1. Among high school football players who had concussions, the number and prevalence of reported symptoms, symptom resolution time, and time to return to play were not associated with impact location.
2. Significantly more athletes who sustained top-of-head collisions experienced loss of consciousness when compared to those who were injured from impacts at other locations.
Evidence Rating Level: 2 (Good)
Study Rundown: Participation in team sports is on the rise among high school students, underscoring the need to explore the impact of sports-related injuries on the health of this population. This study is the first to consider the effects of impact location on concussion outcomes among high school football players. Investigators found that for most parameters, impact location did not affect concussion outcomes including the number of symptoms reported, prevalence of reported symptoms, symptom resolution time, and time to return to play. However, a larger proportion of athletes with top-of-head impacts experienced loss of consciousness when compared to those hit in other locations. The vast majority of top-of-head injuries were sustained by players who had their heads down while tackling, a position with a particularly high risk of causing brain and spinal cord injury. In addition, athletes with recurrent concussions had longer symptom resolution time compared to those with first time concussions. Although this is the first study to analyze the effect of impact location on concussions among high school athletes, the database included information from athletic trainers whose quality of reporting was inconsistent across schools. These results support encouragement of proper “head up” tackling techniques to avoid serious injury.
Relevant reading: Concussions among United States high school and collegiate athletes
In-Depth [cross-sectional study]: This study included data from the National High School Sports-Related Injury Surveillance Study during 2008/2009 through 2012/2013 academic years. Every week, athletic trainers from high schools across the United States reported injuries, via a secure website, to be added to the database. For every 10000 athlete exposures, athletes suffered 10 concussions from player-to-player collisions (95% CI: 9.6-10.4). Of 1975 concussions with known impact locations, 44.7% were to the front of the head, 22.3% were to the side, 5.7% to the back, and 5.5% to the top. Loss of consciousness occurred in 8% of top-of-head impacts compared to 3.5% in other locations (P = .001). In 86.4% of top-of-head injuries, players had their heads in the “downward tackle” position. Concussed players reported an average of 4.6 +/- 2.3 symptoms, with those sustaining top-of-head injuries reporting an average of 6.9 symptoms. Recurrent concussions occurred in 9.6% of cases and 23.1% of recurrences occurred in the same academic year. Players with recurrent concussions had longer symptom resolution time than those with first time concussions (P < .001).
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