TY - JOUR
T1 - Opportunities for Prevention of Concussion and Repetitive Head Impact Exposure in College Football Players
T2 - A Concussion Assessment, Research, and Education (CARE) Consortium Study
AU - McCrea, Michael A.
AU - Shah, Alok
AU - Duma, Stefan
AU - Rowson, Steven
AU - Harezlak, Jaroslaw
AU - McAllister, Thomas W.
AU - Broglio, Steven P.
AU - Giza, Christopher C.
AU - Goldman, Joshua
AU - Cameron, Kenneth L.
AU - Houston, Megan N.
AU - McGinty, Gerald
AU - Jackson, Jonathan C.
AU - Guskiewicz, Kevin
AU - Mihalik, Jason P.
AU - Brooks, M. Alison
AU - Pasquina, Paul
AU - Stemper, Brian D.
N1 - Funding Information:
Football League outside the submitted work. Dr Duma reported grants from the NIH outside the submitted work. Dr Rowson reported grants from National Collegiate Athletic Association and grants from Department of Defense during the conduct of the study. Dr Broglio had current or past research funding from the NIH; US Centers for Disease Control and Prevention; Department of Defense– USA Medical Research Acquisition Activity; National Collegiate Athletic Association; National Athletic Trainers' Association Foundation; National Football League/Under Armour/GE; Simbex; and ElmindA. He has consulted for the National Collegiate Athletic Association (travel expenses only), US Soccer, US Cycling (unpaid), medico-legal litigation, and received speaker honorarium and travel reimbursements for talks given. He is on the University of Calgary SHRed Concussions external advisory board (unpaid) and is/was on the editorial boards (all unpaid) for Journal of Athletic Training (2015 to present), Concussion (2014 to present), Athletic Training & Sports Health Care (2008 to present), and the British Journal of Sports Medicine (2008 to 2019). Dr Giza grants from University of California, Los Angeles (UCLA) Steve Tisch BrainSPORT Program, UCLA Brain Injury Research Center, UCLA Easton Clinic for Brain Health, and National Institute of Neurological Disorders and Stroke NS110757; other support from the Highmark Interactive Advisory Board, Stock Options, National Basketball Association, National Football League, National Hockey League Players’ Association, Los Angeles Lakers Clinical consultant, and Blackwell/Wiley Publishing Book royalties outside the submitted work; and serving on Concussion Committees for Major League Soccer, National Basketball Association, and the US Soccer Federation. Dr Cameron reported grants from the NATA Foundation Board of Directors. Dr Guskiewicz reports having served on the National Collegiate Athletic Association Concussion Safety Protocol Review Committee from 2014 to 2020. Dr Mihalik reported grants from the NIH, the National Football League, and the US Centers for Disease Control and Prevention outside the submitted work; in addition, Dr Mihalik serves as Chief Science Officer and Co-founder (equity) for Senaptec Inc. Dr Brooks reported other support from American Medical Society for Sports Medicine Board of Directors (reimbursement for travel to board meetings) and American Academy of Pediatricians’ Council on Sports Medicine and Fitness (reimbursement for travel to Executive Committee meetings) outside the submitted work. Dr Stemper reported grants from Prevent Biometrics and Advanced Medical Electronics outside the submitted work. No other disclosures were reported.
Funding Information:
reported grants from the National Institutes of Health (NIH), US Centers for Disease Control and Prevention, Abbott Laboratories, and the National
Funding Information:
possible in part with support from the Grand Alliance Concussion Assessment, Research, and Education (CARE) Consortium, funded in part by the National Collegiate Athletic Association (NCAA) and the US Department of Defense (DOD). The US Army Medical Research Acquisition Activity, 820 Chandler St, Fort Detrick, Maryland, is the awarding and administering acquisition office. This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs, through the Combat Casualty Care Research Program, endorsed by the Department of Defense, through the Joint Program Committee 6/ Combat Casualty Care Research Program–Psychological Health and Traumatic Brain Injury Program under award W81XWH1420151.
Publisher Copyright:
© 2021 American Medical Association. All rights reserved.
PY - 2021/3
Y1 - 2021/3
N2 - Importance: Concussion ranks among the most common injuries in football. Beyond the risks of concussion are growing concerns that repetitive head impact exposure (HIE) may increase risk for long-term neurologic health problems in football players. Objective: To investigate the pattern of concussion incidence and HIE across the football season in collegiate football players. Design, Setting, and Participants: In this observational cohort study conducted from 2015 to 2019 across 6 Division I National Collegiate Athletic Association (NCAA) football programs participating in the Concussion Assessment, Research, and Education (CARE) Consortium, a total of 658 collegiate football players were instrumented with the Head Impact Telemetry (HIT) System (46.5% of 1416 eligible football players enrolled in the CARE Advanced Research Core). Players were prioritized for instrumentation with the HIT System based on their level of participation (ie, starters prioritized over reserves). Exposure: Participation in collegiate football games and practices from 2015 to 2019. Main Outcomes and Measures: Incidence of diagnosed concussion and HIE from the HIT System. Results: Across 5 seasons, 528684 head impacts recorded from 658 players (all male, mean age [SD], 19.02 [1.25] years) instrumented with the HIT System during football practices or games met quality standards for analysis. Players sustained a median of 415 (interquartile range [IQR], 190-727) recorded head impacts (ie, impacts) per season. Sixty-eight players sustained a diagnosed concussion. In total, 48.5% of concussions (n = 33) occurred during preseason training, despite preseason representing only 20.8% of the football season (0.059 preseason vs 0.016 regular-season concussions per team per day; mean difference, 0.042; 95% CI, 0.020-0.060; P =.001). Total HIE in the preseason occurred at twice the proportion of the regular season (324.9 vs 162.4 impacts per team per day; mean difference, 162.6; 95% CI, 110.9-214.3; P <.001). Every season, HIE per athlete was highest in August (preseason) (median, 146.0 impacts; IQR, 63.0-247.8) and lowest in November (median, 80.0 impacts; IQR, 35.0-148.0). Over 5 seasons, 72% of concussions (n = 49) (game proportion, 0.28; 95% CI, 0.18-0.40; P <.001) and 66.9% of HIE (262.4 practices vs 137.2 games impacts per player; mean difference, 125.3; 95% CI, 110.0-140.6; P <.001) occurred in practice. Even within the regular season, total HIE in practices (median, 175.0 impacts per player per season; IQR, 76.0-340.5) was 84.2% higher than in games (median, 95.0 impacts per player per season; IQR, 32.0-206.0). Conclusions and Relevance: Concussion incidence and HIE among college football players are disproportionately higher in the preseason than regular season, and most concussions and HIE occur during football practices, not games. These data point to a powerful opportunity for policy, education, and other prevention strategies to make the greatest overall reduction in concussion incidence and HIE in college football, particularly during preseason training and football practices throughout the season, without major modification to game play. Strategies to prevent concussion and HIE have important implications to protecting the safety and health of football players at all competitive levels.
AB - Importance: Concussion ranks among the most common injuries in football. Beyond the risks of concussion are growing concerns that repetitive head impact exposure (HIE) may increase risk for long-term neurologic health problems in football players. Objective: To investigate the pattern of concussion incidence and HIE across the football season in collegiate football players. Design, Setting, and Participants: In this observational cohort study conducted from 2015 to 2019 across 6 Division I National Collegiate Athletic Association (NCAA) football programs participating in the Concussion Assessment, Research, and Education (CARE) Consortium, a total of 658 collegiate football players were instrumented with the Head Impact Telemetry (HIT) System (46.5% of 1416 eligible football players enrolled in the CARE Advanced Research Core). Players were prioritized for instrumentation with the HIT System based on their level of participation (ie, starters prioritized over reserves). Exposure: Participation in collegiate football games and practices from 2015 to 2019. Main Outcomes and Measures: Incidence of diagnosed concussion and HIE from the HIT System. Results: Across 5 seasons, 528684 head impacts recorded from 658 players (all male, mean age [SD], 19.02 [1.25] years) instrumented with the HIT System during football practices or games met quality standards for analysis. Players sustained a median of 415 (interquartile range [IQR], 190-727) recorded head impacts (ie, impacts) per season. Sixty-eight players sustained a diagnosed concussion. In total, 48.5% of concussions (n = 33) occurred during preseason training, despite preseason representing only 20.8% of the football season (0.059 preseason vs 0.016 regular-season concussions per team per day; mean difference, 0.042; 95% CI, 0.020-0.060; P =.001). Total HIE in the preseason occurred at twice the proportion of the regular season (324.9 vs 162.4 impacts per team per day; mean difference, 162.6; 95% CI, 110.9-214.3; P <.001). Every season, HIE per athlete was highest in August (preseason) (median, 146.0 impacts; IQR, 63.0-247.8) and lowest in November (median, 80.0 impacts; IQR, 35.0-148.0). Over 5 seasons, 72% of concussions (n = 49) (game proportion, 0.28; 95% CI, 0.18-0.40; P <.001) and 66.9% of HIE (262.4 practices vs 137.2 games impacts per player; mean difference, 125.3; 95% CI, 110.0-140.6; P <.001) occurred in practice. Even within the regular season, total HIE in practices (median, 175.0 impacts per player per season; IQR, 76.0-340.5) was 84.2% higher than in games (median, 95.0 impacts per player per season; IQR, 32.0-206.0). Conclusions and Relevance: Concussion incidence and HIE among college football players are disproportionately higher in the preseason than regular season, and most concussions and HIE occur during football practices, not games. These data point to a powerful opportunity for policy, education, and other prevention strategies to make the greatest overall reduction in concussion incidence and HIE in college football, particularly during preseason training and football practices throughout the season, without major modification to game play. Strategies to prevent concussion and HIE have important implications to protecting the safety and health of football players at all competitive levels.
UR - http://www.scopus.com/inward/record.url?scp=85100463770&partnerID=8YFLogxK
U2 - 10.1001/jamaneurol.2020.5193
DO - 10.1001/jamaneurol.2020.5193
M3 - Article
C2 - 33523101
AN - SCOPUS:85100463770
SN - 2168-6149
VL - 78
SP - 346
EP - 350
JO - JAMA Neurology
JF - JAMA Neurology
IS - 3
ER -