title: Current state of concussion prevention strategies: a systematic review and meta-analysis of prospective, controlled studies.
abstract: OBJECTIVE
  The aim of the current review was to systematically identify, evaluate and synthesise trials that examine concussion prevention via equipment, educational programmes and training programmes.
  
  
  METHODS
  PubMed and EBSCO host (CINAHL, MEDLINE, SPORTDiscus).
  
  
  METHODS
  The electronic databases PubMed and EBSCO were searched using the phrases:concussion prevention equipment,concussion prevention trainingandconcussion prevention education. Included studies utilised a prospective study design to evaluate the preventative effect of: (1) equipment, (2) training or (3) educational programmes on the incidence of concussions in comparison to a control group.
  
  
  METHODS
  Demographic data and intervention methods were recorded. Intervention and control group concussion rates and superficial head injury rates were extracted and combined using random-effects relative risk meta-analysis.
  
  
  RESULTS
  14 studies evaluated interventions of novel protective equipment. One prospective investigation evaluated an educational programme. The relative risk of concussion for participants enrolled in the interventional arms of trials was not significantly different from that in standard practice arms (RR=0.78, 95% CI 0.55 to 1.11, χ2=1.8, p=0.17; I2=85.3%, 95% CI 71.5% to 90.8%). The relative risk of concussion for participants wearing protective equipment (ie, headgear, full face shields) relative to their counterparts wearing standard or no equipment, calculated from seven available reports, showed no effect of intervention (RR=0.82, 95% CI 0.56 to 1.20, χ2=1.06, p=0.30; I2=86.7%, 95% CI 73.3% to 91.8%). The relative risk of superficial head injury for participants wearing protective equipment relative to their counterparts, calculated from three reports, showed a significant risk reduction (RR=0.41, 95% CI 0.31 to 0.56, χ2=34.13, p<0.0001; I2=53.1%, 95% CI 0% to 85.2%).
  
  
  CONCLUSIONS
  Prospective controlled studies indicate that certain protective equipment may prevent superficial head injury, but these items are suboptimal for concussion prevention in sport.
authors.affiliation: Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.|College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Schneider
authors.affiliation: College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.|Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA.
authors.forename: Ravi K
authors.initials: RK
authors.lastname: Grandhi
authors.affiliation: Division of Primary Care/Sports Medicine, Jennie Stuart Medical Center, Hopkinsville, Kentucky, USA.
authors.forename: Purnima
authors.initials: P
authors.lastname: Bansal
authors.affiliation: College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.
authors.forename: George E
authors.initials: GE
authors.lastname: Kuntz
authors.affiliation: School of Allied Health, La Trobe University, Melbourne, Victoria, Australia.
authors.forename: Kate E
authors.initials: KE
authors.lastname: Webster
authors.affiliation: Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Kelsey
authors.initials: K
authors.lastname: Logan
authors.affiliation: Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.|Division of Health Sciences, Mount St. Joseph University, Cincinnati, Ohio, USA.
authors.forename: Kim D
authors.initials: KD
authors.lastname: Barber Foss
authors.affiliation: Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.|College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.|Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA.|Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, Ohio, USA.|The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA.|Department of Orthopaedics, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Myer
mesh_terms: D001265:Athletic Injuries / Q000517:prevention & control*; D001924:Brain Concussion / Q000517:prevention & control*; D006260:Head Protective Devices; D006801:Humans; D040242:Risk Reduction Behavior; D013177:Sports
keywords: Brain; Concussion; Helmet; Meta-analysis