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Mouthguard use in youth ice hockey and the risk of concussion: nested case–control study of 315 cases
  1. Dirk A Chisholm1,2,3,4,5,6,
  2. Amanda Marie Black1,2,3,4,5,6,
  3. Luz Palacios-Derflingher1,3,
  4. Paul H Eliason1,2,3,4,5,6,
  5. Kathryn J Schneider1,4,6,
  6. Carolyn A Emery1,2,3,4,5,6,
  7. Brent E Hagel1,2,3,5,6
  1. 1Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
  2. 2Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
  3. 3Department of Community Health Sciences, Cumming School of Medicine, Univeristy of Calgary, Calgary, Alberta, Canada
  4. 4Hotchkiss Brain Institute, Cumming School of Medicine, Univeristy of Calgary, Calgary, Alberta, Canada
  5. 5O'Brien Institute of Public Health, Cumming School of Medicine, Univeristy of Calgary, Calgary, Alberta, Canada
  6. 6Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
  1. Correspondence to Dr Brent E Hagel, Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; brent.hagel{at}albertahealthservices.ca

Abstract

Background Concussion is the most common injury in youth ice hockey. Whether mouthguard use lowers the odds of concussion remains an unanswered question.

Objective To determine the association between concussion and mouthguard use in youth ice hockey.

Methods Nested case–control design. Cases and controls were identified from two prospective cohort studies using valid injury surveillance methods. Cases were players concussed during a game or practice; controls were players who sustained a non-concussion injury during a game or practice. The primary exposure was mouthguard use at time of injury; mouthguard type (dental custom fit or off the shelf) was a secondary exposure. Physician-diagnosed or therapist-suspected concussion was the primary outcome. Dental injury was a secondary outcome. Multilevel logistic regression with random effect at a team level was used to obtain ORs for the mouthguard effect, adjusted for level of play, age group, position, concussion history, mechanism of injury, cohort, session type and body checking policy.

Results Among cases, 236/315 (75%) were wearing a mouthguard at time of injury, while 224/270 (83%) controls were wearing a mouthguard at time of injury. Any mouthguard use was associated with an adjusted OR for concussion of 0.36 (95% CI 0.17 to 0.73). Off-the-shelf mouthguards were associated with a 69% lower odds of concussion (adjusted OR: 0.31; 95% CI 0.14 to 0.65). Dental custom-fit mouthguards were associated with a non-significant 49% lower odds of concussion (adjusted OR: 0.51; 95% CI 0.22 to 1.10). No dental injuries were identified in either cohort.

Conclusion Mouthguard use was associated with lower odds of concussion. Players should be required to wear mouthguards in youth ice hockey.

  • concussion
  • Injury prevention
  • Ice hockey
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Footnotes

  • Twitter @aacademic, @Kat_Schneider7, @CarolynAEmery

  • Contributors DAC contributed to data collection, entry, analysis and manuscript preparation. AMB contributed to data collection and provided data analysis and interpretation support. LPD provided data analysis and data interpretation. KJS contributed to acquisition of funding, study design, and led all aspects of the 2012 cohort. PHE contributed to data analysis and interpretation. CAE contributed to study design, funding acquisition, analysis and interpretation of the results. BEH led the design, analysis and interpretation of data. All authors critically reviewed the manuscript.

  • Funding This study was supported by funding from the Canadian Institutes of Health Research (CIHR), Alberta Children’s Hospital Research Institute (ACHRI) and Alberta Innovates Health Solutions (AIHS). DAC was funded through the AIHS Summer Studentship Program and the Markin Undergraduate Student Research Program for Health and Wellness Research. 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.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement 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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