The Effectiveness of Mandated Headgear Use in High School Women’s Lacrosse at Reducing the Rate of Head and Face Injuries

Objectives: There has been continued controversy regarding whether or not headgear use in women’s lacrosse will increase or decrease the rate of head injuries. In 2017, the Public Schools Athletic of New York City became the first high school organization in the country to mandate ASTM standard F3137 headgear for all women’s lacrosse players. The purpose of this study is to investigate the effect of mandated headgear use on the rate of head and face injuries in high school women’s lacrosse.Methods: This was a prospective cohort study. The study group included eight varsity and junior varsity women’s lacrosse teams, as well as their game opponents, who were mandated to wear F3137 headgear for all practice and game events over the course of the 2017 and 2018 seasons. Certified athletic trainers assessed and documented all injuries that occurred as a result of participation on the lacrosse teams and athlete exposures were estimated based on the number of team practice and game events. Injury rates were compared with those from the High School RIO (Reporting Information Online) injury data reports from the 2009 to 2016 seasons.Results: Over the study period, 17 total injuries were reported during 22,397 exposures for an injury rate of 0.76 injuries per 1,000 athlete-exposures. Two head/face injuries, both of which were classified as concussions, were reported during the study for a head/face injury rate and concussion rate of 0.09 per 1,000 athlete-exposures. The headgear cohort demonstrated significant decreases in rates of in-game head/face injury (RR 0.141, 95% CI [0.004, 0.798]), in-game concussion (RR 0.152, 95% CI [0.004, 0.860) and practice non-head/face injury (RR 0.239, 95% CI [0.049, 0.703]) when compared to the control cohort.Conclusion: Mandated use of F3137 headgear was shown to be effective at lowering the rate of head or face injury and concussions in women’s lacrosse. Additionally, mandated headgear use was also shown to lower the rate of injury to body locations other than the head or face during practice.Absolute Risk △No headgear Headgear ARR Relative Risk 95% Cl P ValueHead/fare injuries Practice 0.193 0.068 0.125 0.351 0.009, 2.005 0.455 Game 0.925 0.131 0.794 0.141 0.004, 0.798 0.0215 Total 0.420 0.089 0.331 0.213 0.026, 0.775 0.010Concussions Practice 0.157 0.068 0.089 0.431 0.011, 2.480 0.663 Game 0.859 0.131 0.728 0.152 0.004, 0.860 0.023 Total 0.375 0.089 0.285 0.238 0.029, 0.870 0.022Non-head/face injuries Practice 0.851 0.203 0.648 0.239 0.049, 0.703 0.003 Game 1.557 1.570 -0.013 1.008 0.516,1.785 1.000 Total 1.070 0.670 0.400 0.626 0.349,1.039 0.074Total Practice 1.044 0.271 0.773 0.260 0.070, 0.669 0.001 Game 2.482 1.701 0.781 0.685 0.362,1.182 0.207 Total 1.490 0.759 0.731 0.509 0.296, 0.820 0.003