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Head Impact Exposure in Youth Football: High School Ages 14 to 18 Years and Cumulative Impact Analysis

Abstract

Sports-related concussion is the most common athletic head injury with football having the highest rate among high school athletes. Traditionally, research on the biomechanics of football-related head impact has been focused at the collegiate level. Less research has been performed at the high school level, despite the incidence of concussion among high school football players. The objective of this study is to twofold: to quantify the head impact exposure in high school football, and to develop a cumulative impact analysis method. Head impact exposure was measured by instrumenting the helmets of 40 high school football players with helmet mounted accelerometer arrays to measure linear and rotational acceleration. A total of 16,502 head impacts were collected over the course of the season. Biomechanical data were analyzed by team and by player. The median impact for each player ranged from 15.2 to 27.0 g with an average value of 21.7 (±2.4) g. The 95th percentile impact for each player ranged from 38.8 to 72.9 g with an average value of 56.4 (±10.5) g. Next, an impact exposure metric utilizing concussion injury risk curves was created to quantify cumulative exposure for each participating player over the course of the season. Impacts were weighted according to the associated risk due to linear acceleration and rotational acceleration alone, as well as the combined probability (CP) of injury associated with both. These risks were summed over the course of a season to generate risk weighted cumulative exposure. The impact frequency was found to be greater during games compared to practices with an average number of impacts per session of 15.5 and 9.4, respectively. However, the median cumulative risk weighted exposure based on combined probability was found to be greater for practices vs. games. These data will provide a metric that may be used to better understand the cumulative effects of repetitive head impacts, injury mechanisms, and head impact exposure of athletes in football.

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References

  1. 1.

    “2011-2012 High School Athletics Participation Survey,” T. N. F. o. S. H. S. Associations, Ed., 2012.

  2. 2.

    Broglio, S. P., J. T. Eckner, and J. S. Kutcher. Field-based measures of head impacts in high school football athletes. Curr. Opin. Pediatr. 24:702–708, 2012.

    PubMed  Article  Google Scholar 

  3. 3.

    Broglio, S. P., J. T. Eckner, D. Martini, J. J. Sosnoff, J. S. Kutcher, and C. Randolph. Cumulative head impact burden in high school football. J. Neurotrauma 28:2069–2078, 2011.

    PubMed  Article  Google Scholar 

  4. 4.

    Broglio, S. P., B. Schnebel, J. J. Sosnoff, S. Shin, X. Fend, X. He, and J. Zimmerman. Biomechanical properties of concussions in high school football. Med. Sci. Sports Exerc. 42:2064–2071, 2010.

    PubMed  Article  Google Scholar 

  5. 5.

    Broglio, S. P., J. J. Sosnoff, S. Shin, X. He, C. Alcaraz, and J. Zimmerman. Head impacts during high school football: a biomechanical assessment. J. Athl. Train. 44:342–349, 2009.

    PubMed  Article  Google Scholar 

  6. 6.

    Broglio, S. P., T. Surma, and J. A. Ashton-Miller. High school and collegiate football athlete concussions: a biomechanical review. Ann. Biomed. Eng. 40:37–46, 2012.

    PubMed  Article  Google Scholar 

  7. 7.

    Crisco, J. J., J. J. Chu, and R. M. Greenwald. An algorithm for estimating acceleration magnitude and impact location using multiple nonorthogonal single-axis accelerometers. J. Biomech. Eng. 126:849–854, 2004.

    PubMed  Google Scholar 

  8. 8.

    Crisco, J. J., R. Fiore, J. G. Beckwith, J. J. Chu, P. G. Brolinson, S. Duma, T. W. McAllister, A. C. Duhaime, and R. M. Greenwald. Frequency and location of head impact exposures in individual collegiate football players. J. Athl. Train. 45:549–559, 2010.

    PubMed  Article  Google Scholar 

  9. 9.

    Crisco, J. J., B. J. Wilcox, J. G. Beckwith, J. J. Chu, A. C. Duhaime, S. Rowson, S. M. Duma, A. C. Maerlender, T. W. McAllister, and R. M. Greenwald. Head impact exposure in collegiate football players. J. Biomech. 44:2673–2678, 2011.

    PubMed  Article  Google Scholar 

  10. 10.

    Crisco, J. J., B. J. Wilcox, J. T. Machan, T. W. McAllister, A. C. Duhaime, S. M. Duma, S. Rowson, J. G. Beckwith, J. J. Chu, and R. M. Greenwald. Magnitude of head impact exposures in individual collegiate football players. J. Appl. Biomech. 28:174–183, 2012.

    PubMed  Google Scholar 

  11. 11.

    Daniel, R. W., S. Rowson, and S. M. Duma. Head impact exposure in youth football. Ann. Biomed. Eng. 40:976–981, 2012.

    PubMed  Article  Google Scholar 

  12. 12.

    Dick, R., J. Agel, and S. W. Marshall. National Collegiate Athletic Association Injury Surveillance System commentaries: introduction and methods. J. Athl. Train. 44:173–182, 2009.

    Google Scholar 

  13. 13.

    Duma, S. M., S. J. Manoogian, W. R. Bussone, P. G. Brolinson, M. W. Goforth, J. J. Donnenwerth, R. M. Greenwald, J. J. Chu, and J. J. Crisco. Analysis of real-time head accelerations in collegiate football players. Clin. J. Sport Med. 15:3–8, 2005.

    PubMed  Article  Google Scholar 

  14. 14.

    Eckner, J. T., M. Sabin, J. S. Kutcher, and S. P. Broglio. No evidence for a cumulative impact effect on concussion injury threshold. J. Neurotrauma 28:2079–2090, 2011.

    PubMed  Article  Google Scholar 

  15. 15.

    Funk, J. R., S. M. Duma, S. J. Manoogian, and S. Rowson. Biomechanical risk estimates for mild traumatic brain injury. Annu. Proc. Assoc. Adv. Automot. Med. 51:343–361, 2007.

    PubMed  CAS  Google Scholar 

  16. 16.

    Funk, J. R., S. Rowson, R. W. Daniel, and S. M. Duma. Validation of concussion risk curves for collegiate football players derived from HITS data. Ann. Biomed. Eng. 40:79–89, 2012.

    PubMed  Article  Google Scholar 

  17. 17.

    Gessel, L. M., S. K. Fields, C. L. Collins, R. W. Dick, and R. D. Comstock. Concussions among United States high school and collegiate athletes. J. Athl. Train. 42:495–503, 2007.

    PubMed  Google Scholar 

  18. 18.

    Greenwald, R. M., J. T. Gwin, J. J. Chu, and J. J. Crisco, Head impact severity measures for evaluating mild traumatic brain injury risk exposure. Neurosurgery 62:789–798; discussion 798, 2008.

    Google Scholar 

  19. 19.

    Guskiewicz, K. M., N. L. Weaver, D. A. Padua, and W. E. Garrett, Jr. Epidemiology of concussion in collegiate and high school football players. Am. J. Sports Med. 28:643–650, 2000.

    PubMed  CAS  Google Scholar 

  20. 20.

    Hodgson, V., L. Thomas, and T. Khalil, The role of impact location in reversible cerebral concussion. Proceedings of the 27th Stapp Car Crash Conference., vol. SAE Paper No. 831618: 1983.

  21. 21.

    Irick, E. “NCAA Sports Sponsorship and Participation Rates Report: 1981–1982–2010–2011,” Indianapolis 2011.

  22. 22.

    Langburt, W., B. Cohen, N. Akhthar, K. O’Neill, and J. C. Lee. Incidence of concussion in high school football players of Ohio and Pennsylvania. J. Child Neurol. 16:83–85, 2001.

    PubMed  CAS  Google Scholar 

  23. 23.

    Marar, M., N. M. McIlvain, S. K. Fields, and R. D. Comstock. Epidemiology of concussions among United States high school athletes in 20 sports. Am. J. Sports Med. 40:747–755, 2012.

    PubMed  Article  Google Scholar 

  24. 24.

    McCrea, M., T. Hammeke, G. Olsen, P. Leo, and K. Guskiewicz. Unreported concussion in high school football players: implications for prevention. Clin. J. Sport Med. 14:13–17, 2004.

    PubMed  Article  Google Scholar 

  25. 25.

    Mihalik, J. P., D. R. Bell, S. W. Marshall, and K. M. Guskiewicz, Measurement of head impacts in collegiate football players: an investigation of positional and event-type differences. Neurosurgery 61:1229–1235; discussion 1235, 2007.

    Google Scholar 

  26. 26.

    Pellman, E. J., D. C. Viano, A. M. Tucker, I. R. Casson, and J. F. Waeckerle, Concussion in professional football: reconstruction of game impacts and injuries. Neurosurgery 53:799–812; discussion 812-4, 2003.

    Google Scholar 

  27. 27.

    Rowson, S., J. G. Beckwith, J. J. Chu, D. S. Leonard, R. M. Greenwald, and S. M. Duma. A six degree of freedom head acceleration measurement device for use in football. J. Appl. Biomech. 27:8–14, 2011.

    PubMed  Google Scholar 

  28. 28.

    Rowson, S., G. Brolinson, M. Goforth, D. Dietter, and S. Duma. Linear and angular head acceleration measurements in collegiate football. J. Biomech. Eng. 131:061016, 2009.

    PubMed  Article  Google Scholar 

  29. 29.

    Rowson, S., and S. M. Duma. Brain injury prediction: assessing the combined probability of concussion using linear and rotational head acceleration. Ann. Biomed. Eng. 41(5):873–882, 2013.

    PubMed  Article  Google Scholar 

  30. 30.

    Rowson, S., and S. M. Duma. Development of the STAR evaluation system for football helmets: integrating player head impact exposure and risk of concussion. Ann. Biomed. Eng. 39:2130–2140, 2011.

    PubMed  Article  Google Scholar 

  31. 31.

    Rowson, S., S. M. Duma, J. G. Beckwith, J. J. Chu, R. M. Greenwald, J. J. Crisco, P. G. Brolinson, A. C. Duhaime, T. W. McAllister, and A. C. Maerlender. Rotational head kinematics in football impacts: an injury risk function for concussion. Ann. Biomed. Eng. 40:1–13, 2012.

    PubMed  Article  Google Scholar 

  32. 32.

    Schnebel, B., J. T. Gwin, S. Anderson, and R. Gatlin. In vivo study of head impacts in football: a comparison of National Collegiate Athletic Association Division I versus high school impacts. Neurosurgery 60:490–495; discussion 495-6, 2007.

    Google Scholar 

  33. 33.

    Scott Delaney, J., V. Puni, and F. Rouah. Mechanisms of injury for concussions in university football, ice hockey, and soccer: a pilot study. Clin. J. Sport Med. 16:162–165, 2006.

    PubMed  Article  CAS  Google Scholar 

  34. 34.

    Thurman, D. J., C. M. Branche, and J. E. Sniezek. The epidemiology of sports-related traumatic brain injuries in the United States: recent developments. J. Head Trauma Rehabil. 13:1–8, 1998.

    PubMed  CAS  Google Scholar 

  35. 35.

    Weaver, A. A., K. A. Danelson, and J. D. Stitzel. Modeling brain injury response for rotational velocities of varying directions and magnitudes. Ann. Biomed. Eng. 40:2005–2018, 2012.

    PubMed  Article  Google Scholar 

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Acknowledgments

The authors would like to thank the Reagan High School, especially Ashley Lake, ATC (Reagan High School), Corbin Ratcliffe, Lauren Smith and the football program. Thank you to Elizabeth Lillie and all those who contributed to the study development. Special thanks to the Childress Institute for Pediatric Trauma at Wake Forest Baptist Medical Center for providing support for this study.

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Correspondence to Joel D. Stitzel.

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Associate Editor Peter E. McHugh oversaw the review of this article.

Appendix

Appendix

See appendix Tables A1, A2, A3, and A4.

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Urban, J.E., Davenport, E.M., Golman, A.J. et al. Head Impact Exposure in Youth Football: High School Ages 14 to 18 Years and Cumulative Impact Analysis. Ann Biomed Eng 41, 2474–2487 (2013). https://doi.org/10.1007/s10439-013-0861-z

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Keywords

  • Biomechanics
  • Brain injury
  • Concussion
  • Football
  • Pediatric
  • Youth
  • Helmet
  • Risk
  • High school