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No differences are seen in concussion risk, severity, by helmet brand



ORLANDO – A prospective comparison of three brands of football helmets and various types of mouth guards raises questions about manufacturers’ claims regarding protection against sport-related concussions, according to Dr. Alison Brooks.

During the 2012 football season, 115 of 1,332 (9%) football players from 36 high schools had 116 sport-related concussions (SRCs). More than half (52%) of the players wore Riddell helmets, 35% wore Schutt helmets, and 13% wore Xenith helmets. Thirty-nine percent of the helmets were purchased during 2011-2012, 33% during 2009-2010, and 28% during 2002-2008.

No difference was seen in the rate or severity (based on days lost) of sport-related concussion (SRC) by helmet type or helmet purchase year, Dr. Brooks of the University of Wisconsin, Madison, reported at the annual meeting of the American Academy of Pediatrics.

Dr. Alison Brooks

The incidence rates of SRC were 9.5, 8.1, and 6.7 for the Riddell, Schutt, and Xenith helmets, respectively, and the SRC rates by year purchased were 9.3, 7.9, and 8.8 for helmets purchased during 2011-2012, 2009-2010, and 2002-2008, respectively. Median days lost were 13.5, 13.0, and 13.5, respectively.

"Contrary to manufacturer claims, lower risk and severity of SRC were not associated with a specific helmet brand," Dr. Brooks said.

As for mouth guards, 61% of the players wore generic models provided by their school, and 39% wore specialized mouth guards custom fitted by a dental professional or specifically marketed to reduce SRC.

The SRC rate was actually higher for those who wore a specialized (12.7) or custom-fitted (11.3) mouth guard than for those who wore a generic mouth guard (6.4), Dr. Brooks said.

Students included in the study were 9th through 12th graders with a mean age of 15.9 years. The students – who completed a preseason demographic and injury questionnaire (with 171 reporting a concussion in the prior 12 months) – wore various models of the three football helmet brands. Athletic trainers recorded the incidence and severity of SRC throughout the football season.

Although limited by factors such as possible selection bias (as schools and players were aware of the study), and recall bias (with respect to previous concussion status), the findings are important, because about 40,000 SRCs occur in high school football players in the United States each year. Despite limited prospective data on how specific football helmets and mouth guards affect the incidence and severity of SRC, manufacturers often cite laboratory research – based on impact (drop) testing – showing that their brand and/or a specific model will lessen impact forces associated with SRC, and they often claim that players who use their equipment may have a reduced SRC risk, she said, noting that schools and parents may feel pressured to purchase newer, more expensive equipment.

The current findings suggest that caution should be used when considering these claims, Dr. Brooks said.

In an interview, she added, "These preliminary findings are important in helping parents and coaches understand that there is no compelling evidence that any particular helmet or mouth guard significantly reduces concussion risk."

Helmets and mouth guards are nonetheless effective for doing what they are designed to do – prevent skull fractures and intracranial bleeds and dental injuries – and are important pieces of equipment that need to be maintained in good condition, and be fit and worn properly. There is also always a role for trying to improve technology. However, it may not be possible to significantly reduce concussion risk using helmet technology, she said.

"I think focus could be better spent on rule enforcement and coaching education on tackling technique to limit/avoid contact to the head, perhaps limiting contact practices, and behavior change about the intent of tackling to injure or ‘punish’ the opponent," she added.

Dr. Brooks reported having no relevant financial disclosures.

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