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Original Investigation |

Incidence of Concussion During Practice and Games in Youth, High School, and Collegiate American Football Players

Thomas P. Dompier, PhD, ATC1; Zachary Y. Kerr, PhD, MPH1; Stephen W. Marshall, PhD2; Brian Hainline, MD3; Erin M. Snook, PhD1; Ross Hayden, MA1; Janet E. Simon, PhD, ATC4
[+] Author Affiliations
1Datalys Center for Sports Injury Research and Prevention, Inc, Indianapolis, Indiana
2Injury Prevention Research Center, Department of Epidemiology, University of North Carolina, Chapel Hill
3Sport Science Institute, National Collegiate Athletic Association, Indianapolis, Indiana
4Department of Kinesiology, University of Toledo, Toledo, Ohio
JAMA Pediatr. 2015;169(7):659-665. doi:10.1001/jamapediatrics.2015.0210.
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Importance  A report by the Institute of Medicine called for comprehensive nationwide concussion incidence data across the spectrum of athletes aged 5 to 23 years.

Objective  To describe the incidence of concussion in athletes participating in youth, high school, and collegiate American football.

Design, Setting, and Participants  Data were collected by athletic trainers at youth, high school, and collegiate football practices and games to create multiple prospective observational cohorts during the 2012 and 2013 football seasons. Data were collected from July 1, 2012, through January 31, 2013, for the 2012 season and from July 1, 2013, through January 31, 2014, for the 2013 season. The Youth Football Surveillance System included 118 youth football teams, providing 4092 athlete-seasons. The National Athletic Treatment, Injury and Outcomes Network program included 96 secondary school football programs, providing 11 957 athlete-seasons. The National Collegiate Athletic Association Injury Surveillance Program included 24 member institutions, providing 4305 athlete-seasons.

Exposures  All injuries regardless of severity, including concussions, and athlete exposure information were documented by athletic trainers during practices and games.

Main Outcomes and Measures  Injury rates, injury rate ratios, risks, risk ratios, and 95% CIs were calculated.

Results  Concussions comprised 9.6%, 4.0%, and 8.0% of all injuries reported in the Youth Football Surveillance System; National Athletic Treatment, Injury and Outcomes Network; and National Collegiate Athletic Association Injury Surveillance Program, respectively. The game concussion rate was higher than the practice concussion rate across all 3 competitive levels. The game concussion rate for college athletes (3.74 per 1000 athlete exposures) was higher than those for high school athletes (injury rate ratio, 1.86; 95% CI, 1.50-2.31) and youth athletes (injury rate ratio, 1.57; 95% CI, 1.17-2.10). The practice concussion rate in college (0.53 per 1000 athlete exposures) was lower than that in high school (injury rate ratio, 0.80; 95% CI, 0.67-0.96). Youth football had the lowest 1-season concussion risks in 2012 (3.53%) and 2013 (3.13%). The 1-season concussion risk was highest in high school (9.98%) and college (5.54%) in 2012.

Conclusions and Relevance  Football practices were a major source of concussion at all 3 levels of competition. Concussions during practice might be mitigated and should prompt an evaluation of technique and head impact exposure. Although it is more difficult to change the intensity or conditions of a game, many strategies can be used during practice to limit player-to-player contact and other potentially injurious behaviors.

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Figure.
Injury Rates by Level of Competition

Concussion, ankle sprain, knee sprain, and fracture injury rates in football games (A) and practices (B). AE indicates athlete exposure.

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