Basic strategies such as wearing a helmet can help minimise the likelihood of major fractures and safeguard against sub-mild traumatic brain injury (TBI) blows, but they do not prevent mild TBIs.[34]Knapik JJ, Marshall SW, Lee RB, et al. Mouthguards in sport activities: history, physical properties and injury prevention effectiveness. Sports Med. 2007;37(2):117-44.
http://www.ncbi.nlm.nih.gov/pubmed/17241103?tool=bestpractice.com
Monitoring in-game fatigue in sports is a practical means of decreasing the chances for a mild TBI, but it cannot prevent an injury from happening.[35]Benson BW, Hamilton GM, Meeuwisse WH, et al. Is protective equipment useful in preventing concussion? A systematic review of the literature. Br J Sports Med. 2009 May;43 Suppl 1:i56-67.
http://www.ncbi.nlm.nih.gov/pubmed/19433427?tool=bestpractice.com
[36]Stevens ST, Lassonde M, de Beaumont L, et al. In-game fatigue influences concussions in national hockey league players. Res Sports Med. 2008;16(1):68-74.
http://www.ncbi.nlm.nih.gov/pubmed/18373290?tool=bestpractice.com
Measures that may be helpful in preventing sport-related concussion in children and adolescents include improving education and awareness of concussion, neck strengthening programmes, and rule changes with proper enforcement of these rules.[3]Harmon KG, Clugston JR, Dec K, et al. American Medical Society for Sports Medicine position statement on concussion in sport. Clin J Sport Med. 2019 Mar;29(2):87-100.
https://journals.lww.com/cjsportsmed/fulltext/2019/03000/american_medical_society_for_sports_medicine.1.aspx
http://www.ncbi.nlm.nih.gov/pubmed/30730386?tool=bestpractice.com
[33]Halstead ME, Walter KD, Moffatt K, et al. Sport-related concussion in children and adolescents. Pediatrics. 2018 Dec;142(6):e20183074.
https://publications.aap.org/pediatrics/article/142/6/e20183074/37534/Sport-Related-Concussion-in-Children-and?autologincheck=redirected
http://www.ncbi.nlm.nih.gov/pubmed/30420472?tool=bestpractice.com
Studies of recreational activities such as snowboarding, skiing, all terrain vehicle riding, and bicycling have also demonstrated a significant risk reduction in head trauma with helmet use.[37]Macnab AJ, Smith T, Gagnon FA, et al. Effect of helmet wear on the incidence of head/face and cervical spine injuries in young skiers and snowboarders. Inj Prev. 2002 Dec;8(4):324-7.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1756587
http://www.ncbi.nlm.nih.gov/pubmed/12460972?tool=bestpractice.com
[38]Rughani AI, Lin CT, Ares WJ, et al. Helmet use and reduction in skull fractures in skiers and snowboarders admitted to the hospital. J Neurosurg Pediatr. 2011 Mar;7(3):268-71.
http://www.ncbi.nlm.nih.gov/pubmed/21361765?tool=bestpractice.com
[39]Bergenstal J, Davis SM, Sikora R, et al. Pediatric bicycle injury prevention and the effect of helmet use: the West Virginia experience. W V Med J. 2012 May-Jun;108(3):78-81.
http://www.ncbi.nlm.nih.gov/pubmed/22792660?tool=bestpractice.com
[40]Miller M, Davidov D, Tillotson R, et al. Injury prevention and recreational all-terrain vehicle use: the impact of helmet use in West Virginia. W V Med J. 2012 May-Jun;108(3):96-101.
http://www.ncbi.nlm.nih.gov/pubmed/22792664?tool=bestpractice.com
Studies on helmet use in riders of bicycles, all-terrain vehicles, and motorcycles have consistently demonstrated a significant reduction in death and head injury.[41]Bowman SM, Aitken ME, Helmkamp JC, et al. Impact of helmets on injuries to riders of all-terrain vehicles. Inj Prev. 2009 Feb;15(1):3-7.
http://www.ncbi.nlm.nih.gov/pubmed/19190268?tool=bestpractice.com
Refer people with a head injury to investigate its causes and manage contributing factors, if appropriate. This could include, for example, referral for a falls assessment or to safeguarding services.[42]National Institute for Health and Care Excellence. Head injury: assessment and early management. May 2023 [internet publication].
https://www.nice.org.uk/guidance/ng232