Headgear Is Associated With Protection Against Equipment- And Player-Versus-Player Concussions In High School Girls’ Lacrosse

PURPOSE: Despite being a non-contact sport, girls’ lacrosse has a high incidence of concussions. Evidence indicates headgear may reduce this risk, but the mechanisms by which a protective effect is conferred are unknown. This study examined the relative risk of concussions in high school girls’ lacrosse between headgear mandating (HM) and non-headgear mandating (NHM) states by mechanism of injury (MOI). METHODS: Concussions and athlete exposures (AEs) were obtained using an athletic trainer-driven national injury surveillance system (NATION) from 2019 to 2024. Incidence rates (IR), defined as the number of concussions per 1,000 AEs, were calculated for HM and NHM play by MOI including equipment-vs-player (EVP), player-vs-player (PVP), and ground-vs-player (GVP) for those concussions with an identifiable MOI. 95% confidence intervals (CIs) were calculated for incidence rate ratios (IRR) comparing the HM and NHM groups for each using Poisson regressions with values excluding 1.00 being significant. RESULTS: 481 concussions over 994,606 AEs were recorded [Table 1]. NHM had higher overall (IRR: 2.017, 95%CI: 1.500 to 2.713), EVP (IRR: 2.922, 95%CI: 1.809 to 4.748) and PVP (IRR: 1.823, 95%CI: 1.085 to 3.080) incidence rates compared to HM. No significant difference in the rate of GVP concussions (IRR: 1.288, 95%CI: 0.676 to 2.451) was observed. DISCUSSION: Mandated headgear use was associated with a large reduction in concussion risk in high school girls’ lacrosse. The greatest reduction was achieved with the EVP MOI, for which the headgear was primarily designed to address; however, a notable and somewhat unexpected effect was also observed with the PVP mechanism of impact. This suggests that mandating headgear may offer broader protective benefits than initially anticipated, potentially extending its effectiveness to other impact mechanisms. These findings can inform stakeholders of player safety when considering headgear mandates. Table 1: - Concussion Incidence by Mandate Status and Mechanism of Injury N AE IR 95% CI Overall - HM 49 184618 0.265 0.200 - 0.352 Overall - NHM 432 809988 0.533 0.485 - 0.586 EVP - HM 18 184618 0.097 0.061 - 0.155 EVP - NHM 230 809988 0.284 0.249 - 0.323 PVP - HM 16 184618 0.087 0.053 - 0.141 PVP - NHM 128 809988 0.158 0.133 - 0.188 GVP - HM 11 184618 0.060 0.033 - 0.108 GVP - NHM 62 809988 0.077 0.060 - 0.098 AE = Athlete Exposure, IR = Incidence Rate per 1000 AE, CI - Confidence Interval, HM = Headgear Mandate, NHM = No Headgear Mandate, EVP = Equipment versus Player, PVP = Player versus Player, GVP = Ground versus Player Supported by: National Operating Committee for Standards on Athletic Equipment, USA Lacrosse, Foundation for the American Medical Society for Sports Medicine