Effects of field location, time in competition, and phase of play on injury severity in high school football

Psychological and Psychiatric Aspects of Brain and Spinal Cord Tumors

Central nervous system (CNS) tumors are mainly diagnosed by physical symptoms such as paralysis, visual field defect, seizure, and loss of consciousness. The psychological and psychiatric background of CNS tumors, whether in preoperative or postoperative period, has long been a neglected topic; however, lately, many authors and researchers have paid more attention to these manifestations. Neurocognition is a subset of parameters, including attention, memory, mood, emotions, language production, personality, executive function, problem-solving, calculation, and spatial cognition, making up the patient's cognitive performance. Also, it is worthy to say that neurocognition is considered a parameter of quality of life (QoL). Currently, we know that neurocognitive disorders are a group of symptoms presenting by the patients. These symptoms may be the first picture of CNS lesions, which result in incorrect treatment, a higher financial burden on the patient and health system, and finally, poorer QoL and performance scale if they are not diagnosed early. Psychological and psychiatric problems such as depression, anxiety, and phobia following the CNS tumors have two aspects. These may present before any treatment resulting from the tumoral mass effect, peritumoral edema, or cerebral tissue disruption due to the space-occupying lesion. On the other hand, we can see these features after a kind of therapy such as surgery, medical therapy, or adjuvant therapy. Sometimes, the CNS tumors lead to psychosocial complications postoperatively. Indeed, considering tumor surgery complications, some patients may find various degrees of deficits that make the patient isolated either socially or professionally. Obviously, the improvement rate and outcome of this specific situation depend on the mechanism of occurrence and its causes. For instance, postoperative symptom relief would be expected when the symptoms are related to the tumoral mass effect. Getting familiar with this constellation of the symptoms, realizing them, and then localizing them to the correct area of the CNS are very crucial. Accordingly, because of their importance in QoL, their influence on patient's survival even more than the extent of resection of the tumor, and somehow their ignorance, we will discuss different neurocognitive manifestations related to CNS tumors in this chapter.

National Athletic Trainers' Association Position Statement: Reducing Intentional Head-First Contact Behavior in American Football Players

OBJECTIVE

To provide evidence-based recommendations for reducing the prevalence of head-first contact behavior in American football players with the aim of reducing the risk of head and neck injuries.

BACKGROUND

In American football, using the head as the point of contact is a persistent, well-documented, and direct cause of catastrophic head and cervical spine injury. Equally concerning is that repeated head-impact exposures are likely to result from head-first contact behavior and may be associated with long-term neurocognitive conditions such as dementia, depression, and chronic traumatic encephalopathy.

CONCLUSIONS

The National Athletic Trainers' Association proposes 14 recommendations to help the certified athletic trainer, allied health care provider, coach, player, parent, and broader community implement strategies for reducing the prevalence of head-first contact in American football.

Head Games: A Systematic Review and Meta-analysis Examining Concussion and Head Impact Incidence Rates, Modifiable Risk Factors, and Prevention Strategies in Youth Tackle Football

OBJECTIVES

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.

METHODS

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.

MAIN RESULTS

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).

CONCLUSIONS

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.

Head Impact Telemetry System's Video-based Impact Detection and Location Accuracy

PURPOSE

This study aimed to quantify the Head Impact Telemetry (HIT) System's impact detection and location measurement accuracy using an impact biomechanics data set paired with video of high school football special teams plays.

METHODS

The head impact biomechanics data set and video were collected from 22 high school football players, wearing HIT System instrumented helmets, competing in 218 special teams plays over a single high school football season. We used two separate video analysis approaches. To quantify the impact detection accuracy, we evaluated the video for head impacts independently of the impact data collection triggers collected by the HIT System. Video-observed impacts matched to valid and invalid head impacts by the HIT System algorithm were categorized as true positives, false positives, false negatives, and true negatives. To quantify impact location accuracy, we analyzed video-synchronized head impacts for impact location independent of the HIT System's impact location measurement and quantified the estimated percent agreement of impact location between the HIT System recorded impact location and the impact location observed on video.

RESULTS

The HIT System's impact-filtering algorithm had 69% sensitivity, 72% specificity, and 70% accuracy in categorizing true and non-head impact data collection triggers. The HIT System agreed with video-observed impact locations on 64% of the 129 impacts we analyzed (unweighted k = 0.43, 95% confidence interval = 0.31-0.54).

CONCLUSION

This work provides data on the HIT System's impact detection and location accuracy during high school football special teams plays using game video analysis that has not been previously published. Based on our data, we believe that the HIT System is useful for estimating population-based impact location distributions for special teams plays.

Randomized Controlled Trial of a Novel Peer Concussion-Education Program for Collegiate Athletes

CONTEXT

The National Collegiate Athletic Association and US Department of Defense have called for educational programs to change the culture of concussion reporting, increase reporting behavior, and enhance the safety of players and service members.

OBJECTIVE

To evaluate the effects of a novel peer concussion-education program (PCEP) in changing knowledge, attitudes, and norms about concussion reporting among collegiate student-athletes and assess program implementation.

DESIGN

Randomized controlled trial and qualitative analysis of interviews.

SETTING

National Collegiate Athletic Association athletic teams from randomly selected colleges or universities.

PATIENTS OR OTHER PARTICIPANTS

A total of 1614 male and female student-athletes from 60 teams at 10 colleges and universities and 8 athletic trainers.

INTERVENTION(S)

The PCEP intervention trains 2 peer concussion educators to provide 2 education modules to their teammates. Knowledge, attitudes (oneself and teammates), and concussion occurrence or reporting were assessed at baseline, postintervention, and 1 month later. Eight athletic trainers were interviewed about program implementation.

RESULTS

Compared with the control group, the intervention group showed greater increases occurred postintervention and at 1 month in concussion knowledge (F_1,2648 = 51.3, P < .0001), intention to report (oneself, F_2,2633 = 82.3, P < .0001; teammates, F_2,2624 = 53.9, P < .0001), return-to-play protocol knowledge, (F_2,2632 = 28.4, P < .0001), direct subjective norms (oneself, F_2,2625 = 51.7, P < .0001; teammates, F_2,2644 = 40.6, P < .0001), direct perceived behavioral control (oneself, F_2,2628 = 53.7, P < .0001; teammates, F_2,2615 = 68.2, P < .0001), and indirect attitudes (oneself, F_2,2626 = 47.1, P < .001; teammates, F_2,2623 = 40.9, P < .0001). Peer concussion-education program participants discussed concussion more often with a teammate (F_1,1396 = 13.96, P < .0001) or athletic staff (F_1,1396 = 6.62, P < .001). Qualitative program analysis revealed both positive aspects of the PCEP and areas for improvement.

CONCLUSIONS

The PCEP showed promise in increasing concussion knowledge, intention to report concussion, reporting a teammate's concussion, and facilitating attitudinal changes that support reporting among student-athletes.

Development of an Eco-Friendly Head Impact Protection Device

Nowadays, the number of people practising contact sports has increased. In many of them, using head protective equipment is not mandatory, even if the use of headbands could increase the level of safety regarding several types of traumatic brain injuries. Many commercial solutions are currently available, based on plastic-based foams providing a decent level of protection and comfort to the user. This work introduces the use of agglomerated cork as an eco-friendly alternative to synthetic foams but at least keeping safety levels. Cork is a natural cellular material that has been showing excellent crashworthiness properties. In this study, cork agglomerate density is carefully chosen to be incorporated into a protective headband. Results are compared against three other commercial headbands. For each one, the risk of brain injury was analysed for different injury thresholds and impact energies. The results clearly demonstrate that the cork-based apparel may provide comparable, and in some cases, better performances, outlasting the commercial ones.

Epidemiology of Injuries Sustained in Boys' High School Contact and Collision Sports, 2008-2009 Through 2012-2013

Background:

Injury epidemiology for boys’ high school contact and collision sport has been described in several overlapping but fragmented studies. Comprehensive comparisons of injuries sustained in boys’ soccer, wrestling, football, ice hockey, and lacrosse are lacking.

Purpose:

To describe patterns of injury by severity, body site, and diagnosis among high school boys’ contact and collision sports in the United States.

Study Design:

Descriptive epidemiology study.

Methods:

Injury rates and rate ratios (RRs) were calculated for injuries sustained in boys’ high school soccer, wrestling, football, ice hockey, and lacrosse through use of the High School RIO (Reporting Information Online) surveillance data from 2008-2009 through 2012-2013. Injury patterns were described by site, diagnosis, time loss, and severity. Severe injury was defined as an injury that resulted in 21 days or more of time loss from sport participation. Risk of sustaining a concussion was compared between sports.

Results:

The risk of sustaining an injury was higher in competition compared with practice overall (RR, 4.01; 95% CI, 3.90-4.12); the same pattern was true for severe injuries (RR, 4.61; 95% CI, 4.34-4.90). Football players experienced the highest injury rate (3.87 per 1000 athlete-exposures [AEs]) and the highest severe injury rate (0.80 per 1000 AEs). Overall, the most commonly injured body site was the head/face (22.5%), and the most prevalent injury diagnosis was ligament sprain not requiring surgery (23.5%). The most frequently injured body site from severe injury was the knee (24.6%), and fracture or avulsion was the most prevalent severe injury diagnosis (37.0%). Football players had a significantly higher risk of sustaining a concussion compared with other contact or collision sport athletes (P < .05).

Conclusion:

Injuries rates were higher in competition than those in practice for boys’ high school contact and collision athletes. Football players sustained the highest injury rate, the highest severe injury rate, and the highest concussion rate among the sports included in this analysis. Understanding these patterns of injury can generate policy and rule changes to make sports safer and maintain high levels of participation.

Timing of Lower Extremity Injuries in Competition and Practice in High School Sports

Background:

Laboratory-based experiments demonstrate that fatigue may contribute to lower extremity injury (LEI). Few studies have examined the timing of LEIs during competition and practice, specifically in high school athletes across multiple sports, to consider the possible relationship between fatigue and LEIs during sport events.

Hypothesis:

The purpose of this study was to describe the timing of LEIs in high school athletes within games and practices across multiple sports, with a hypothesis that more and severe injuries occur later in games and practices.

Study Design:

Descriptive epidemiologic study.

Level of Evidence:

Level 4.

Methods:

Using the National High School RIO (Reporting Information Online) sport injury surveillance system, LEI severity and time of occurrence data during practice and competition were extracted for 9 high school sports.

Results:

During the school years 2005-2006 through 2013-2014, 16,967,702 athlete exposures and 19,676 total LEIs were examined. In all sports surveyed, there was a higher LEI rate, relative risk for LEI, and LEI requiring surgery during competition than practice. During practice, the majority of LEIs occurred over an hour into practice in all sports. In quarter-based competition, more LEIs occurred in the second (31% to 32%) and third quarters (30% to 35%) than in the first (11% to 15%) and fourth quarters (22% to 26%). In games with halves, the majority (53% to 66%) of LEIs occurred in the second half. The greater severity LEIs tended to occur earlier in games.

Conclusion:

Fatigue may play a role in the predominance of injuries in the second half of games, though various factors may be involved. Greater severity of injuries earlier in games may be because of higher energy injuries when athletes are not fatigued.

Clinical Relevance:

These findings can help prepare sports medicine personnel and guide further related research to prevent LEIs.

Concussion: key stakeholders and multidisciplinary participation in making sports safe

As unstructured play declines, organized sports leagues have become a highly popular form of physical activity in young people. As concussive injuries are garnering increased media attention and public awareness, there is a growing concern for athlete safety. Although athletic trainers and physicians play a large role in keeping athletes healthy and safe, this article investigates nontraditional, multidisciplinary teams that are involved in promoting athlete safety, including the role of equipment makers, coaches, referees, governing bodies of sport, lawmakers, and fans. As opposed to a focus on diagnosing or managing concussive injuries, this article seeks to promote injury prevention strategies.

Epidemiology of concussion in sport: a literature review

OBJECTIVE

The purpose of this study was to summarize sport concussion incidence data, identify sports that present higher injury frequency, reveal the degree of risk in some lesser-known sports, and outline specific details within the sports literature that raise additional concerns, such as helmet-to-helmet contact and player positions that experience frequent impact.

METHODS

A systematic literature review of Pub Med using keyword search on injury, concussion, and sports was performed through May 2012. Abstracts were identified, selections were made based upon inclusion criteria, and full-length articles were obtained. Additional articles were considered following review of reference sections. Articles were reviewed and tabulated according to sport.

RESULTS

Two hundred eighty-nine articles were screened, and 62 articles were reviewed. The overall incidence of concussion in sport ranged from 0.1 to 21.5 per 1000 athletic exposures. The lowest incidence was reported in swimming and diving. Concussion incidence was highest in Canadian junior ice hockey, but elevated incidence in American football remains a concern because of the large number of participants.

CONCLUSIONS

The literature reviewed included incidence of concussion on the field of play under real-world conditions and influenced by the current culture of sport. The studies examined in this article show that there is risk of concussion in nearly every sport. Some sports have higher concussion frequency than others, which may depend upon the forces and roles of the positions played in these sports. Younger athletes have a higher incidence of concussion, and female incidence is greater than male in many comparable sports. Headgear may reduce concussion in some sports but may also give athletes a false sense of protection.