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Systematic review
Primary prevention of contact sports-related concussions in amateur athletes: a systematic review from the Eastern Association for the Surgery of Trauma
  1. Toby M Enniss1,
  2. Khaled Basiouny2,
  3. Brian Brewer3,
  4. Nikolay Bugaev4,
  5. Julius Cheng5,
  6. Omar K Danner6,
  7. Thomas Duncan7,
  8. Shannon Foster8,
  9. Gregory Hawryluk9,
  10. Hee Soo Jung10,
  11. Felix Lui11,
  12. Rishi Rattan12,
  13. Pina Violano13,
  14. Marie Crandall14
  1. 1 Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
  2. 2 Department of Trauma Surgery, George Washington University School of Medicine and Health Sciences, Washington, Columbia, USA
  3. 3 Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
  4. 4 Department of Surgery, Tufts University School of Medicine, Boston, Massachusetts, USA
  5. 5 Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA
  6. 6 Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia, USA
  7. 7 Department of Trauma Services, Ventura County Medical Center, Ventura, California, USA
  8. 8 Department of Trauma and Surgical Critical Care, University of Pennsylvania Reading Hospital, West Reading, Pennsylvania, USA
  9. 9 Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
  10. 10 Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
  11. 11 Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
  12. 12 Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
  13. 13 Injury Prevention, Community Outreach and Research, Yale-New Haven Hospital, New Haven, Connecticut, USA
  14. 14 Department of Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA
  1. Correspondence to Dr Toby M Enniss, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT 84132, USA; toby.enniss{at}hsc.utah.edu

Abstract

Background Awareness of the magnitude of contact sports-related concussions has risen exponentially in recent years. Our objective is to conduct a prospectively registered systematic review of the scientific evidence regarding interventions to prevent contact sports-related concussions.

Methods Using the Grading of Recommendations Assessment, Development, and Evaluation methodology, we performed a systematic review of the literature to answer seven population, intervention, comparator, and outcomes (PICO) questions regarding concussion education, head protective equipment, rules prohibiting high-risk activity and neck strengthening exercise for prevention of contact sports-related concussion in pediatric and adult amateur athletes. A query of MEDLINE, PubMed, Scopus, Cumulative Index of Nursing and Allied Health Literature, and Embase was performed. Letters to the editor, case reports, book chapters, and review articles were excluded, and all articles reviewed were written in English.

Results Thirty-one studies met the inclusion criteria and were applicable to our PICO questions. Conditional recommendations are made supporting preventive interventions concussion education and rules prohibiting high-risk activity for both pediatric and adult amateur athletes and neck strengthening exercise in adult amateur athletes. Strong recommendations are supported for head protective equipment in both pediatric and adult amateur athletes. Strong recommendations regarding newer football helmet technology in adult amateur athletes and rules governing the implementation of body-checking in youth ice hockey are supported.

Conclusion Despite increasing scientific attention to sports-related concussion, studies evaluating preventive interventions remain relatively sparse. This systematic review serves as a call to focus research on primary prevention strategies for sports-related concussion.

Level of evidence IV.

PROSPERO registration number #42016043019.

  • Brain Concussion
  • mild traumatic brain injury
  • athletic injuries
  • injury prevention

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/tsaco-2017-000153

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    Footnotes

    • Presented at Interim progress delivered as podium presentation at the 29th Eastern Association for the Surgery of Trauma Annual Scientific Assembly, San Antonio, Texas, January 12-16, 2016.

    • Contributors KB, NB, JC, MC, OKD, TD, TME, GH, HSJ, and FL contributed to project design and PICO question formulation. TME performed literature search. KB, BB, NB, JC, MC, OKD, TD, TME, SF, GH, HSJ, FL, and PV performed reference review to identify additional studies. KB, BB, NB, JC, MC, OKD, TD, TME, SF, GH, HSJ, FL, and PV performed literature review and data extraction. KB, BB, NB, JC, MC, OKD, TD, TME, SF, GH, HSJ, FL, RR, and PV interpreted the results and formulated the recommendations. KB, BB, NB, JC, MC, OKD, TD, TME, SF, GH, HSJ, FL, RR, and PV contributed to drafting and critical revision of the article. This article has already undergone revision through a blind review process by the Practice Management Guideline Committee of the Eastern Association for the Surgery of Trauma.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement There are no additional unpublished data associated with this systematic review.