Opportunities for Prevention of Concussion and Repetitive Head Impact Exposure in College Football Players A Concussion Assessment, Research, and Education (CARE) Consortium Study

IMPORTANCE Concussion ranks among the most common injuries in football. Beyond the risks of concussion are growing concerns that repetitive head impact exposure (HIE) may increase risk for long-term neurologic health problems in football players. OBJECTIVE To investigate the pattern of concussion incidence and HIE across the football season in collegiate football players. DESIGN, SETTING, AND PARTICIPANTS In this observational cohort study conducted from 2015 to 2019 across 6 Division I National Collegiate Athletic Association (NCAA) football programs participating in the Concussion Assessment, Research, and Education (CARE) Consortium, a total of 658 collegiate football players were instrumented with the Head Impact Telemetry (HIT) System (46.5% of 1416 eligible football players enrolled in the CARE Advanced Research Core). Players were prioritized for instrumentation with the HIT System based on their level of participation (ie, starters prioritized over reserves). EXPOSURE Participation in collegiate football games and practices from 2015 to 2019. MAIN OUTCOMES AND MEASURES Incidence of diagnosed concussion and HIE from the HIT System. RESULTS Across 5 seasons, 528 684 head impacts recorded from 658 players (all male, mean age [SD], 19.02 [1.25] years) instrumented with the HIT System during football practices or gamesmet quality standards for analysis. Players sustained a median of 415 (interquartile range [IQR], 190-727) recorded head impacts (ie, impacts) per season. Sixty-eight players sustained a diagnosed concussion. In total, 48.5% of concussions (n = 33) occurred during preseason training, despite preseason representing only 20.8% of the football season (0.059 preseason vs 0.016 regular-season concussions per team per day; mean difference, 0.042; 95% CI, 0.020-0.060; P =.001). Total HIE in the preseason occurred at twice the proportion of the regular season (324.9 vs 162.4 impacts per team per day; mean difference, 162.6; 95% CI, 110.9-214.3; P <.001). Every season, HIE per athletewas highest in August (preseason) (median, 146.0impacts; IQR, 63.0-247.8) and lowest inNovember (median, 80.0impacts; IQR, 35.0-148.0). Over 5 seasons, 72% of concussions (n = 49) (game proportion, 0.28; 95% CI, 0.18-0.40; P <.001) and 66.9% of HIE (262.4 practices vs 137.2 games impacts per player; mean difference, 125.3; 95% CI, 110.0-140.6; P <.001) occurred in practice. Even within the regular season, total HIE in practices (median, 175.0impacts per player per season; IQR, 76.0-340.5) was 84.2% higher than in games (median, 95.0impacts per player per season; IQR, 32.0-206.0). CONCLUSIONS AND RELEVANCE Concussion incidence and HIE among college football players are disproportionately higher in the preseason than regular season, and most concussions and HIE occur during football practices, not games. These data point to a powerful opportunity for policy, education, and other prevention strategies to make the greatest overall reduction in concussion incidence and HIE in college football, particularly during preseason training and football practices throughout the season, without major modification to game play. Strategies to prevent concussion and HIE have important implications to protecting the safety and health of football players at all competitive levels.

Automated summary

The study found that concussion incidence and HIE among college football players are higher in the preseason than the regular season. Most concussions and HIE occur during football practices rather than games.