The Effect of Protective Headgear on Concussion Injury Rates in High School Girls’ Lacrosse

Background: The use of headgear is a controversial issue in girls’ lacrosse with competing arguments pitting the potential benefits of protective headgear versus the potential for increased aggression and related injury due to risk compensation. However, there is scant field-based evidence regarding the effectiveness of protective headgear for reducing the risk of concussion among girls’ lacrosse players to support either argument. Furthermore, there is a recognized difference in lacrosse game play geographically with some regions having mature and others still developing girls’ lacrosse traditions. Therefore, we aimed to (i) compare concussion rates among high school lacrosse players with headgear versus without headgear; and (ii) compare concussion rates among players with headgear versus without headgear among states with “emerging” lacrosse play.

Methods: Study participants included high school girls’ lacrosse players from across the country during the Spring 2019 season, the initial part of the 2020 season (prior to the COVID-19 shutdown), and through the middle of the 2021 season. A convenience sample of high schools with athletic trainers were recruited to report injury and athlete exposure (AE) data for girls’ lacrosse to the High School National Athletic Treatment, Injury and Outcomes Network (NATION) injury surveillance system. Comparisons were made between concussion rates in the state of Florida (a state with emerging game play that mandates the use of headgear during high school girls’ lacrosse participation) to (i) all states without a headgear use mandate, and (ii) emerging states without a headgear use mandate. Emerging states were categorized a-priori by an expert panel as states other than CT, DC, DE, MA, MD, ME, NC, NH, NJ, NY, PA, RI, VA, and VT. Incidence Rate Ratios (IRR) and 95% Confidence Intervals (CI) were calculated. IRRs with corresponding CIs that excluded 1.000 were deemed statistically significant.

Results: A total of 84 concussions (Headgear: 20; Non-Headgear: 64) and 239,693AE were reported (Headgear: 78,464AE; Non-Headgear: 161,229AE) across all games and practices. Concussion incident rates per 1000 AE were (Headgear: 0.255; and Non-Headgear: 0.397; IRR = 1.557, 95% CI: 0.943 - 2.573). Comparing incident rates for Headgear to the Emerging Non-Headgear states (61,197 AE; 0.458 concussions per 1000 AE) yielded an IRR of1.795 (95% CI: 1.011, 3.186).

Conclusion: These interim findings indicate that concussion rates among high school girls’ lacrosse players not wearing headgear were 56% higher than those wearing headgear in the state of Florida, although these results did not reach statistical significance. In comparison with other emerging states where the level of lacrosse play is similar, players not wearing headgear experienced a 79.5% higher rate of concussion (statistically significant). Final results will include data from the remainder of the 2021 season.