Concussion Characteristics in High School Football by Helmet Age/Recondition Status, Manufacturer, and Model: 2008-2009 Through 2012-2013 Academic Years in the United States

Am J Sports Med. 2016 Jun;44(6):1382-90. doi: 10.1177/0363546516629626. Epub 2016 Feb 23.


Background: Football helmets used by high school athletes in the United States should meet the National Operating Committee on Standards for Athletic Equipment performance standards. Despite differences in interior padding and exterior shells, all football helmets should provide comparable protection against concussions. Yet, debate continues on whether differences in the rates or severity of concussions exist based on helmet age/recondition status, manufacturer, or model.

Purpose: To investigate whether high school football concussion characteristics varied by helmet age/recondition status, manufacturer, and model.

Study design: Descriptive epidemiological study.

Methods: High school football concussion and helmet data were collected from academic years 2008-2009 through 2012-2013 as part of the National High School Sports-Related Injury Surveillance Study. The certified athletic trainers of participating schools submitted athlete-exposure (AE) and injury information weekly.

Results: Participating schools reported 2900 football concussions during 3,528,790 AEs for an overall rate of 8.2 concussions per 10,000 AEs. Concussion rates significantly increased from 2008-2009 through 2012-2013 overall (P = .006) as well as in competition (P = .027) and practice (P = .023). Characteristics of concussed football players (ie, mean number of symptoms, specific concussion symptoms, symptom resolution time, and time until return to play) were similar among players wearing new helmets when compared with reconditioned helmets. Fewer players wearing an old/not reconditioned helmet had concussion symptoms resolve within 1 day compared with players wearing a new helmet. Despite differences in the manufacturers and models of helmets worn by all high school football players compared with players who sustained a concussion, the mean number of concussion symptoms, specific concussion symptoms, symptom resolution time, and time until return to play were similar for concussions sustained by football players wearing the most common helmet manufacturers and models.

Conclusion: Overall, for new and reconditioned football helmets, the most common helmet manufacturers and models on the market today appear to provide high school football players with similar protection against concussions.

Clinical relevance: Concussions can have serious acute and long-term effects. An understanding of concussion patterns in high school athletes can drive targeted preventive measures, including improvements to and/or better use of protective equipment, to reduce the incidence and/or severity of sports-related concussions.

Keywords: adolescent; concussion; football; helmet.

MeSH terms

  • Adolescent
  • Athletes* / statistics & numerical data
  • Brain Concussion / epidemiology*
  • Brain Concussion / etiology
  • Football / injuries*
  • Head Protective Devices / standards*
  • Humans
  • Male
  • Schools
  • Students* / statistics & numerical data
  • United States / epidemiology