Systematic review results and conclusions
| Author(s) and Journal | Results | Conclusions |
| LaPrade et al,4 Am J Sports Med, 1995 | 1. Lower incidence of facial lacerations per 1000 player-hours in the face mask group compared with the historical group (14.7 to 15.1 in games and 0.0 to 0.2 in practice vs 21.8 in games and 0.6 in practice, respectively; based on 95% CI) | Face masks decreased the incidence of facial lacerations when compared with a historical cohort wearing NFP. The study was unable to assess the effect of face mask use on head and neck injury incidence due to lack of a comparable historical cohort to analyse data. |
| Benson et al,13 JAMA, 1999 | 1. Significantly fewer head and facial injuries in the FFS cohort (p<0.001, RR 2.52, CI 1.73 to 3.68) | There is a reduced risk of head injuries, specifically facial lacerations and dental injuries, in collegiate ice hockey players who wear FFS as opposed to HFS. FFS do not increase the risk of neck injuries or concussions. |
| 2. Risk of facial laceration was 2.31 times greater in HFS cohort compared with FFS cohort (p<0.001, CI 1.53 to 3.48) | ||
| 3. Risk of dental injury was 9.90 times greater in HFS cohort compared with FFS cohort (p<0.007, CI 1.88 to 52.1) | ||
| 4. Risk of neck injury was not significantly different between cohorts (p = 0.78, CI 0.43 to 3.16) | ||
| 5. No significant difference in number of concussions between the cohorts (p = 0.90, RR 0.97, CI 0.61 to 1.54) | ||
| Benson et al,14 Br J Sports Med, 2002 | 1. No significant difference in overall risk of concussion between the HFS and FFS cohorts (p = 0.90, RR 0.97, CI 0.61 to 1.54) | There is no difference in the incidence of concussion in players wearing a FFS versus those wearing a HFS; however, in players who do sustain concussion, those wearing a FFS return to play sooner. |
| 2. In players who did sustain concussion, those in the FFS cohort returned to practice or games sooner (1.7 sessions, CI 1.32 to 2.18) than those in the HFS cohort (4.07 sessions, CI 3.48 to 4.74) | ||
| 3. Less time lost after concussion in players wearing mouth guards | ||
| 4. No difference in risk of sustaining a concussion based on position played or on level of play | ||
| Stuart et al,3 Am J Sports Med, 2002 | 1. Significantly decreased injury rate in the FFP and PFP cohorts compared with the NFP cohort (p<0.001, p<0.001, respectively) | FFP and PFP significantly reduce facial and eye injuries compared with NFP without an increase in neck injuries and concussions. No association between mouth guard protection use and rate of injuries. |
| 2. Players in the NFP cohort sustained injuries at a rate more than twice those in the PFP cohort and almost seven times more than those in the FFP cohort | ||
| 3. No significant differences in the rate of concussions between the cohorts (p = 0.58, p = 0.11) | ||
| 4. Similar frequency of mouth guard use in those injured and not injured | ||
| Stevens et al,10 J Sci Med Sport, 2006 | 1. Significant difference in rates of injuries (recorded in rate per 1000 player-hours) among the cohorts with the lowest rate in the FFP cohort and highest rate in the NFP cohort (FFP 23.2, CI 13.3 to 37.7; PFP 73.5, CI 53.6 to 98.3; NFP 158.9, CI 118.7 to 208.5; p<0.001) | FFP and PFP significantly reduce facial and eye injuries compared with NFP without increasing neck injuries and concussions; thus FFP is more protective of facial and eye injuries than PFP. Mouth guard use does not appear to affect the rate of injuries, although this was not specifically studied and further research would need to be done. |
| 2. Players with NFP sustained injuries at a rate more than twice that of players with PFP and almost seven times more than those with FFP | ||
| 3. No significant differences in the rate of concussions per 1000 player-hours (p = 0.58) | ||
| 4. No significant differences in the rate of neck injuries per 1000 player-hours (p = 0.11) | ||
| Bunn,15 Phys Sportsmed, 2008 | 1. Significantly higher ISS for forehead lacerations in the HFS cohort compared with NFS cohort (4 (SD 0.15), 2.75 (SD 0.49), respectively, p<0.05) | The HFS or visor does not reduce the severity of injuries to the upper half of the face compared with NFP. Visors may thus not adequately protect the athlete’s upper half face and eye region. Study validity is questioned given methodological flaws. |
| 2. Significantly higher ISS for cheek lacerations in the HFS cohort compared with the NFS cohort (3.69 (SD 0.35), 2.30 (SD 0.49), respectively, p<0.05) | ||
| 3. No significant difference in the number of periorbital injuries between the cohorts although trend towards more in the NFS cohort | ||
| 4. High-sticking was the most common mechanism of injury |
FFP, full facial protection; FFS, full face shield; HFS, half face shield; ISS, injury severity score; NFP, no facial protection; NFS, no face shield; PFP, partial facial protection; RR, relative risk.