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Epidemiology of Head Injuries Focusing on Concussions in Team Contact Sports: A Systematic Review

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Abstract

Background

Although injuries to the head represent a small proportion of all sport injuries, they are of great concern due to their potential long-term consequences, which are even suspected in mild traumatic brain injuries.

Objective

The aim of this review was to compare the incidence of concussions and other head injuries in elite level football, rugby, ice hockey and American Football.

Methods

Four electronic databases (CINAHL, PsycINFO, Web of Science, PubMed) were searched. Prospective cohort studies on the incidence of concussion in elite athletes aged 17 years or older that were published in an English-language peer-reviewed journal since 2000 were included. Two authors independently evaluated study eligibility and quality. The extracted data on concussions were pooled in a meta-analysis using an inverse-variance fixed-effects model. The extracted data on head injuries were reported in a narrative and tabular summary.

Results

The search yielded 7673 results of which 70 articles were included in the qualitative and 47 in the quantitative analysis. In our meta-analysis, we found the highest concussion incidences in rugby match play (3.89 and 3.00 concussions per 1000 h and athletic exposures (AEs), respectively), and the lowest in men’s football training (0.01 and 0.08 per 1000 h and AEs, respectively). Overall, concussions and all head injuries were rare in training when compared to match play. Female players had an increased concussion risk in football and ice hockey when compared to male players.

Conclusion

Future research should focus on concussion in women’s contact sports, as there is little evidence available in this area. Methodological deficits are frequent in the current literature, especially regarding sample size and study power, and should be avoided.

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Authors and Affiliations

  1. Department of Prevention, Health Promotion and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany

    Annika Prien, Alexander Grafe & Astrid Junge

  2. Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, The Netherlands

    Annika Prien, Roland Rössler & Evert Verhagen

  3. Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland

    Roland Rössler

  4. Swiss Concussion Centre and Schulthess Clinic, Zurich, Switzerland

    Astrid Junge

  5. Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Cape Town, South Africa

    Evert Verhagen

  6. Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, VIC, Australia

    Evert Verhagen

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  1. Annika Prien
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  5. Evert Verhagen
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Correspondence to Annika Prien.

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Funding

The authors gratefully acknowledge FIFA (Fédération Internationale de Football Association) for the funding of this review.

Conflict of interest

Annika Prien, Alexander Grafe, Roland Rössler, Astrid Junge and Evert Verhagen declare that they have no conflicts of interest relevant to the content of this review.

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Prien, A., Grafe, A., Rössler, R. et al. Epidemiology of Head Injuries Focusing on Concussions in Team Contact Sports: A Systematic Review. Sports Med 48, 953–969 (2018). https://doi.org/10.1007/s40279-017-0854-4

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