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431 Protective equipment in youth ice hockey: are mouthguards and helmet age relevant in evaluating concussion risk?
  1. Ash T Kolstad1,2,3,
  2. Paul H Eliason1,2,3,4,
  3. Jean-Michel Galarneau1,2,
  4. Amanda M Black1,2,3,4,5,
  5. Brent E Hagel1,2,3,4,5,6,7,
  6. Carolyn A Emery1,2,3,4,5,6,7,8
  1. 1Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
  2. 2Integrated Concussion Research Program, University of Calgary, Calgary, Canada
  3. 3Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Canada
  4. 4Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
  5. 5O’Brien Institute for Public Health, University of Calgary, Calgary, Canada
  6. 6Departments of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
  7. 7Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
  8. 8McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada


Background The high concussion burden in youth ice hockey is concerning. An important yet understudied area for prevention is protective equipment (e.g., wearing a mouthguard, age of helmet).

Objective To compare rates of concussion between players based on mouthguard use and helmet age.

Design Prospective cohort.

Setting Calgary, Canada over five ice hockey seasons (2013/14–2017/18).

Participants Male and female youth ice hockey players ages 11–18.

Assessment of Risk Factors Participant baseline reports of mouthguard use (yes/always and sometimes use, no/never use), helmet age (newer/<2 years old, older/≥2 years old), and other important covariables [i.e., weight (kilograms), age group (under-13, under-15, under-18), position (forward, defense, goalie), concussion history (yes, no), body checking policy (allowed, disallowed)] were collected near the start of each season. Moreover, each player’s participation hours were collected throughout each season.

Main Outcome Measurements Number of medically diagnosed or therapist identified suspected concussions using validated surveillance methodology in games and practices over 5 seasons of play.

Results Multilevel negative binomial regression adjusted for player position, level of play, body checking policy, concussion history, weight, cluster by team, and offset by player-hours was used. The model included 426 concussions suffered by 369 players (from 394 player-seasons; 29 players had recurrent concussions in a single season) over 4,541 player-seasons (271,148.7 player hours). The model demonstrated that players who reported wearing a mouthguard had a 28% lower rate of concussion compared to those who did not (IRR=0.72, 95%CI: 0.55–0.93). Moreover, there were no differences in the concussion rate between newer and older helmet ages (IRR=0.94, 95%CI: 0.76–1.16).

Conclusions Protective equipment is an important consideration for concussion prevention and player safety. Wearing a mouthguard was associated with a lower concussion rate and policy mandating mouthguard use should be considered in youth ice hockey. More specific helmet age categories may require further investigation.

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