Update on the Epidemiology of Concussion/Mild Traumatic Brain Injury

  • Jameson D. VossEmail author
  • Joseph Connolly
  • Karen A. Schwab
  • Ann I. Scher
Concussion and Head Injury (S Lucas, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Concussion and Head Injury


Mild traumatic injuries to the brain (e.g., concussion) are common and have been recognized since antiquity, although definitions have varied historically. Nonetheless, studying the epidemiology of concussion helps clarify the overall importance, risk factors, and at-risk populations for this injury. The present review will focus on recent findings related to the epidemiology of concussion including definition controversies, incidence, and patterns in the population overall and in the military and athlete populations specifically. Finally, as this is an area of active research, we will discuss how future epidemiologic observations hold promise for gaining greater clarity about concussion and mild traumatic brain injury.


Concussion Mild traumatic brain injury Epidemiology Burden Military Athletes 



The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the US Air Force, the Department of Defense, or the US Government. Distribution A: Approved for public release; distribution is unlimited. Case Number: 88ABW-2014-4905, 28 Oct 2014.

Compliance with Ethics Guidelines

Conflict of Interest

Jameson D. Voss, Joseph Connolly, Karen A. Schwab, and Ann I. Scher each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. 1.
    McCrory PR, Berkovic SF. Concussion: the history of clinical and pathophysiological concepts and misconceptions. Neurology. 2001;57(12):2283–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Menon DK, Schwab K, Wright DW, Maas AI. Position statement: definition of traumatic brain injury. Arch Phys Med Rehabil. 2010;91(11):1637–40. doi: 10.1016/j.apmr.2010.05.017.PubMedCrossRefGoogle Scholar
  3. 3.
    McAllister TW, Ford JC, Flashman LA, Maerlender A, Greenwald RM, Beckwith JG, et al. Effect of head impacts on diffusivity measures in a cohort of collegiate contact sport athletes. Neurology. 2014;82(1):63–9. doi: 10.1212/01.wnl.0000438220.16190.42.PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Taber KH, Hurley RA, Haswell CC, Rowland JA, Hurt SD, Lamar CD, et al. White matter compromise in veterans exposed to primary blast forces. J Head Trauma Rehabil. 2014. doi: 10.1097/htr.0000000000000030.Google Scholar
  5. 5.
    Saatman KE, Duhaime AC, Bullock R, Maas AI, Valadka A, Manley GT. Classification of traumatic brain injury for targeted therapies. J Neurotrauma. 2008;25(7):719–38. doi: 10.1089/neu.2008.0586.PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.••
    Roozenbeek B, Maas AI, Menon DK. Changing patterns in the epidemiology of traumatic brain injury. Nat Rev Neurol. 2013;9(4):231–6. doi: 10.1038/nrneurol.2013.22. Provides an overview of epidemiologic trends in TBI throughout the world.PubMedCrossRefGoogle Scholar
  7. 7.
    Defense Centers of Excellence For Psychological Health and Traumatic Brain Injury. Case management of concussion/Mild TBI 2013. Accessed 19 May 2015.
  8. 8.
    National Center for Injury Prevention and Control. Report to Congress on mild traumatic brain injury in the United States: steps to prevent a serious public health problem. Centers for Disease Control and Prevention; 2003.Google Scholar
  9. 9.
    Walker W, Cifu DX, Hudak A, Goldberg G, Kunz RD, Sima A. Structured interview for mild traumatic brain injury after military blast: interrater agreement and development of diagnostic algorithm. J Neurotrauma. 2014. doi: 10.1089/neu.2014.3433.Google Scholar
  10. 10.
    Echlin PS, Skopelja EN, Worsley R, Dadachanji SB, Lloyd-Smith DR, Taunton JA et al. A prospective study of physician-observed concussion during a varsity university ice hockey season: incidence and neuropsychological changes. Part 2 of 4. Neurosurgical focus. 2012;33(6):E2: 1–11. doi: 10.3171/2012.10.focus12286.
  11. 11.
    Chrisman SP, Schiff MA, Chung SK, Herring SA, Rivara FP. Implementation of concussion legislation and extent of concussion education for athletes, parents, and coaches in Washington State. Am J Sports Med. 2014;42(5):1190–6. doi: 10.1177/0363546513519073.PubMedCrossRefGoogle Scholar
  12. 12.
    Llewellyn T, Burdette GT, Joyner AB, Buckley TA. Concussion reporting rates at the conclusion of an intercollegiate athletic career. Clin J Sport Med: Off J Can Acad Sport Med. 2014;24(1):76–9. doi: 10.1097/01.jsm.0000432853.77520.3d.CrossRefGoogle Scholar
  13. 13.
    Meehan 3rd WP, Mannix RC, O’Brien MJ, Collins MW. The prevalence of undiagnosed concussions in athletes. Clin J Sport Med: Off J Can Acad Sport Med. 2013;23(5):339–42. doi: 10.1097/JSM.0b013e318291d3b3.CrossRefGoogle Scholar
  14. 14.
    McCrea M, Hammeke T, Olsen G, Leo P, Guskiewicz K. Unreported concussion in high school football players: implications for prevention. Clin J Sport Med: Off J Can Acad Sport Med. 2004;14(1):13–7.CrossRefGoogle Scholar
  15. 15.
    Bazarian JJ, Veazie P, Mookerjee S, Lerner EB. Accuracy of mild traumatic brain injury case ascertainment using ICD-9 codes. Acad Emerg Med : Off J Soc Acad Emerg Med. 2006;13(1):31–8. doi: 10.1197/j.aem.2005.07.038.
  16. 16.
    Surveillance methods and standards—Section 13—Neurology. Armed Forces Health Surveillance Center. 2012. Accessed 20 December 2014.
  17. 17.
    The Barell injury diagnosis matrix, classification by body region and nature of the injury. The Centers For Disease Control and Prevention. 2006.
  18. 18.
    Harmon KG, Drezner JA, Gammons M, Guskiewicz KM, Halstead M, Herring SA, et al. American Medical Society for Sports Medicine position statement: concussion in sport. Br J Sports Med. 2013;47(1):15–26. doi: 10.1136/bjsports-2012-091941.PubMedCrossRefGoogle Scholar
  19. 19.
    Setnik L, Bazarian JJ. The characteristics of patients who do not seek medical treatment for traumatic brain injury. Brain Inj : [BI]. 2007;21(1):1–9. doi: 10.1080/02699050601111419.CrossRefGoogle Scholar
  20. 20.
    Demakis GJ, Rimland CA. Untreated mild traumatic brain injury in a young adult population. Arch Clin Neuropsychol: Off J Nat Acad Neuropsychologists. 2010;25(3):191–6. doi: 10.1093/arclin/acq004.CrossRefGoogle Scholar
  21. 21.
    Rosenthal JA, Foraker RE, Collins CL, Comstock RD. National high school athlete concussion rates from 2005–2006 to 2011–2012. Am J Sports Med. 2014;42(7):1710–5. doi: 10.1177/0363546514530091.PubMedCrossRefGoogle Scholar
  22. 22.
    The Centers for Disease Control and Prevention. Rates of TBI-related emergency department visits, hospitalizations, and deaths by sex—United States, 2001–2010. 2014. Accessed 13 October 2014.
  23. 23.
    DVBIC. DoD worldwide numbers for TBI. 2014. Accessed September - October 2014.
  24. 24.
    Kilcoyne KG, Dickens JF, Svoboda SJ, Owens BD, Cameron KL, Sullivan RT, et al. Reported concussion rates for three division I football programs: an evaluation of the new NCAA concussion policy. Sports Health. 2014;6(5):402–5. doi: 10.1177/1941738113491545.PubMedCrossRefGoogle Scholar
  25. 25.
    The Centers for Disease Control and Prevention. Traumatic brain injury. 2014. Accessed 11 October 2014.
  26. 26.
    CDC grand rounds: reducing severe traumatic brain injury in the United States. MMWR Morbidity and MortalityWeekly Report. 2013;62(27):549–52.Google Scholar
  27. 27.
    Centers for Disease Control and Prevention. Percent distributions of TBI-related emergency department visits by age group and injury mechanism—United States, 2006–2010. 2014. Accessed 11 Oct 2014.
  28. 28.
    Mason CN. Mild traumatic brain injury in children. Pediatr Nurs. 2013;39(6):267.PubMedGoogle Scholar
  29. 29.
    Bruns Jr J, Hauser WA. The epidemiology of traumatic brain injury: a review. Epilepsia. 2003;44 Suppl 10:2–10.PubMedCrossRefGoogle Scholar
  30. 30.
    Corrigan JD, Selassie AW, Orman JA. The epidemiology of traumatic brain injury. J Head Trauma Rehabil. 2010;25(2):72–80. doi: 10.1097/HTR.0b013e3181ccc8b4.PubMedCrossRefGoogle Scholar
  31. 31.
    Scher AI, Ross GW, Sigurdsson S, Garcia M, Gudmundsson LS, Sveinbjornsdottir S, et al. Midlife migraine and late-life parkinsonism: AGES-Reykjavik study. Neurology. 2014;83(14):1246–52. doi: 10.1212/wnl.0000000000000840.PubMedCrossRefGoogle Scholar
  32. 32.
    Langlois JA, Rutland-Brown W, Wald MM. The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil. 2006;21(5):375–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Feigin VL, Theadom A, Barker-Collo S, Starkey NJ, McPherson K, Kahan M, et al. Incidence of traumatic brain injury in New Zealand: a population-based study. Lancet Neurol. 2013;12(1):53–64. doi: 10.1016/s1474-4422(12)70262-4.PubMedCrossRefGoogle Scholar
  34. 34.
    Hoge CW, McGurk D, Thomas JL, Cox AL, Engel CC, Castro CA. Mild traumatic brain injury in U.S. Soldiers returning from Iraq. N Engl J Med. 2008;358(5):453–63. doi: 10.1056/NEJMoa072972.PubMedCrossRefGoogle Scholar
  35. 35.
    Hoge CW, Goldberg HM, Castro CA. Care of war veterans with mild traumatic brain injury—flawed perspectives. N Engl J Med. 2009;360(16):1588–91. doi: 10.1056/NEJMp0810606.PubMedCrossRefGoogle Scholar
  36. 36.
    Hendricks AM, Amara J, Baker E, Charns MP, Gardner JA, Iverson KM, et al. Screening for mild traumatic brain injury in OEF-OIF deployed US military: an empirical assessment of VHA’s experience. Brain Inj : [BI]. 2013;27(2):125–34. doi: 10.3109/02699052.2012.729284.CrossRefGoogle Scholar
  37. 37.
    Lange RT, Brickell TA, Kennedy JE, Bailie JM, Sills C, Asmussen S, et al. Factors influencing postconcussion and posttraumatic stress symptom reporting following military-related concurrent polytrauma and traumatic brain injury. Arch Clin Neuropsychol : Off J Nat Acad Neuropsychol. 2014;29(4):329–47. doi: 10.1093/arclin/acu013.CrossRefGoogle Scholar
  38. 38.
    Xydakis MS, Robbins AS, Grant GA. Mild traumatic brain injury in U.S. soldiers returning from Iraq. N Engl J Med. 2008;358(20):2177. doi: 10.1056/NEJMc086083.
  39. 39.
    Hawley CA, de Burgh HT, Russell RJ, Mead A. Traumatic brain injury recorded in the UK Joint Theatre Trauma Registry among the UK Armed Forces. J Head Trauma Rehabil. 2014. doi: 10.1097/htr.0000000000000023.Google Scholar
  40. 40.
    External causes of traumatic brain injury, 2000–2011. Msmr. 2013;20(3):9–14.Google Scholar
  41. 41.
    Incident diagnoses of common symptoms (“sequelae”) following traumatic brain injury, active component, U.S. Armed Forces, 2000–2012. Msmr. 2013;20(6):9–13.Google Scholar
  42. 42.
    Medical evacuations from Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF), active and reserve components, U.S. Armed Forces, October 2001 - September 2009. Msmr. 2010;17(2):6.Google Scholar
  43. 43.
    O’Donnell FL, Brundage JF, Wertheimer ER, Olive DS, Clark LL. Deployment-related conditions of special surveillance interest, U.S. Armed Forces, by month and service, January 2003 - January 2011 (data as of 23 February 2012). Msmr. 2012;19(2):25.Google Scholar
  44. 44.
    National Defense Authorization Act for Fiscal Year 2014, Section 723, Report on the Memorandum Regarding Traumatic Brain Injuries. 2014. Accessed 20 Dec 2014.
  45. 45.
    Chase RP, Nevin RL. Population estimates of undocumented incident traumatic brain injuries among combat-deployed US military personnel. J Head Trauma Rehabil. 2014. doi: 10.1097/htr.0000000000000061.Google Scholar
  46. 46.••
    Giza CC, Kutcher JS, Ashwal S, Barth J, Getchius TS, Gioia GA, et al. Summary of evidence-based guideline update: evaluation and management of concussion in sports: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2013;80(24):2250–7. doi: 10.1212/WNL.0b013e31828d57dd. Provides evidence-based guidelines focused on concussion in sports.PubMedCentralPubMedCrossRefGoogle Scholar
  47. 47.
    Kontos AP, Elbin RJ, Fazio-Sumrock VC, Burkhart S, Swindell H, Maroon J, et al. Incidence of sports-related concussion among youth football players aged 8–12 years. J Pediatr. 2013;163(3):717–20. doi: 10.1016/j.jpeds.2013.04.011.PubMedCrossRefGoogle Scholar
  48. 48.
    Ruhe A, Gansslen A, Klein W. The incidence of concussion in professional and collegiate ice hockey: are we making progress? A systematic review of the literature. Br J Sports Med. 2014;48(2):102–6. doi: 10.1136/bjsports-2012-091609.PubMedCrossRefGoogle Scholar
  49. 49.
    Kerr ZY, Collins CL, Mihalik JP, Marshall SW, Guskiewicz KM, Comstock RD. Impact locations and concussion outcomes in high school football player-to-player collisions. Pediatrics. 2014;134(3):489–96. doi: 10.1542/peds.2014-0770.PubMedCrossRefGoogle Scholar
  50. 50.
    Wong RH, Wong AK, Bailes JE. Frequency, magnitude, and distribution of head impacts in Pop Warner football: the cumulative burden. Clin Neurol Neurosurg. 2014;118:1–4. doi: 10.1016/j.clineuro.2013.11.036.PubMedCrossRefGoogle Scholar
  51. 51.
    Eirale C, Tol JL, Targett S, Holmich P, Chalabi H. Concussion surveillance: do low concussion rates in the Qatar Professional Football League reflect a true difference or emphasize challenges in knowledge translation? Clin J Sport Med : Off J Can Acad Sport Med. 2014. doi: 10.1097/jsm.0000000000000066.Google Scholar
  52. 52.
    Smith DW, Myer GD, Currie DW, Comstock RD, Clark JF, Bailes JE. Altitude modulates concussion incidence implications for optimizing brain compliance to prevent brain injury in athletes. Orthop J Sports Med. 2013;1(6):2325967113511588.CrossRefGoogle Scholar
  53. 53.
    Myer GD, Smith D, Barber Foss KD, Dicesare CA, Kiefer AW, Kushner AM, et al. Rates of concussion are lower in National Football League games played at higher altitudes. J Orthop Sports Phys Ther. 2014;44(3):164–72.PubMedCrossRefGoogle Scholar
  54. 54.
    Wilson MH, Wright A, Imray CH. Intracranial pressure at altitude. High Altitude Med Biol. 2014;15(2):123–32. doi: 10.1089/ham.2013.1151.CrossRefGoogle Scholar
  55. 55.
    Mannix R, O’Brien MJ, Meehan 3rd WP. The epidemiology of outpatient visits for minor head injury: 2005 to 2009. Neurosurgery. 2013;73(1):129–34. doi: 10.1227/01.neu.0000429846.14579.41.
  56. 56.
    Chan V, Thurairajah P, Colantonio A. Defining traumatic brain injury in children and youth using international classification of diseases version 10 codes: a systematic review protocol. Syst Rev. 2013;2:102. doi: 10.1186/2046-4053-2-102.

Copyright information

© Springer Science+Business Media New York (outside the USA) 2015

Authors and Affiliations

  • Jameson D. Voss
    • 1
    • 2
    Email author
  • Joseph Connolly
    • 3
  • Karen A. Schwab
    • 4
    • 2
  • Ann I. Scher
    • 2
  1. 1.Epidemiology Consult ServiceU.S. Air Force School of Aerospace Medicine (USAFSAM)Wright-Patterson Air Force Base (WPAFB)USA
  2. 2.Department of Preventive Medicine and BiometricsUniformed Services University of the Health SciencesBethesdaUSA
  3. 3.Residency in Aerospace MedicineUSAFSAMFairbornUSA
  4. 4.Defense and Veterans Brain Injury CenterSilver SpringUSA

Personalised recommendations