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High school football concussion risk greater for young athletes and on turf
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BOSTON — Concussion risk in high school football is greater for younger players and on practices on turf-based surfaces, according to a study presented at the American Orthopaedic Society for Sports Medicine Annual Meeting.
The epidemiological study examined high school football concussion data in male players aged 14 to 18 years at 1,999 U.S. high schools. Scott Burkhart, PsyD, and colleagues collected data between 2012 to 2017 using the Rank One Health Injury Surveillance Database, a software used for mandatory and voluntary student-athlete injury documentation.
“While concussion prevention efforts like education and safe tackling appear to be working in high school football, it may be advantageous to provide more sports medicine coverage at more vulnerable time points like freshman and JV football,” Burkhart told Orthopedics Today. “Further, data supports reducing practice exposures on turf-based surfaces may lead to lower concussion incidence.”
The study included nearly one million male athletes who played football. Researchers recorded a total of 14,103 concussions in this group, accounting for 6% of all injuries in high school sports and making this the largest epidemiological high school football concussion study to date.
Rates of injury decreased from 2012 to 2016 in both practices and games. Burkhart noted injury proportion ratios decreased by year from 2012 to 2016 with an increase in 2017. He added that more concussions occurred in games (51.8%) than during practices (48.2%).
“No matter how we looked at this – whether it was injury proportion rates, overall incidence rates or risk ratios – you can see significant difference from games to practices,” he said at a presentation at the ASSOM meeting.
Turf outweighed all other mechanisms of injury, including helmet-to-helmet and grass. Almost 90% of all injuries occurred on turf-based surfaces, according to Burkhart.
“You can exponentially see the difference in terms of the amount of injuries occurring on turf versus anywhere else,” he said. “While we’ve done a great job in terms of educating athletes and reducing the number of helmet-to-helmet concussions, you can see that turf drastically outweighs others as the mechanism of injury. This gets even more pronounced when you look at game day.”
Burkhart noted that athletes aged 14, 15 and 16 years were at a greater risk for concussion compared players aged 17 and 18 years. He concluded that schools could mitigate risks by avoiding turf and examining coaching techniques. -by Julia Lowndes
Disclosures: The authors report no relevant financial disclosures.
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Edward R. McDevitt, MD, FAAOS
Burkart and colleagues should be congratulated on a study that provides the largest epidemiological high school football concussion incidence. Almost a million players were monitored over an 8 year period and more than 14,000 concussions were documented which accounted for 6% of all injuries reported. More concussions were seen in games than in practice. There was a slight decline in concussions reported during the time frame studied, but the number of concussions —14,000 — is a significant and worrisome number.
Recent studies show that a concussion has a negative effect on performance in the rest of the season. More concerning are the reports that concussion may have long term serious effects on cognition. In 1905, President Teddy Roosevelt brought college presidents together to brainstorm safety measures for college football. There were so many deaths and serious injuries that a ban on football was contemplated. The group moved to found the NCAA, an organization started to promote safety in sport.
In 2019, football at all levels is being scrutinized because of the data that show long term deleterious effects from concussion. We, as team physicians and the advocates for safety of our athletes in sport, must be the vanguards who promote safety in football. A 6% injury rate is too substantial to ignore.
References:
Mez J, et al. Ann Neurol. 2019;doi:10.1002/ana.25611.
Navarro SM, et al. J Neurotrauma. 2018;doi:10.1089/neu.2017.5611.
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