Helmet Fit Assessment and Concussion Risk in Youth Ice Hockey Players: A Nested Case-Control Study

Context: Injury surveillance has shown that concussions are the most common injury in youth ice hockey. Research examining criteria to ensure correct fit of protective equipment and its potential relationship with concussion risk is very limited.Objective: To evaluate the association between helmet fit and odds of concussion in youth ice hockey players.Design: Nested case-control in a cohort study. 10Setting: COUNTRY-XXX.Participants: Data were collected for 72 concussed, 41 non-concussion injured, and 62 uninjured ice hockey players ages 11–18 years.Main Outcome Measures: Helmet fit assessments were conducted across players encompassing helmet specifications, condition, certification, and criteria measuring helmet fit. Using a validated injury surveillance system, cases included players with suspected and/or physician-diagnosed concussion. One control group included players who sustained non-concussion injuries and a second control group included uninjured players. Helmet fit criteria (score/16) were assessed for concussed players and compared with each of two control groups. The primary outcome was dichotomous (>1 helmet fit criteria missing vs. 0 or 1 criteria missing). Logistic and conditional logistic regression were used to investigate the effect of helmet fit on odds of concussion.Results: The primary analysis (54 pairs matched for age, sex, and level of play) suggested that inadequate helmet fit (>1 criterion missing) resulted in greater odds of concussion when comparing concussed and uninjured players [OR: 2.67 (95% CI 1.04–6.81), p=0.040]. However, a secondary unmatched analysis including all participants suggested no significant association between helmet fit and odds of concussion when comparing concussed players with non-concussion injured players [OR: 0.98 (95% CI 0.43–2.24), p=0.961] or uninjured players [OR: 1.66 (95% CI 0.90–3.05), p=0.103].Conclusion: Inadequate helmet fit may affect the odds of sustaining a concussion in youth ice hockey. Future research with larger sample sizes should continue to evaluate this relationship and inform helmet fit recommendations.