Objectives To compare the incidence rates and odds of concussion between youth ice hockey players based on mouthguard use and helmet age.
Materials and methods Within a 5-year longitudinal cohort (2013/2014 to 2017/2018) of male and female ice hockey players (ages 11–18; n=3330 players) in Alberta (Canada), we analysed the relationship of equipment and concussion in both a prospective cohort and nested case (concussion) control (acute musculoskeletal injury) approach. The prospective cohort included baseline assessments documenting reported mouthguard use (yes/sometimes, no use), helmet age (newer/<2 years old, older/≥2 years old) and important covariables (weight, level of play, position of play, concussion history, body checking policy), with weekly player participation throughout the season. The nested case–control component used injury reports to document equipment (mouthguard use, helmet age) and other information (eg, mechanism and type of injury) for the injury event. Multivariable mixed effects negative binomial regression (prospective cohort, incidence rate ratios (IRRs)) and multivariable mixed effects logistic regression (nested case–control, odds ratios (OR)) examined the association between equipment and concussion.
Results Players who reported wearing a mouthguard had a 28% lower concussion rate (IRR=0.72, 95% CI 0.56 to 0.93) and 57% lower odds of concussion (OR=0.43, 95% CI 0.27 to 0.70) compared with non-wearers. There were no associations in the concussion rate (IRR=0.94, 95% CI 0.75 to 1.15) and odds (OR=1.16, 95% CI 0.73 to 1.86) between newer and older helmets.
Conclusions Wearing a mouthguard was associated with a lower concussion rate and odds. Policy mandating use should be considered in youth ice hockey. More research is needed to identify other helmet characteristics (eg, quality, fit) that could lower concussion risk.
- brain concussion
Data availability statement
Data are available upon reasonable request. Data are available upon reasonable request. Deidentified participant data are held by Dr. Carolyn Emery and the Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary.
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Contributors ATK contributed to data collection, data entry, data analysis, study development, and manuscript preparation. PE contributed to data collection, data analysis and interpretation of the results. J-MG contributed to data analysis and interpretation of the results. AMB contributed to data collection, data analysis and interpretation of the results. BEH contributed to the study development, funding acquisition, data analysis and interpretation of the results. CE contributed to the study development, funding acquisition, data analysis and interpretation of the results. All authors critically reviewed the manuscript. CE is the study gurantor.
Funding We acknowledge the support of Alberta Innovates, Canadian Institutes of Health Research, and the Alberta Children’s Hospital Research Institute (Alberta Children’s Hospital Foundation). Ash Kolstad held a Canadian Institutes for Health Research Canada Graduate Scholarship, and Scholarships from the University of Calgary’s Integrated Concussion Research Program and Alberta Children’s Hospital Research Institute. Carolyn Emery holds a Canada Research Chair in Concussion. The University of Calgary Sport Injury Prevention Research Centre is one of the International Research Centres for Prevention of Injury and Protection of Athlete Health supported by the International Olympic Committee. This work was previously part of Ash Kolstad’s Master of Science Thesis [©Ash Kolstad; Kolstad, A. (2021). Equipment and Concussion in Youth Ice Hockey and Ringette (Unpublished master’s thesis). University of Calgary, Calgary, AB] which can be accessed with the following link https://prism.ucalgary.ca/handle/1880/113591.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
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