Department of Neurosurgery, Medical College of Wisconsin, Milwaukee.
Department of Biomedical Engineering, Virginia Tech, Blacksburg.
JAMA Neurol. 2021 Mar 1;78(3):346-350. doi: 10.1001/jamaneurol.2020.5193.
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.
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).
Participation in collegiate football games and practices from 2015 to 2019.
Incidence of diagnosed concussion and HIE from the HIT System.
Across 5 seasons, 528 684 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).
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.
脑震荡是足球运动中最常见的损伤之一。除了脑震荡的风险之外，人们越来越担心重复性头部撞击暴露（HIE）可能会增加足球运动员长期神经健康问题的风险。
研究大学生足球运动员在整个赛季中脑震荡发生率和 HIE 的模式。
设计、地点和参与者：在这项从 2015 年到 2019 年进行的观察性队列研究中，共有 658 名大学生足球运动员参加了 6 个一级全国大学体育协会（NCAA）足球项目的碰撞评估、研究和教育（CARE）联盟，其中共有 46.5%（1416 名有资格参加 CARE 高级研究核心的足球运动员）配备了头部撞击遥测（HIT）系统。根据他们的参与水平（即首发球员优先于替补球员），优先为 HIT 系统配备仪器。
2015 年至 2019 年参加大学足球比赛和练习。
从 HIT 系统记录的 HIE 和诊断性脑震荡的发生率。
在 5 个赛季中，从配备 HIT 系统的 658 名球员（均为男性，平均年龄[标准差]，19.02[1.25]岁）在足球练习或比赛中记录了 528684 次头部撞击，符合分析的质量标准。球员每个赛季平均记录 415 次（四分位距[IQR]，190-727）记录的头部撞击（即撞击）。68 名球员患有诊断性脑震荡。共有 48.5%（33 人）的脑震荡发生在季前训练期间，尽管季前赛仅占足球赛季的 20.8%（每个队每天季前赛脑震荡 0.059 次，常规赛脑震荡 0.016 次；平均差异，0.042；95%CI，0.020-0.060；P=.001）。季前赛的总 HIE 发生比例是常规赛的两倍（每个队每天 324.9 次与 162.4 次；平均差异，162.6；95%CI，110.9-214.3；P<.001）。每个赛季，运动员的 HIE 最高发生在 8 月（季前赛）（中位数，146.0 次撞击；IQR，63.0-247.8），11 月最低（中位数，80.0 次撞击；IQR，35.0-148.0）。在 5 个赛季中，72%（49 人）的脑震荡（比赛比例，0.28；95%CI，0.18-0.40；P<.001）和 66.9%（262.4 次练习与 137.2 次比赛撞击每名球员；平均差异，125.3；95%CI，110.0-140.6；P<.001）发生在练习中。即使在常规赛中，练习中的总 HIE（中位数，每名球员每个赛季 175.0 次撞击；IQR，76.0-340.5）也比比赛中高 84.2%（中位数，每名球员每个赛季 95.0 次撞击；IQR，32.0-206.0）。
大学生足球运动员的脑震荡发生率和 HIE 在季前赛中明显高于常规赛，而且大多数脑震荡和 HIE 发生在足球练习中，而不是比赛中。这些数据表明，在不重大改变比赛规则的情况下，政策、教育和其他预防策略有很大的机会在大学足球中最大限度地减少脑震荡发生率和 HIE，特别是在季前训练和整个赛季的足球练习中。预防脑震荡和 HIE 的策略对保护各级足球运动员的安全和健康具有重要意义。
