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      Twelve Years of National Football League Concussion Data

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          Abstract

          Background:

          Concussion in the National Football League (NFL) remains an important issue. An initial description of the injury epidemiology involved 6 years from 1996 to 2001.

          Hypothesis:

          The increased attention to concussions may have resulted in team physicians being more conservative in treating players in recent years.

          Study Design:

          Two consecutive 6-year periods (1996-2001 and 2002-2007) were compared to determine changes in the circumstances associated with the injury, the patterns of signs and symptoms, and the players’ time loss from participation in the NFL.

          Methods:

          During 2002-2007, concussions were recorded by NFL team physicians and athletic trainers using the same standardized reporting form used from 1996 to 2001. Player position, type of play, concussion signs and symptoms, loss of consciousness, and medical action taken were recorded.

          Results:

          There were 0.38 documented concussions per NFL game in 2002-2007—7.6% lower than the 0.42 in the earlier period (1996-2001). The injury rate was lower in quarterbacks and wide receivers but significantly higher in tight ends during the second 6 years. The most frequent symptoms were headaches and dizziness; the most common signs were problems with information processing and immediate recall. During 2002-2007, a significantly lower fraction of concussed players returned to the same game, and more were removed from play. Most concussed players (83.5%) returned to play in < 7 days; the percentage decreased to 57.4% with loss of consciousness. The number of players returning in < 7 days was 8% lower during 2002-2007 and 25% lower for those with loss of consciousness.

          Conclusion:

          The most recent 6 years of NFL concussion data show a remarkable similarity to the earlier period. However, there was a significant decrease in the percentage of players returning to the same game, and players were held out of play longer.

          Clinical Relevance:

          There was a more conservative management of concussion in NFL players from 2002 to 2007 even though the clinical signs and symptoms remained similar to the earlier 6-year period.

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          Most cited references7

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          Concussion in professional football: epidemiological features of game injuries and review of the literature--part 3.

          A 6-year study was performed to determine the circumstances, causes, and outcomes of concussions in the National Football League. Between 1996 and 2001, the epidemiological features of concussions were recorded by National Football League teams with a standardized reporting form. Symptoms were reported and grouped as general symptoms, cranial nerve symptoms, memory or cognitive problems, somatic complaints, and loss of consciousness. The medical actions taken were recorded. In total, 787 game-related cases were reported, with information on the players involved, type of helmet impact, symptoms, medical actions, and days lost. Concussion risks were calculated according to player game positions. There were 0.41 concussions per National Football League game. The relative risk was highest for quarterbacks (1.62 concussions/100 game-positions), followed by wide receivers (1.23 concussions/100 game-positions), tight ends (0.94 concussion/100 game-positions), and defensive secondaries (0.93 concussion/100 game-positions). The majority of concussions (67.7%) involved impact by another player's helmet. The remainder involved impact by other body regions of the striking player (20.9%) or ground contact (11.4%). The three most common symptoms of mild traumatic brain injury were headaches (55.0%), dizziness (41.8%), and blurred vision (16.3%). The most common signs noted in physical examinations were problems with immediate recall (25.5%), retrograde amnesia (18.0%), and information-processing problems (17.5%). In 58 of the reported cases (9.3%), the players lost consciousness; 19 players (2.4%) were hospitalized. A total of 92% of concussed players returned to practice in less than 7 days, but that value decreased to 69% with unconsciousness. The professional football players most vulnerable to concussions are quarterbacks, wide receivers, and defensive secondaries. Concussions involved 2.74 symptoms/injury, and players were generally removed from the game. More than one-half of the players returned to play within 1 day, and symptoms resolved in a short time in the vast majority of cases.
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            Concussion in professional football: injuries involving 7 or more days out--Part 5.

            A 6-year study was conducted to determine the signs, symptoms, and outcome of concussions with 7 or more (7+) days out from play or extended postconcussion recovery in the National Football League (NFL). From 1996 to 2001, reporting of concussion was performed by NFL teams using a special standardized reporting form filled out by team physicians. Signs and symptoms were grouped by general symptoms, somatic complaints, cranial nerve effects, cognition problems, memory problems, and unconsciousness. Medical action taken and management were recorded. In all, 887 concussions were reported in practices and games. There were 72 concussions (8.1%) involving 7+ days out from play. The highest frequency occurred in quarterbacks (14.8%), the return unit on special teams (11.8%), and secondary (10.8%). Quarterbacks had the highest odds ratio (OR) of 7+ days out with concussion (OR = 2.10, P = 0.049), whereas running backs had the lowest relative risk (OR = 0.13, P = 0.021). The greatest fraction of 7+ days out occurred in passing plays (36.1%) and kickoffs (22.2%). Many signs and symptoms occurred at a greater frequency on initial examination in players 7+ days out; the average number per player was 4.64 with 7+ days out versus 2.58 with fewer days out (t = 6.02, df = 77.1). The signs and symptoms with the highest incidence for 7+ days out were disorientation to time (chi(2) = 51.2, P = 001), retrograde amnesia (chi(2) = 33.2, P = 0.001), fatigue (chi(2) = 28.1, P = 0.001), and the general category of cognition problems (chi(2) = 21.7, P = 0.001). Loss of consciousness for more than 1 minute was a predictor of 7+ days out (chi(2) = 33.5, P = 0.001), although it occurred in only 7.9% of cases. Of players with 7+ days out, 72.2% were removed from the game and 12.5% were hospitalized. These frequencies were significantly greater than for players with fewer than 7 days out (chi(2) = 68.03, df = 3, P < 0.0001). Approximately 90% of players were managed by rest, irrespective of days out, but a greater fraction were given drug or medical therapies with prolonged days out. The most vulnerable players for 7+ days out with concussion were quarterbacks and the secondary in professional football. Although 8.1% of concussions involved 7+ days out, only 1.6% involved a prolonged postconcussion syndrome. They recovered from symptoms and had a consistent return to play in the NFL.
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              Concussion in professional football: repeat injuries--part 4.

              A 6-year study was conducted to determine the signs, symptoms, and management of repeat concussion in National Football League players. From 1996 to 2001, concussions were reported by 30 National Football League teams using a standardized reporting form filled out by team physicians with input from athletic trainers. Signs and symptoms were grouped by general symptoms, somatic complaints, cranial nerve effects, cognition problems, memory problems, and unconsciousness. Medical actions taken and management were recorded. Data were captured for 887 concussions in practices and games involving 650 players. A total of 160 players experienced repeat injury, with 51 having three or more concussions during the study period. The median time between injuries was 374.5 days, with only six concussions occurring within 2 weeks of the initial injury. Repeat concussions were more prevalent in the secondary (16.9%), the kick unit on special teams (16.3%), and wide receivers (12.5%). The ball return carrier on special teams (odds ratio [OR] = 2.08, P = not significant) and quarterbacks (OR = 1.92, P < 0.1) had elevated odds for repeat injury, followed by the tight end (OR = 1.24, P = not significant) and linebackers (OR = 1.22, P = not significant). There were similar signs and symptoms with single and repeat concussion, except for a higher prevalence of somatic complaints in players on their repeat concussions compared with their first concussion (27.5% versus 18.8%, P < 0.05). More than 90% of players were managed by rest, and 57.5% of those with second injuries returned to play within a day. Players with three or more concussions had signs, symptoms, and treatment similar to those with only a single injury. The most vulnerable players for repeat concussion in professional football are the ball return carrier on special teams and quarterbacks. Single and repeat concussions are managed conservatively with rest, and most players return quickly to play.
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                Author and article information

                Journal
                Sports Health
                Sports Health
                SPH
                spsph
                Sports Health
                SAGE Publications (Sage CA: Los Angeles, CA )
                1941-7381
                1941-0921
                November 2010
                November 2010
                : 2
                : 6
                : 471-483
                Affiliations
                [* ]Department of Neurology, Long Island Jewish Medical Center, New Hyde Park, New York
                []Department of Neurology, Albert Einstein College of Medicine, Bronx, New York
                [§ ]ProBiomechanics LLC, Bloomfield Hills, Michigan
                []Departments of Kinesiology and Radiology, Michigan State University, Lansing, Michigan
                []ProHEALTH Care Associates, LLP, Lake Success, New York
                [# ]Departments of Medicine and Orthopedics, Mount Sinai School of Medicine, New York, New York
                Author notes
                [*] []Address correspondence to David C. Viano, ProBiomechanics LLC, 265 Warrington Road, Bloomfield Hills, MI 48304-2952 (e-mail: dviano@ 123456comcast.net ).
                Article
                10.1177_1941738110383963
                10.1177/1941738110383963
                3438866
                23015977
                16206938-8a4b-4c8a-994d-0fbdf83e4c75
                © 2010 The Author(s)
                History
                Categories
                Primary Care
                4
                8
                34
                124
                Custom metadata
                November/December 2010

                Sports medicine
                sport injury prevention,injury epidemiology,concussion,traumatic brain injury
                Sports medicine
                sport injury prevention, injury epidemiology, concussion, traumatic brain injury

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