title: Effectiveness of rugby headgear in preventing soft tissue injuries to the head: a case-control and video cohort study.
abstract: OBJECTIVE
  To determine if headgear use by rugby players was associated with a reduced risk of head or facial laceration, abrasion, or fracture.
  
  
  METHODS
  An emergency department based case-control study in South Wales, UK, with cases being rugby players treated for superficial head and facial injuries and controls being their matched opponents during the game. A review of videos of the 41 games in the 1999 Rugby World Cup was also carried out to compare with the case-control study. Odds ratios (OR) and 95% confidence intervals (95% CI) were used to measure association between exposure (headgear wearing) and outcome (head and facial injuries).
  
  
  RESULTS
  In the case-control study, 164 pairs were analysed, with headgear worn by 12.8% of cases and 21.3% of controls. Headgear use was associated with substantial but non-significant reductions in superficial head (OR = 0.43, 95% CI 0.13 to 1.19) and facial (OR = 0.57, 95% CI 0.21 to 1.46) injuries. The video study followed 547 players over 41 games, during which there were 47 bleeding injuries to the head. Headgear use significantly reduced the risk of bleeding head injury in forwards (OR = 0.14, 95% CI 0.01 to 0.99, p = 0.02), but not in backs. There was also a higher risk of facial injury among forwards, but this was not significant.
  
  
  CONCLUSIONS
  The combined results suggest that headgear can prevent certain types of superficial head injuries in players at all levels of the game, but the evidence is strongest for superficial head injury in elite forwards. A randomised controlled trial would be the best way to study this further.
authors.affiliation: Department of Epidemiology, Statistics and Public Health, University of Wales College of Medicine, Cardiff, Wales, UK. jonessj3@cardiff.ac.uk
authors.forename: S J
authors.initials: SJ
authors.lastname: Jones
authors.forename: R A
authors.initials: RA
authors.lastname: Lyons
authors.forename: R
authors.initials: R
authors.lastname: Evans
authors.forename: R G
authors.initials: RG
authors.lastname: Newcombe
authors.forename: P
authors.initials: P
authors.lastname: Nash
authors.forename: M
authors.initials: M
authors.lastname: McCabe
authors.forename: S R
authors.initials: SR
authors.lastname: Palmer
mesh_terms: D016022:Case-Control Studies; D006259:Craniocerebral Trauma / Q000209:etiology / Q000517:prevention & control*; D004636:Emergency Service, Hospital; D005151:Facial Injuries / Q000209:etiology / Q000517:prevention & control; D005538:Football / Q000293:injuries*; D006260:Head Protective Devices; D006801:Humans; D008297:Male; D017695:Soft Tissue Injuries / Q000209:etiology / Q000517:prevention & control*; D019876:Sports Equipment; D014743:Videotape Recording; D014852:Wales