Youth helmet design in sports with repetitive low- and medium-energy impacts: a systematic review

Concussion awareness in youth sports has increased secondary to recent legislation, public health campaigns, and media coverage. The potential for long-term negative sequelae is now widely recognized and there have been a number of initiatives nationwide to prevent pediatric head injuries, including efforts to design more effective helmets for repetitive impact sports. The primary aim of this review is to systematically assess the literature regarding helmet design in youth sports specifically designed to mitigate repetitive low- and medium-energy impacts. Secondary aims include identifying areas for future research and opportunities for helmet design improvement. A systematic review of the literature was performed to identify articles relating to youth helmet design and biomechanical studies of concussion in youth sports. Pubmed, Google scholar, Cochrane Review and article citations were used to identify all pertinent English articles between 1971 and January 2016. A total of 14 studies met criteria for inclusion in this review, three of which included clinical outcomes (all Level of Evidence II) and eleven of which included biomechanical outcomes. The vast majority focused on adolescents playing football. Six of the biomechanical studies demonstrated improved biomechanical metrics in helmets with increasing foam thickness and number of foam layers. Two clinical studies also seem to support this concept, with significant caveats. To date, there are limited clinical and biomechanical data on youth helmet design. There is a need for further research in order to optimize helmet design and reduce the number and severity of pediatric sports-related head injuries.