injury rates were extracted and combined using random-effects relative risk meta-analysis.

Results 14 studies evaluated interventions of novel protective equipment. One prospective investigation evaluated an educational programme. The relative risk of concussion for participants enrolled in the interventional arms of trials was not significantly different from that in standard practice arms (RR=0.78, 95% CI 0.55 to 1.11, χ2=1.8, p=0.17; I2=85.3%, 95% CI 71.5% to 90.8%). The relative risk of concussion for participants wearing protective equipment (ie, headgear, full face shields) relative to their counterparts wearing standard or no equipment, calculated from seven available reports, showed no effect of intervention (RR=0.82, 95% CI 0.56 to 1.20, χ2=1.06, p=0.30; I2=86.7%, 95% CI 73.3% to 91.8%). The relative risk of superficial head injury for participants wearing protective equipment relative to their counterparts, calculated from three reports, showed a significant risk reduction (RR=0.41, 95% CI 0.31 to 0.56, χ2=34.13, p<0.0001; I2=53.1%, 95% CI 0% to 85.2%).

Conclusions Prospective controlled studies indicate that certain protective equipment may prevent superficial head injury, but these items are suboptimal for concussion prevention in sport.

  • Brain
  • Concussion
  • Helmet
  • Meta-analysis

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.