PT - JOURNAL ARTICLE AU - Carolyn A Emery AU - Amanda M Black AU - Ash Kolstad AU - German Martinez AU - Alberto Nettel-Aguirre AU - Lars Engebretsen AU - Karen Johnston AU - James Kissick AU - David Maddocks AU - Charles Tator AU - Mark Aubry AU - Jiří Dvořák AU - Shinji Nagahiro AU - Kathryn Schneider TI - What strategies can be used to effectively reduce the risk of concussion in sport? A systematic review AID - 10.1136/bjsports-2016-097452 DP - 2017 Jun 01 TA - British Journal of Sports Medicine PG - 978--984 VI - 51 IP - 12 4099 - http://bjsm.bmj.com/content/51/12/978.short 4100 - http://bjsm.bmj.com/content/51/12/978.full SO - Br J Sports Med2017 Jun 01; 51 AB - Aim or objective To examine the effectiveness of concussion prevention strategies in reducing concussion risk in sport.Design Systematic review according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines.Data sources Eleven electronic databases searched and hand-search of references from selected studies.Eligibility criteria for selecting studies The following were the study inclusion criteria: (1) contained original human research data; (2) investigated an outcome of concussion or head impact; (3) evaluated a concussion prevention intervention; (4) included sport participants; (5) analytical study designand (6) peer-reviewed. The following were the exclusion criteria: (1) review articles, case series or case studies and (2) not in English.Results The studies selected (n=48) provided evidence related to protective gear (helmets, headgear, mouthguards) (n=25), policy and rule changes (n=13) and other interventions (training, education, facilities) (n=10). Meta-analyses demonstrate a combined effect of a 70% reduction (incidence rate ratio (IRR)=0.3 (95% CI: 0.22 to 0.41)) in concussion risk in youth ice hockey leagues where policy disallows body checking, and the point estimate (IRR=0.8 (95% CI: 0.6 to 1.1)) suggests a protective effect of mouthguards in contact and collision sport (basketball, ice hockey, rugby).Summary/conclusions Highlights include a protective effect of helmets in skiing/snowboarding and the effectiveness of policy eliminating body checking in youth ice hockey. Future research should examine mouthguards in contact sport, football helmet padding, helmet fit in collision sport, policy limiting contact practice in youth football, rule enforcement to reduce head contact in ice hockey and soccer, ice surface size and board/glass flexibility in ice hockey and training strategies targeting intrinsic risk factors (eg, visual training).Systematic review registration PROSPERO 2016:CRD42016039162