@article{ref1,
title="Inadequate helmet fit increases concussion severity in American high school football players",
journal="Sports health",
year="2016",
author="Greenhill, Dustin A. and Navo, Paul and Zhao, Huaqing and Torg, Joseph and Comstock, R. Dawn and Boden, Barry P.",
volume="8",
number="3",
pages="238-243",
abstract="BACKGROUND: There is limited information on the relationship between American football helmet fit and concussion severity. HYPOTHESIS: Poor helmet fit may predispose football players to a more severe concussion. STUDY DESIGN: Descriptive epidemiology study. LEVEL OF EVIDENCE: Level 3. <br><br>METHODS: Data from concussion injury reports were obtained from the National High School Sports-Related Injury Surveillance System over a 9-year period. Symptoms, duration, and helmet parameters (fit, interior padding) were analyzed for all first-time concussions. <br><br>RESULTS: Data from 4580 concussions were analyzed. Patients who suffered concussions with a helmet that did not fit properly (3.22%), as determined by an athletic trainer, had higher rates of drowsiness (RR, 1.46; P = 0.005), hyperexcitability (RR, 2.38; P = 0.047), and sensitivity to noise (RR, 1.88; P < 0.001); had more symptoms (5.34 vs 4.54, P = 0.004); and had longer symptom duration (P = 0.04). Athletes with helmets lined with an air bladder had greater rates of sensitivity to light (RR, 1.13; P = 0.02), sensitivity to noise (RR, 1.25; P = 0.009), and longer symptom duration (P = 0.004) compared with foam or gel liners. <br><br>CONCLUSION: An improperly fitted football helmet is a risk factor for a concussion with more symptoms and of longer duration. Concussions of longer duration are also more common in players with an air bladder-lined helmet. Current high school football rules should mandate supervision and maintenance of helmet fit throughout the season, prior to impact. CLINICAL RELEVANCE: Team physicians, athletic trainers, coaches, and high school officials should ensure proper oversight of helmet fit in high school athletes to decrease concussion severity and duration.<br><br>© 2016 The Author(s).<p /> <p>Language: en</p>",
language="en",
issn="1941-7381",
doi="10.1177/1941738116639027",
url="http://dx.doi.org/10.1177/1941738116639027"
}