Accuracy of US College Football Players' Estimates of Their Risk of Concussion or Injury

Design Considerations for the Attenuation of Translational and Rotational Accelerations in American Football Helmets

Participants in American football experience repetitive head impacts that induce negative changes in neurocognitive function over the course of a single season. This study aimed to quantify the transfer function connecting the force input to the measured output acceleration of the helmet system to provide a comparison of the impact attenuation of various modern American football helmets. Impact mitigation varied considerably between helmet models and with location for each helmet model. The current data indicate that helmet mass is a key variable driving force attenuation, however flexible helmet shells, helmet shell cutouts, and more compliant padding can improve energy absorption.

Youth Tackle Football Head-Impact Estimation by Players and Parents: Is the Perception the Reality?

CONTEXT

With growing concerns surrounding exposure to head impacts in youth tackle football, players and parents must understand the exposure level when assenting and consenting to participate.

OBJECTIVE

To determine whether youth football players and parents could estimate on-field head-impact frequency, severity, and location.

DESIGN

Prospective cohort study.

SETTING

Football field.

PATIENTS OR OTHER PARTICIPANTS

We administered a 10-question head-impact estimation tool to parents (n = 23; mean age = 36.5 years [95% CI = 31.7, 37.3 years]) and players (n = 16 boys; mean age = 11.1 years [95% CI = 10.3, 11.8 years]).

MAIN OUTCOME MEASURE(S)

Player on-field head-impact exposure was captured using the Triax SIM-G system. We determined the accuracy between player and parent estimates relative to on-field head-impact exposures using κ and weighted κ values.

RESULTS

Youth tackle football players and parents did not accurately estimate on-field head-impact frequency (κ range = -0.09 to 0.40), severity (κ range = -0.05 to 0.34), or location (κ range = -0.30 to 0.13). Players and parents overestimated head-impact frequency in practices but underestimated the frequency in games. Both groups overestimated head-impact severity, particularly in games. Most players and parents underestimated the number of head impacts to the top of the head, particularly during practices.

CONCLUSIONS

Underestimations of head-impact frequency in games and to the top of the head suggest that informed consent processes aimed at educating players and parents should be improved. Overestimations of head-impact frequency in practices and severity may explain declining rates of youth tackle football participation.

Litigation involving sports-related spinal injuries: a comprehensive review of reported legal claims in the United States in the past 70 years

BACKGROUND CONTEXT

Sports-related spinal injuries can be catastrophic in nature. Athletes competing in collision sports (eg, football) may be particularly prone to injury given the high-impact nature of these activities. Due to the oftentimes profound impact of sports-related spinal injuries on health and quality-of-life, they are also associated with a substantial risk of litigation. However, no study to date has assessed litigation risks associated with sports-related spinal injuries. A better understanding of the risk factors surrounding these legal claims may provide insights into injury prevention and other strategies to minimize litigation risks. In addition, it may allow the spine surgeon to better recognize the health, socioeconomic, and legal challenges faced by this patient population.

PURPOSE

To provide a comprehensive assessment of reported legal claims involving sports-related spinal injuries, including a comparative analysis of legal outcomes between collision and non-collision sports. To discuss strategies to prevent sports-related spinal injuries and minimize litigation risks.

STUDY DESIGN/SETTING

Retrospective review.

PATIENT SAMPLE

Athletes experiencing spinal injuries during sports.

OUTCOME MEASURES

Outcomes included verdict outcome (defendant vs. plaintiff), legal claims, injuries sustained, clinical symptoms, and award payouts.

METHODS

The legal research database Westlaw Edge (Thomson Reuters) was queried for legal claims brought in the United States from 1950 to 2021 involving sports-related spinal injuries. Verdict or settlement outcomes were collected as well as award payouts, time to case closure, case year, and case location. Demographic data, including type of sport (ie collision vs. non-collision sport) and level of play were obtained. Legal claims, spinal injuries sustained, and clinical symptoms were also extracted. Furthermore, the nature of injury, injured spinal region, and treatment pursued were collected. Descriptive statistics were reported for all cases and independent-samples t-tests and chi-square tests were used to compare differences between collision and non-collision sports.

RESULTS

Of the 840 cases identified on initial search, 78 met our criteria for in-depth analysis. This yielded 62% (n=48) defendant verdicts, 32% (n=25) plaintiff verdicts, and 6% (n=5) settlements, with a median inflation-adjusted award of $780,000 (range: $5,480-$21,585,000) for all cases. The most common legal claim was negligent supervision (n=38, 46%), followed by premises liability (n=23, 28%), and workers' compensation/no fault litigation (n=10, 12%). The most common injuries sustained were vertebral fractures (n=34, 44%) followed by disc herniation (n=14, 18%). Most cases resulted in catastrophic neurological injury (n=37, 49%), either paraplegia (n=6, 8%) or quadriplegia (n=31, 41%), followed by chronic/refractory pain (n=32, 43%). Non-collision sport cases had a higher percentage of premises liability claims (41% vs. 11%, p=.006) and alleged chronic/refractory pain (53% vs. 28%, p=.04). Conversely, collision sport cases had a higher proportion of workers' compensation/no fault litigation (23% vs. 4%, p=.03) and cases involving disc herniation (29% vs. 9%, respectively; p=.04).

CONCLUSION

Sports-related spinal injuries are associated with multiple and complex health, socioeconomic, and legal consequences, with median inflation-adjusted award payouts nearing $800,000 per case. In our cohort, the most commonly cited legal claims were negligent supervision and premises liability, emphasizing the need for prevention guidelines for safe sports practice, especially in non-professional settings. Cases involving athletes participating in non-collision sports were significantly associated with claims citing chronic/refractory pain, highlighting the importance of long-term care in severely injured athletes.

Concussion Nondisclosure in Youth Sports

CONTEXT

Researchers conducting studies about sport-related concussion (SRC) reporting behaviors and reasons for nondisclosure primarily focus on older athletic populations. Youth athletes participating in contact sports are also at risk for SRC; however, little is known about their SRC disclosure patterns and reasons for nondisclosure.

OBJECTIVE

To examine the self-reported SRC history and reasons for SRC nondisclosure of youth athletes aged 8-14 years.

DESIGN

Cross-sectional study.

SETTING

Youth athletes in organized football, ice hockey, lacrosse, or soccer.

PATIENTS OR OTHER PARTICIPANTS

A total of 411 youth athletes (boys = 70.0% [n = 287/410]; median age = 11 [interquartile range = 10-13] years).

MAIN OUTCOME MEASURE(S)

A 15-minute survey including self-reported demographics, diagnosed and nondisclosed SRC history, and reasons for nondisclosure of suspected SRCs.

RESULTS

Ten percent of respondents (n = 41/411) recounted ≥1 diagnosed SRC, 12.7% (n = 52/411) did not report a suspected SRC, 13.1% (n = 53/404) indicated they continued to practice, and 12.3% (n = 50/406) reported they continued to play in a game after a suspected SRC. Significant associations between sport and nondisclosure existed (P values < .001) but not with self-reported concussion history (P = .14). In sex-comparable analyses, boys' lacrosse players had a higher frequency of nondisclosure than girls (P = .05). The most common reasons for nondisclosure were not wanting to lose playing time (66.7%, n = 32/48), miss a game (56.3%, n = 27/48), and let the team down (43.8%, n = 21/48) and uncertainty over injury severity and the presence of SRC (43.8%, n = 21/48).

CONCLUSIONS

Ten percent of youth athletes self-reported at least 1 diagnosed SRC. However, they also described continuing to practice or play in a game after a suspected SRC. Reasons for nondisclosure at this age were similar to those reported in high school and collegiate athletes. Recent researchers suggested negative consequences of continued play with SRC, especially in the acute stages. Anyone conducting future educational initiatives should emphasize these risks and focus on reasons why athletes of both sexes withhold reporting.

Factors Influencing College Football Players' Beliefs About Incurring Football-Related Dementia

Background:

Football participation is associated with risks to acute and long-term health, including the possibility of incurring football-related dementia. Concerns have been raised regarding media coverage of these risks, which may have influenced athletes’ beliefs. However, little is known about football players’ views on football-related dementia. The risk-perception literature suggests that related risk perceptions and features of individual cognition, such as the ability to switch to reasoned, deliberative thinking, may influence individual perception of a long-term risk.

Purpose:

To evaluate factors influencing college football players’ belief that they are likely to incur football-related dementia in the future.

Study Design:

Cross-sectional study.

Methods:

Members of 4 National Collegiate Athletic Association Division I Power 5 Football teams participated in this survey-based study, providing responses to demographic, athletic, and risk-posture questions, and completed the cognitive reflection test. Logistic regressions were used to evaluate relationships between beliefs about football-related dementia and factors including athletic and demographic characteristics, football risk posture, health-risk posture, and cognitive reflection test score.

Results:

About 10% of the 296 participating athletes thought football-related dementia was likely to occur in their future. Skill players had lower odds than linemen of believing that football-related dementia was likely (odds ratio [OR], 0.35; 95% CI, 0.14-0.89). For each additional suspected concussion in an athlete’s career, his odds of believing football-related dementia was likely increased by 24% (OR, 1.24; 95% CI, 1.07-1.45). Acute and chronic football-related risk perceptions, as well as non–football-related health-risk perceptions, were positively associated with athletes’ belief that football-related dementia was likely. Higher cognitive reflection test scores, a measure of ability to switch to slow, deliberative thinking, was positively associated with odds of believing football-related dementia was likely (OR, 1.57; 95% CI, 1.12-2.21).

Conclusion:

Some athletes view football as generally riskier, while others view football as generally lessri sky. These risk postures are informed by athletes’ concussion history, primary playing position, and ability to switch from fast, reactive thinking to slow, deliberative thinking. Ensuring that athletes are appropriately informed of the risks of participation is an ethical obligation of universities; sports medicine clinicians are appropriate facilitators of conversations about athletes’ health risks.