Injury Epidemiology

Sports concussions, considered a form of mild traumatic brain injury [mTBI], accounts for 5.5% of all athletic injuries (Powell & Barber-Foss, 1999) for 10 high school sports over a 3 year period [boys football, wrestling, baseball, field hockey, girls volleyball, softball, boys & girls basketball and soccer]. In a epidemiological study published in the Journal of American Medical Association, 1,219 concussions were documented at 235 high schools by athletic trainers. Football had the greatest incidence of concussions, nearly twice as many as all other sports combined. The following lists the case rate of concussions by sport in the study:

Football:                  63.4%
Wrestling:               10.5%
 Soccer (G):                6.2%
 Soccer (B):                5.7%
 Basketball (G):          5.2%
 Basketball (B):          4.2%
Softball:                     2.1%
 Baseball:                   1.2%
 F. Hockey (B):           1.1%
 Volleyball:                 0.5%
Concussion Facts
  • Head Injuries are reported twice as frequent as neck injuries.
  • Teenage football players are most at-risk.
  • Concussion Injury Rates are typically found to range from 3% - 6% of all athletic injuries in contact/collision sports.
  • Once having sustained a concussion, the chances of an athlete sustaining a 2nd concussion are 4 – 6 times greater.
  • Even after mild traumatic brain injury (mTBI), cerebral metabolic derangements require approximately 10 days to recover.
  • High school athletes sustain 3 times as many concussions per capita, and recover more slowly from concussions than collegiate or professional athletes. Therefore, the course of injury management and Return to Play (RTP) recommendations differ by age.
  • Sports-related head injury catastrophes may not accur from the blow to the head on the day of the catastrophe – but, rather from an exacerbation of an earlier blow that did not heal.
  • There is no universal agreement on concussion severity grading systems.
  • There is unanimous agreement that athletes under 19 yrs. old with post-concussion symptoms should be removed from activity immediately, and not allowed to return to play contact/collision sports until symptoms cease, where upon they are evaluated by a medical or an appropriate licensed health care professional with training and experience in managing sports-related concussions.


The following study by the Nat’l Center for Catastrophic Sports Injury Research: Catastrophic Head Injuries in High School and College Football. Am. J Sports Medicine, Jul 2007, catastrophic head injures were reported over 13 academic years (1989-2002).  The catastrophic injury rate in high school athletes was 3 times that of the collegiate ranks. 

  • 94 catastrophic head injuries
    • 75 subdural hematomas (80%)
    • 10 subdural hematomas & diffuse brain edema (11%)
    • 5 diffuse brain edema (5%)
    • 4 aneurysms or congenital A-V malformations (4%)
  • 7.23 catastrophic head injuries per year in high school and college
  • Catastrophic Injuries - High School:  .67/100,000 athletic-exposures
  • Catastrophic Injuries - College:  .21/100,000 athletic-exposures
  • 59% reported prior history of head injury
    • 71% of these from same season
  • 39% were playing with residual symptoms
  • 8 (9%) deaths
  • 46 (51%) permanent neurologic injury
  • 36 (40%) serious injury


Second Impact Syndrome - A Catastrophic Event

Second ImPACT Syndrome is a condition where an athlete remains symptomatic from previous concussion(s) where the brain is in a state of vulnerability, who returns to play and sustains additional trauma to the head or central nervous system, usually within minutes after appearing to be “dinged”.  They collapse, become semi-comatose, pupils rapidly dilate, eye movement is lost, with respiratory failure not far away.  Such a condition can result in loss of the brain’s vascular autoregulation.  This leads to vascular engorgement and increased intracranial pressure. 

This catastrophic condition carries a 50% chance of death (mortality), and a 100% likihood of permanent neurological impairment (morbidity).

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