Facial protection and head injuries in ice hockey: a systematic review

Objective: To summarise the best available evidence to determine if facial protection reduces head injury in ice hockey. Data Sources: MEDLINE and Cochrane databases through January 2009. Review Methods: Utilising terms: "head injuries,'' "craniocerebral trauma [MeSH]'', "head injuries, closed [MeSH]'', head injuries, penetrating [MeSH]'', "face mask'', "face shield'', "visor'' and "hockey'', 24 articles were identified through our systematic literature search. Of these, six studies met the inclusion criteria. Three independent reviewers reviewed the articles. The study results and generated conclusions were extracted and agreed upon. Results: Studies reviewed suggest that facial protection reduces overall head injuries in ice hockey. Facial protection showed a statistically significant (p<0.05) reduction in the number and type of facial injuries. In studies evaluating full facial protection (FFP) versus half facial protection (HFP), FFP offered a significantly higher level of protection against facial injuries and lacerations than HFP (relative risk (RR) 2.31, CI 1.53 to 3.48). There was no significant difference in the rate of concussion (RR 0.97, CI 0.61 to 1.54) or neck injury (CI 0.43 to 3.16) between full and partial protection. In those who sustained concussion players with FFP returned to practice or games sooner than players with partial facial protection (PFP) (1.7 sessions, CI 1.32 to 2.18). Conclusions: There is good evidence that FFP reduces the number and risk of overall head and facial injuries in ice hockey compared with PFP and no facial protection. PFP, while not as protective as FFP, appears to offer more risk reduction than no protection.