Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada.
O'Brien Institute of Public Health, University of Calgary, Calgary, Canada.
Sports Med. 2022 Jun;52(6):1259-1272. doi: 10.1007/s40279-021-01609-4. Epub 2021 Dec 11.
The aims were to (1) examine the rates and mechanisms of concussion and head impact in youth football (high school level or younger); (2) identify modifiable risk factors for concussion and head impact; and (3) evaluate the effectiveness of prevention strategies in tackle football at any level.
Nine databases (CINAHL Plus with Full Text; Cochrane Central Register of Controlled Trials; EMBASE; ERIC; Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily; ProQuest Dissertations & Theses Global Database; PsycINFO; Scopus; and SPORTDiscus with Full Text) were searched using the search strategy focusing on four main concepts: concussion/head impact, tackle football, modifiable risk factors, and primary prevention. Two reviewers completed title, abstract, and full-text screening as well as risk of bias assessment (using the Downs and Black checklist), with a third author available to resolve any disagreements.
After removing duplicates, 1911 articles were returned. Fifty-eight articles were included in the review and 20 in the meta-analysis. The overall combined rates of concussion (including game and practice-related concussion) based on the meta-analysis were 0.78 concussions/1000 athlete exposures [95% confidence interval (CI) 0.67-0.89] for high school football (ages 13-19) and 1.15 concussions/1000 athlete exposures (95% CI 0.89-1.41) for minor football players (ages 5-15). There is evidence that contact training and practice contact restrictions have reduced the rate of head impacts and concussion. Heads Up Football (an intervention focused on coach education and contact training) has been shown to reduce the rate of concussion by 32% and head impacts by 38% amongst high school football players. Limiting contact practices in high schools to 2 days per week reduced practice head impacts per player-season by 42%, and limiting full contact in practice to 75 min per week in the second week of the season and 60 min in week 3 and beyond resulted in a 54% decrease in the practice-related concussion rate (p = 0.003).
This review identified a critical need for interventions to address the high rates of concussion and head impact in youth football. To date, contact training and contact restrictions have the strongest evidence supporting their effectiveness at reducing these rates. Future research should use consistent concussion definitions and validated injury surveillance systems, and ensure complete reporting of participant characteristics and sampling details. Prospero ID CRD42020193775.
（1）研究青少年足球（高中或以下年龄段）中脑震荡和头部撞击的发生率和机制；（2）确定脑震荡和头部撞击的可改变风险因素；（3）评估任何级别的触身式橄榄球中预防策略的效果。
使用侧重于四个主要概念的搜索策略，对九个数据库（CINAHL Plus with Full Text；Cochrane 中央对照试验注册中心；EMBASE；ERIC；Ovid MEDLINE（R）和 Epub 提前印刷、处理中和其他非索引引文和每日；ProQuest 博士论文和全球数据库；PsycINFO；Scopus；以及 SPORTDiscus with Full Text）进行了搜索。两名评审员完成了标题、摘要和全文筛选以及偏倚风险评估（使用 Downs 和 Black 清单），第三名评审员可解决任何分歧。
去除重复项后，返回了 1911 篇文章。58 篇文章被纳入综述，20 篇文章被纳入荟萃分析。基于荟萃分析，高中足球（年龄 13-19 岁）中总共有 0.78 例脑震荡/每 1000 名运动员暴露[95%置信区间（CI）0.67-0.89]，而少年足球运动员（年龄 5-15 岁）的总共有 1.15 例脑震荡/每 1000 名运动员暴露[95%CI 0.89-1.41]。有证据表明接触训练和练习接触限制降低了头部撞击和脑震荡的发生率。“抬头橄榄球”（一项专注于教练教育和接触训练的干预措施）已被证明可以将高中橄榄球运动员的脑震荡发生率降低 32%，头部撞击率降低 38%。每周限制高中练习接触 2 天可使每个球员/赛季的练习头部撞击次数减少 42%，而在赛季的第二周将练习中的全接触限制为每周 75 分钟，第 3 周及以后将限制为每周 60 分钟，则可使与练习相关的脑震荡率降低 54%（p=0.003）。
本综述确定了需要采取干预措施来解决青少年橄榄球中脑震荡和头部撞击发生率高的问题。到目前为止，接触训练和接触限制在降低这些发生率方面具有最强的证据支持。未来的研究应使用一致的脑震荡定义和经过验证的伤害监测系统，并确保完整报告参与者特征和抽样细节。注册号：CRD42020193775。
