Concussion Mechanisms and Activities in Youth,High School,and College Football

Abstract

Our purpose was to determine concussion mechanism and activity differences among three cohorts of football players: youth, high school, and college. Participants in this prospective cohort study were youth (ages 5–14 years, 118 teams, 310 team-seasons), high school (96 teams, 184 team-seasons), and college (34 teams, 71 team-seasons) football players. Athletic trainers collected athlete-exposure (AE) and concussion data during the 2012–2014 seasons. Injury mechanism referred to the object that made contact with the concussed player, resulting in the concussion. Injury activity referred to the type of football-specific activity that the player was involved in when the concussion was sustained. Injury proportion ratios (IPR) compared distributions of concussion mechanisms and activities among age levels. A total of 1429 concussions were reported over 1,981,284 AE across all levels (Rate: 0.72/1000AE). Overall, most concussions were caused by player contact (84.7%). During games, a greater proportion of youth football concussions (14.7%) were caused by surface contact than high school (7.3%, IPR = 2.02; 95% confidence interval [CI]: 1.10–3.72) and college (7.1%, IPR = 2.07, 95% CI: 1.02–4.23) football. Compared with college football concussions (90.2%), a smaller proportion of youth (80.0%, IPR = 0.89, 95% CI: 0.79–0.99) and high school (83.2%, IPR = 0.92, 95% CI: 0.86–0.99) football concussions were caused by player contact. A greater proportion of game youth football concussions (42.1%) occurred while an individual was being tackled than occurred in high school (23.2%, IPR = 1.81, 95% CI: 1.34–2.45) and college (23.0%, IPR = 1.83, 95% CI: 1.29–2.62) football. Findings were similar during practices. Compared with college football game concussions (15.8%), a smaller proportion of youth (6.3%, IPR = 0.40, 95% CI: 0.17–0.93) and high school (9.5%, IPR = 0.60, 95% CI: 0.38–0.95) football game concussions occurred while an individual was being blocked. Concussion mechanism and activity differences should be considered when developing concussion prevention and sport-safety methods specific to different age levels, in order to maximize effectiveness.