Traumatic Brain Injury in Sport: Incidence of Injury by Kevin Guskiewicz

Traumatic Brain Injury In Sport: Incidence of Injury

Kevin Guskiewicz, PhD, ATCKenan Distinguished Professor

Department of Exercise and Sport ScienceUNIVERSITY of NORTH CAROLINA at CHAPEL HILL

University of Michigan Injury CenterConcussion Summit Sept. 24, 2015

Are football programs’ millions in profits exploitation? Or are they still a celebration of amateur sport?

Does football’s inherent danger and violence have any place in institutions of higher learning? Or does it provide young men with educational opportunities they would not otherwise have?Arguing for the motion will be Malcolm Gladwell and Buzz Bissinger, arguing against will be Jason Whitlock and Tim Green.

May 8, 2012 – On-line debate FOR A.tv

10 Ideas That Changed the World in 2012

Cumulative risks for youth athletes

Should kids be playing contact or collision sports?

National Center for Catastrophic Sport Injury Research: Direct (traumatic) Head and Neck Catastrophic Injuries – All sports all levels

1985-1989

1990-1994

1995-1999

2000-2004

2005-2009

2010-2014

0

50

100

150

200

250

300

Total Fatal Non-fatal neck Non-fatal Head

Num

ber o

f eve

nts

Catastrophic Head & Neck Injuries Academic Year 2014-15

Sport n % Football 22 84.6 Lacrosse 1 3.9 Soccer 3 11.5Level Professional 3 11.5 Collegiate 4 15.4 High school 18 69.2 Youth league 1 3.9Part Head 13 50.0 Neck 12 46.2 Spine 1 3.9

Disability n %Fatal 6 23.1Paralysis 1 3.9

Severe no paralysis 9 34.6

Temporary Paralysis 6 23.1Unknown 4 15.4ActivityGame 24 92.3Practice 1 3.9Unknown 1 3.9TOTAL head & spine 26 100TOTAL events 81 32.1

*AY 2013/14 there were 31 catastrophic head & spine injuries captured

Courtesy of National Center for Catastrophic Sport Injury Research


FootballIndirect Fatalities (Heat Stroke, Cardiac, etc.) vs.

Direct (Head & Neck) Fatalities

Characteristics of 2014 Football-Related Direct Fatalities


Concussion Rates per 10,000 AEsSport Overall Rank Practice RankFootball 7.44 1 3.54 1Boys’ Ice Hockey 6.57 2 1.48 5Boys’ Lacrosse 4.97 3 1.64 4Girls’ Soccer 4.63 4 0.96 10Girls’ Lacrosse 3.82 5 1.41 6Girls’ Basketball 3.12 6 1.08 9Boys’ Wrestling 3.08 7 2.08 3Boys’ Soccer 2.68 8 0.65 13Girls’ Field Hockey 2.63 9 1.19 7Cheerleading 2.02 10 2.16 2Boys’ Basketball 1.68 11 0.82 11Girls’ Softball 1.66 12 1.11 8

Cheerleaders don’t always have a safe practice space. Cheerleading practice concussions occur on tile, asphalt, and concrete.

Courtesy of R. Dawn Comstock, PhD; National High School Sports-Related Injury Surveillance System (High School RIO)

Concussion Burden High School RIOTM Data


State Concussion LawsSports Concussion Legislation – All 50 states (2009-2014) Essential components

1) Education (athletes, parents, coaches).

2) Instituting a concussion policy and emergency action plan.

3) Removal from practice or play at the time of suspected concussion.

4) Medical evaluation and return to play clearance by a health care provider with training in concussion management.

State Youth Sport Concussion Laws Enacted by Year

K.M. Lowrey, 2014

Concussion Rates per 10,000 AE Over Time: High School RIO Data


Concussion crisis?No!

Trends Over Time: Compliance with Return to Play Guidelines Following Concussion (All Sports)

07/08 08/09 09/10 10/11 11/12 12/13

<1 day 7.9 2.6 1.5 0.8 1.8 0.6

1-2 days 6.7 6.4 3.9 2.4 1.9 0.8

3-6 days 21.4 19.5 17.9 12.9 8.9 8.3

Season ended 0.8 0.1 8.7 12.2 14.2 14.5

Athlete decides not to continue

0.4 1.4 1.2 1.4 1.9 1.9

% of Student Athletes in Each Category of RTP by Year

“Education (coupled with legislation?) has been effective!”Courtesy of R. Dawn Comstock, PhD;

National High School Sports-Related Injury Surveillance System (High School RIO)

Across 25 sports, no significant increase detected over the past 10 years; Lacrosse and football showed linear trends suggesting an increase in reported concussions.

Concussion Incidence

• HS overall rate (2011/12 HS RIO): 0.51 per 1,000 AEs – 2x greater than rate for 2005/2006 season

Rosenthal, 2014

• NCAA overall rate (2009/2010 to 2013/2014 NCAA ISS):0. 447 per 1,000 AEs

Zuckerman, 2015

Concussion incidence in the NFL

• 1996 – 2001: 0.41 concussions per game (Pellman et al, 2004)

• 2002 – 2007: 0.38 concussions per game (Casson et al, 2010)

• 2010 – 2014: 0.66 concussions per game (Clark et al, Unpublished)

Incidence rate by type of play (NFL)

Type of Play Injuries Frequency of

Play Type

Adjusted Frequency of Play Types Incidence Rate per 1,000

Plays (95% C.I.) Rate Ratio (95% C.I.)

Run 123 58,133 28,572 4.31. (3.61 – 5.14) –

Pass 241 73,703 36,183 6.67 (5.87 – 7.56) 1.55 (1.25 – 1.92)

Punt 17 10,256 5,043 3.37 (2.10 – 5.42) 0.78 (0.47 – 1.30)

Field Goal 4 4,140 2,037 1.96 (0.74 – 5.23) 0.46 (0.17 – 1.73)

Kickoff 44 6,362 5,043 14.14 (10.52 – 19.00) 3.28 (2.33 – 4.63)

Incidence rate by time of play (NFL)

Half Quarter Number of Injuries

Adjusted Frequency of Plays

Incidence Rate per 1000 Plays (95% C.I.)

Rate Ratio (95% C.I.)

FirstFirst 91

38,650 4.68 (4.05 – 5.42) –Second 90

SecondThird 122

38,619 6.32 (5.57 – 7.16) 1.35 (1.11 – 1.64) Fourth 122

Overtime 4 N/A N/A

Injurious impact type by time of play (NFL)

Half (%)

First Second

helmet-to-ground 78 (33.8) 84 (27.0) 162 (29.9)

helmet-to-helmet 71 (30.7) 104 (33.4) 175 (32.3)

helmet-to-pad 82 (35.5) 123 (39.6) 205 (37.8)231 311 542

Χ2 = 2.900 , P=0.235

Impact location by time of play (NFL)

Half First Second

Back 6 14 207.32 11.38

Crown 14 16 3017.07 13.01

Facemask 8 18 269.76 14.63

Front 10 16 2612.2 13.01

Left 16 24 4019.51 19.51

Right 28 35 6334.15 28.46

82 123 205

Helmet-to-Pad Impacts Half

First Second

Back 5 7 127.14 6.8

Crown 10 21 3114.29 20.39

Facemask 6 11 178.57 10.68

Front 11 15 2615.71 14.56

Left 24 25 4934.29 24.27

Right 14 24 3820 23.3

70 103 173

Helmet-to-Helmet Impacts

Χ2 = 2.781 P=0.734

Χ2 = 2.856 P=0.722

Table 2. Regular Season Game Kickoff Statistics in 2011; 3-year Comparison

Result of Kickoff

Year Total Returns Touchbacks Fair

Catches Kick Out of

Bounds Short Free or Onside Kicks

Opponent Received

Total Kickoffs

2008 2114 371 7 36 47 1 2576

2009 2004 401 12 30 36 1 2484

2010 2034 416 7 39 43 0 2539

2011 1375 1120 1 26 50 0 2572

Average 2008-2010 2050.7 396 8.7 35 42 0.7 2533

NFL’s 2011 Kick-off Rule Change

33% reduction in the number of returned kickoffs

Table 3. Significant Injuries As a Function of Kickoff Plays 2011 Regular Season; 3-year Comparison

Regular Season Games Year Concussions Neck/Spine Fractures ACL Sprain All Injuries 2008

(N=2576) 26

(1.0%) 12

(0.5%) 10

(0.4%) 3

(0.1%) 152

(5.9%) 2009

(N=2484) 25

(1.0%) 7

(0.3%) 6

(0.2%) 2

(0.1%) 147

(5.9%) 2010

(N=2539) 28

(1.1%) 7

(0.3%) 11

(0.4%) 8

(0.3%) 135

(5.3%) 2011

(N=2572) 15

(0.6%) 8

(0.3%) 8

(0.3%) 7

(0.3%) 136

(5.3%) Average 2008-2010

(N=2533) 26.3

(1.0%) 8.7

(0.3%) 9.0

(0.4%) 4.3

(0.2%) 144.7

(5.7%)

NFL’s 2011 Kick-off Rule Change

42% reduction in the number of concussions

…perhaps the pendulum has swung too far in the direction of concussion phobia…

…“concussion” is not a single entity, and should be replaced with the term “concussion spectrum”…

What We Don’t Know: Concussion (biomechanical) thresholds and why they vary from person to person

A specific age at which kids are safer to begin playing contact sports

If playing contact sports for any number of years makes someone more susceptible to neurodegenerative disease (MCI, AD, CTE, etc.)

What We Think We Know: Athletes are safer when coaches, parents and athletes understand effective concussion recognition & response

Concussion education and state concussion laws are working…There is NOT a concussion crisis or epidemic

Contact in youth sports should be minimized, but not eliminated when it’s part of the game

Thank [email protected]

SPORT CONCUSSION SUMMIT

September 24, 2015 #uminjuryctr

Traumatic Brain Injury in Sport: Incidence of Injury by Kevin Guskiewicz

Health & Medicine

Transcript of Traumatic Brain Injury in Sport: Incidence of Injury by Kevin Guskiewicz