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Original research
Association of headgear mandate and concussion injury rates in girls’ high school lacrosse
  1. Daniel C Herman1,
  2. Shane V Caswell2,3,
  3. Patricia M Kelshaw3,4,
  4. Heather K Vincent5,
  5. Andrew E Lincoln3,6
  1. 1 Department of Physical Medicine and Rehabilitation, University of California Davis, Sacramento, California, USA
  2. 2 School of Kinesiology; College of Education and Human Development, Exercise, Fitness and Health Promotion; Sports Medicine Assessment, Research & Testing (SMART) Laboratory, Advancing Healthcare Initiative for Underserved Students (ACHIEVES), George Mason University, Manassas, Virginia, USA
  3. 3 Virginia Concussion Initiative, George Mason University, Manassas, Virginia, USA
  4. 4 Department of Kinesiology, Brain Research & Assessment Initiative of New Hampshire (BRAIN) Laboratory, University of New Hampshire, Durham, New Hampshire, USA
  5. 5 Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville, Florida, USA
  6. 6 Special Olympics, Washington, DC, USA
  1. Correspondence to Dr Daniel C Herman, Department of Physical Medicine and Rehabilitation, University of California Davis, Sacramento, California, USA; dcherman{at}ucdavis.edu

Abstract

Objectives Headgear use is a controversial issue in girls’ lacrosse. We compared concussion rates among high school lacrosse players in an American state with a headgear mandate (HM) to states without an HM.

Methods Participants included high schools with girls’ lacrosse programmes in the USA. Certified athletic trainers reported athlete exposure (AE) and injury data via the National Athletic Treatment, Injury and Outcomes Network during the 2019–2021 seasons. The HM cohort was inclusive of high schools from the state of Florida, which mandates the use of ASTM standard F3137 headgear, while the non-HM (NHM) cohort was inclusive of high schools in 31 states without a state-wide HM. Incidence rate ratios (IRRs) and 95% CIs were calculated.

Results 141 concussions (HM: 25; NHM: 116) and 357 225 AEs were reported (HM: 91 074 AEs; NHM: 266 151 AEs) across all games and practices for 289 total school seasons (HM: 96; NHM: 193). Overall, the concussion injury rate per 1000 AEs was higher in the NHM cohort (0.44) than the HM cohort (0.27) (IRR=1.59, 95% CI: 1.03 to 2.45). The IRR was higher for the NHM cohort during games (1.74, 95% CI: 1.00 to 3.02) but not for practices (1.42, 95% CI: 0.71 to 2.83).

Conclusions These findings suggest a statewide HM for high school girls’ lacrosse is associated with a lower concussion rate than playing in a state without an HM. Statewide mandates requiring ASTM standard F3137 headgear should be considered to reduce the risk of concussion.

  • Brain Concussion
  • Lacrosse
  • Head Protective Devices

Data availability statement

Data may be obtained from a third party (Datalys Center, Inc.; www.datalyscenter.org) and are not publicly available.

https://doi.org/10.1136/bjsports-2021-105031

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    Data availability statement

    Data may be obtained from a third party (Datalys Center, Inc.; www.datalyscenter.org) and are not publicly available.

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    Footnotes

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    • Contributors DCH provided substantial contributions to the conception and design of the work, as well as the acquisition, analysis and interpretation of the data, substantial contributions to the drafting and revising of the work and final approval of the version to be published and agree to be accountable for all aspects of the work and is the guarantor for the overall content. SVC provided substantial contributions to the conception and design of the work, as well as the analysis and interpretation of the data, substantial contributions to the drafting and revising of the work and final approval of the version to be published and agree to be accountable for all aspects of the work. PMK provided substantial contributions to the design of the work, as well as the analysis and interpretation of the data, substantial contributions to the drafting and revising of the work and final approval of the version to be published and agree to be accountable for all aspects of the work. HKV provided substantial contributions to the design of the work, as well as the analysis and interpretation of the data, substantial contributions to the drafting and revising of the work and final approval of the version to be published and agree to be accountable for all aspects of the work. AEL provided substantial contributions to the design of the work, as well as the analysis and interpretation of the data, substantial contributions to the drafting and revising of the work and final approval of the version to be published and agree to be accountable for all aspects of the work.

    • Funding Grant support for this study was provided by USA Lacrosse and the National Operating Committee on Standards for Athletic Equipment.

    • 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.