Objective Outline the frequency of helmet strikes (HS) the prevalence of concussion, and how batting order may impact these occurrences.

Design Retrospective cohort analysis.

Setting England and Wales Cricket Board (ECB) international and professional County domestic cricket.

Participants 218 senior and academy, male and female cricketers sustaining a HS playing international and domestic cricket between 2016 and 2018.

Outcome Measures Analysis of ECB central injury database to determine HS frequency and concussion from injury surveillance protocols.

Main Results 167 total HS were recorded during the study period, with 23 in 2016, 38 in 2017 and 106 in 2018. Over the three years, a total of 49 HS was concussive. In 2016 the ratio of HS to concussion was 1.9:1 respectively, in 2017 3.5:1 and 2018 4.0:1, indicating a non-linear increase year on year. From 2016 to 2018, 21 HS (from 81) were concussive for those in the batting order 1 to 7, with 28 concussive HS (from 51) for lower order batsmen 8 to 11. A Chi square test found significant difference in likelihood of concussive HS between higher/middle and lower order batsmen (X² (1, N = 132) = 10.05, p < 0.01) with an increased risk for lower order batsmen (OR = 3.5 (95% CI: 1.7, 7.3).

Conclusions HS frequency and concussion prevalence is increasing year on year. Players batting in the lower order, who typically have alternative primary positions such as bowling and wicketkeeping, may be at increased risk of concussive HS, highlighting an area for future prevention.