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  • Sports-Related Concussion in Helmeted vs. Unhelmeted Athletes: Who Fares Worse?

    Final Number:

    Scott L. Zuckerman MD; Young Min Lee BSPH; Mitchell Odom; Jonathan Forbes MD; Gary Solomon PhD; Allen K. Sills MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: Sports-related concussion (SRC) has emerged as an international public health dilemma. Little is known about the effect of wearing or not wearing a helmet (i.e., helmet status) on the acute outcomes of concussed athletes. We endeavored to assess acute neurocognitive and symptom changes after SRC in helmeted vs. unhelmeted athletes. We were not assessing helmet use on concussion prevention; rather, we attempted to address the question of once the concussion has occurred in a helmeted vs. non-helmeted athletes, are the clinical outcomes the same?

    Methods: In a retrospective study, 1,025 athletes from two regional databases with SRC were evaluated. 235 athletes were excluded, and the remaining 790 were grouped according to helmet status and matched by age, gender, number of prior concussions, and days to post-concussion test, yielding a final cohort of 138 athletes. For each group of 69, differences in post-concussion neurocognitive and total symptom scores were compared using group mean differences as well as reliable change index (RCI) scores set at the 80% confidence interval. All scores were compared with either student’s t-test or Mann-Whitney U test. Statistical significance was set at an alpha of 0.05.

    Results: By design, gender, number of prior concussions, and days to post-concussion test were identical in both groups, with age nearly identical. The only between group differences in demographic variables were higher weight and BMI in the helmeted group. Using group mean change scores and RCI methodology, we found no significant differences between the helmeted and unhelmeted groups in four neurocognitive tests and one aggregate symptom score.

    Conclusions: In our cohort of carefully matched athletes from two regional concussion centers, helmet status was unrelated to neurocognitive scores and total symptoms in athletes after suffering a SRC. These findings suggest that the concussion syndrome and acute outcome in helmeted and unhelmeted sports are quite similar.

    Patient Care: We hope our results will help practitioners treat pediatric athletes in the acute concussion phase and dictate treatment based on helmet status.

    Learning Objectives: To assess acute post-concussion outcomes in helmeted vs. unhelmeted athletes. To determine if helmet status portends a better or worse prognosis in the acute post-concussive phase.


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