The Effect Of Exterior Helmet Padding On Concussion Severity In High School Football Players

INTRODUCTION: The Guardian Cap (GC) is a type of exterior helmet padding increasingly worn by high school football players during practices and is thought to reduce the degree of head impacts which may lead to sport-related concussions (SRCs). PURPOSE: The purpose of this study was to determine if SRCs sustained during practices for football players wearing GCs (YesGC) were less severe than SRCs sustained by players not wearing GCs (NoGC). METHODS: High school football players in Wisconsin were recruited to participate for the 2023 football season. Prior to the season, each player reported the number of previous SRCs they had sustained and the Sport Concussion Assessment Tool-5th edition (SCAT5) Symptom and Severity form. Licensed Athletic Trainers at each school reported SRCs that occurred during the season, administered the SCAT5 concussion symptom evaluation form to the injured player within 24 hours of sustaining their SRC, and documented when the player recovered from their SRC and was allowed to return to sports. Mixed effect modeling was used to model changes in SCAT5 scores with GC while controlling for previous SRC and treating school as a random effect. RESULTS: Participants included 2640 players (15.9 + 1.2 Yrs. old, YesGC = 1453, NoGC = 1187) who completed a pre-season SCAT5 (Baseline symptom score (Mean + SD) = 1.1 + 2.5; baseline severity score = 1.8 + 5.3) and participated in a total of 118,061 practices during the season. Sixty-four (2.4%) of the players (YesGC = 33, NoGC = 31) sustained an SRC during practices and were included in subsequent analyses. These athletes reported post-SRC Symptom and Severity scores of 13.2 + 5.3 and 30.3 + 18.5, respectively, and taking 14.9 + 8.2 days to recover. There was no difference between the YesGC and NoGC players in the pre-season to post-SRC changes for the Symptom score (YesGC = 11.1 + 1.3, NoGC = 8.8 + 1.5, p = 0.20), pre-season to post SRC changes for the Severity score (YesGC = 28.4 + 4.4, NoGC = 22.4 + 4.7, p = 0.30) and the days to recover (YesGC = 14.0 + 1.6, NoGC = 16.0 + 1.7, p = 0.34). CONCLUSIONS: The severity of SRCs sustained by high school football players during practices was similar regardless of whether they wore GC. Medical providers should work with high school football stakeholders to consider other methods to reduce the severity of SRCs sustained by high school football players. UW SMPH Fund AAM4484