Introduction The high concussion burden in youth ice hockey is concerning. An important yet understudied area for prevention is protective equipment (e.g., wearing a mouthguard, age of helmet). Therefore, the objective of this study was to compare incidence rates of concussion between players based on mouthguard use and helmet age.

Materials and Methods This prospective cohort collected concussion information and player participation over five seasons (2013/14–2017/18) in male and female youth ice hockey players (ages 11–18). Baseline assessments were completed near the season start and collected reports on mouthguard use (yes, no), helmet age (newer/<2 years old, older/≥2 years old), and other important covariables (i.e., weight, age group, position of play, concussion history, body checking). Moreover, each player’s participation hours and the number of therapist-suspected and physician-diagnosed concussions were collected throughout each season. A multilevel negative binomial regression model was used to estimate the concussion incidence rate and incidence rate ratio (IRR) for equipment.

Results The model included 426 player concussions (suffered by 369 players) with 271,148.7 player-hours and was adjusted for covariables, clustered by team, and offset by player-hours. Results showed that players who reported wearing a mouthguard had a 28% lower concussion rate compared with non-wearers (IRR=0.72, 95%CI: 0.55–0.93) while no differences in the concussion rate between newer and older helmet ages (IRR=0.94, 95%CI: 0.76–1.16) were detected.

Conclusions Wearing a mouthguard was associated with significantly lower concussion rates; thus, policy mandating use should be considered in youth ice hockey. More specific helmet age categories may require further investigation.