Concussion in professional football:​ repeat injuries—Part 4

Pellman, Elliot J.; Viano, David C.; Casson, Ira R.; Tucker, Andrew M.; Waeckerle, Joseph F.; Powell, John W.; Feuer, Henry

Affiliations

¹Mild Traumatic Brain Injury Committee, National Football League, New York, New York

²ProHEALTH Care Associates, LLP, Lake Success, New York

³ProBiomechanics LLC, Bloomfield Hills, Michigan

⁴Department of Neurology, Long Island Jewish Medical Center, New Hyde Park, New York

⁵Department of Neurology, New York University Medical Center, New York, New York

⁶Department of Neurology, Albert Einstein College of Medicine, Bronx, New York

⁷University of Maryland School of Medicine, Timonium, Maryland

⁸Acute Care and Emergency Specialists, MD, PC, Leawood, Kansas

⁹Departments of Kinesiology and Physical Medicine and Rehabilitation, Michigan State University, Lansing, Michigan

¹⁰Indianapolis Neurosurgical Group, Indianapolis, Indiana

Abstract and keywords

Objective: A 6-year study was conducted to determine the signs, symptoms, and management of repeat concussion in National Football League players.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Concussion; Epidemiology; Injury surveillance; Repeat or multiple concussions; Second-impact syndrome; Traumatic brain injury

Links

DOI: 10.1227/01.NEU.0000137657.00146.7D

PubMed: 15458594

WoS: 000224309100029

History

Received: 2003-11-11

Accepted: 2004-06-25

Cited Works (14)

Year	Entry
1999	Powell JW, Barber-Foss KD. Traumatic brain injury in high school athletes. JAMA. September 8, 1999;282(10):958-963.
2003	McCrea M, Guskiewicz KM, Marshall SW, Barr W, Randolph C, Cantu RC, Onate JA, Yang J, Kelly JP. Acute effects and recovery time following concussion in collegiate football players: the NCAA concussion study. JAMA. November 19, 2003;290(19):2556-2563.
1998	Cantu RC. Second-impact syndrome. Clin Sports Med. January 1998;17(1):37-44.
2002	Delaney JS, Lacroix VJ, Leclerc S, Johnston KM. Concussions among university football and soccer players. Clin J Sport Med. November 2002;2(6):331-338.
2003	Pellman EJ. Background on the National Football League's research on concussion in professional football. Neurosurgery. October 2003;53(4):797-798.
1983	Gerberich SG, Priest JD, Boen JR, Straub CP, Maxwell RE. Concussion incidences and severity in secondary school varsity football players. Am J Public Health. 1983;73(12):1370-1375.
2001	Langburt W, Cohen B, Akhthar N, O’Neill K, Lee J-C. Incidence of concussion in high school football players of Ohio and Pennsylvania. J Child Neurol. February 2001;16(2):83-85.
2003	Field M, Collins MW, Lovell MR, Maroon J. Does age play a role in recovery from sports-related concussion? a comparison of high school and collegiate athletes. J Pediatr. May 2003;142(5):546-553.
2000	Guskiewicz KM, Weaver NL, Padua DA, Garrett WE Jr. Epidemiology of concussion in collegiate and high school football players. Am J Sports Med. September 2000;28(5):643-650.
2003	Guskiewicz KM, McCrea M, Marshall SW, Cantu RC, Randolph C, Barr W, Onate JA, Kelly JP. Cumulative effects associated with recurrent concussion in collegiate football players: the NCAA concussion study. JAMA. November 19, 2003;290(19):2549-2555.
2002	Collins MW, Lovell MR, Iverson GL, Cantu RC, Maroon JC, Field M. Cumulative effects of concussion in high school athletes. Neurosurgery. November 2002;51(5):1175-1179.
2003	Pellman EJ, Viano DC, Tucker AM, Casson IR. Concussion in professional football: location and direction of helmet impacts—part 2. Neurosurgery. December 2003;53(6):1328-1341.
2003	Pellman EJ, Viano DC, Tucker A, Casson IR, Waeckerle JF. Concussion in professional football: reconstruction of game impacts and injuries. Neurosurgery. October 2003;53(4):799-814.
2004	Pellman EJ, Powell JW, Viano DC, Casson IR, Tucker AM, Feuer H, Lovell M, Waeckerle JF, Robertson DW. Concussion in professional football: epidemiological features of game injuries and review of the literature—Part 3. Neurosurgery. January 2004;54(1):81-94.

Cited By (9)

Year	Entry
2012	Funk JR, Rowson S, Daniel RW, Duma SM. Validation of concussion risk curves for collegiate football players derived from HITS data. Ann Biomed Eng. January 2012;40(1):79-89.
2012	Beckwith JG, Greenwald RM, Chu JJ. Measuring head kinematics in football: correlation between the head impact telemetry system and Hybrid III headform. Ann Biomed Eng. January 2012;40(1):237-248.
2012	Daniel RW, Rowson S. Head impact exposure in youth football. Ann Biomed Eng. April 2012;40(4):976-981.
2005	Viano DC, Casson IR, Pellman EJ, Zhang L, King AI, Yang KH. Concussion in professional football: brain responses by finite element analysis: part 9. Neurosurgery. November 2005;57(5):891-916.
2005	Viano DC, Casson IR, Pellman EJ, Bir CA, Zhang L, Sherman DC, Boitano MA. Concussion in professional football: comparison with boxing head impacts: part 10. Neurosurgery. December 2005;57(6):1154-1172.
2007	Viano DC, Casson IR, Pellman EJ. Concussion in professional football: biomechanics of the struck player—Part 14. Neurosurgery. August 2007;61(2):313-327.
2020	Hanna B. Development of a Metamaterial for Use in American Football Head Protection [PhD thesis]. Cardiff University; September 2020.
2012	Daniel RW II. Head Acceleration Measurements in Helmet-Helmet Impacts and the Youth Population [Master's thesis]. Virginia Polytechnic Institute and State University; April 16, 2012.
2014	Daniel RW II. Evaluation of Football Safety Techniques Utilizing Biomechanical Measurements [PhD thesis]. Virginia Polytechnic Institute and State University; June 3, 2014.