EPIDEMIOLOGY OF

CONCUSSION IN COLLEGIATE
AND HIGH SCHOOL
FOOTBALL PLAYERS
GUSKIEWICZ ET. AL, SEPTEMBER 2000

Jolie Brown, Advanced Topics Lab, Fall 2023

ABSTRACT
-Evolutions in protective headgear
-888 (5.1%) sustained at least one
concussion,and 131 (14.7% of the
888) sustained a second injuryduring
the same season
-Epidemiologic issues (1) incidence
of injury, 2) common signs and
symptoms, and 3) patterns in making
return-to-play decisions)
-The greatest incidence
ofconcussion was found at the high
school (5.6%) andcollegiate division
III (5.5%) levels
-242 Surveys, 17,549 players, 3
seasons, High School, D1, D2, D3
collegiate football
-8.9% of all injuries involved loss
of conscious-ness, while 86%
involved a headache, and 30.8%of all
players sustaining a concussion
returned to participation on the same
day of injury
BACKGROUND

• THE INCIDENCE OF CONCUSSIONS IN FOOTBALL

HAVE RISEN SIGNIFICANTLY IN RECENT YEARS
DESPITE THE TECHNOLOGY ADVANCEMENTS IN
HEADGEAR. CONCUSSIONS ALSO PREVAIL AS THE
MOST COMMON INJURY AMONG FOOTBALL PLAYERS.
THE RETURN TO PLAY DECISION IS DIFFICULT, AND
MADE INCREASINGLY COMPLEX BY THE NATURE OF
THE INJURY. EVEN WHEN IMMEDIATELY PRESENT
SYMPTOMS SEEM TO RESOLVE, THE DAMAGE COULD
STILL BE LIFE THREATENING.
METHODS

Random selection of players from NATA (National Athletic Trainers'

Association) from 1995-97 from high school, and D1-3 Collegiate
teams

- Method of testing: Questionnaire

 • ATHLETIC TRAINERS WERE INSTRUCTED TO
COMPLETE A QUESTIONNAIRE DIRECTLY
AFTER A HEAD INJURY, AT ANY LEVEL OF
SEVERITY, WAS SUSTAINED BY A PLAYER.
CONCUSSIONS WERE DEFINED AS AN
ACCELERATION OR DECELERATION OF THE
QUESTIONNAIR HEAD THAT RESULTED IN HALLMARK
SYMPTOMS OF THE INJURY (HEADACHE,
E CONFUSION, AMNESIA, ETC.). THE
QUESTIONNAIRE ALSO INCLUDED ITEMS LIKE
PLAYER POSITION, WHETHER THE INJURY WAS
SUSTAINED IN A GAME OR PRACTICE, GENERAL
NATURE OF THE INJURY, AND HOW SOON
AFTER THE INJURY THE PLAYER WAS
ALLOWED TO RETURN TO PLAY.
RESULTS

• 17,549 PLAYERS WERE REPRESENTED IN THE 242 SCHOOLS WHO SUBMITTED

COMPLETE DATA. OF THESE PLAYERS 888 SUSTAINED ONE CONCUSSION, AND
OF THOSE 888, 131 SUSTAINED A SECOND CONCUSSION DURING THE SEASON.
SUSTAINING ONE CONCUSSION MADE PLAYERS 3 TIMES AS LIKELY TO HAVE
ANOTHER ONE WHEN COMPARED TO THOSE WHO HADN'T SUSTAINED A
CONCUSSION.
 CONCUSSION GRADES:
GRADE 1: NO LOSS OF CONSCIOUSNESS, TEMPORARY
ALTERATIONS IN MENTAL STATUS, LESS THAN 30
MINUTES OF AMNESIA
GRADE 2: TEMPORARY ALTERATION IN MENTAL STATUS
WITH IN-CREASED SIGNS AND SYMPTOMS USUALLY
LASTING LONGER THAN THOSE OF A GRADE I
CONCUSSION—HOWEVER, ANY LOSS OF CONSCIOUSNESS
LASTS LESS THAN 5 MINUTES AND ANY AMNESIA LASTS
BETWEEN 30 MINUTES AND 24 HOURS
GRADE 3: INVOLVING SOME DEGREE OF LOSS OF
CONSCIOUSNESS, 5 MINUTES OR MORE, OR AMNESIA, 24
HOURS OR MORE, OR BOTH
RESULTS
CONTINUED

• THE PLAYERS INJURED MOST

WERE DEFENSIVE BACKS,
OFFENSIVE LINEMEN, AND
LINEBACKERS, BUT SPECIAL
TEAMS PLAYERS AND WIDE
RECEIVERS WERE THE MOST
LIKELY TO SUFFER A GRADE II
CONCUSSION. THE MAJORITY
OF INJURIES (ABOUT 60%)
WERE SUSTAINED DURING
GAMEPLAY (AS OPPOSED TO
PRACTICE).
RESULTS… RETURN TO PLAY

• MOST OF THE TIME (70%) RETURN TO PLAY (RTP) DECISIONS ARE MADE BY
BOTH THE PHYSICIAN AND ATHLETIC TRAINER, BUT IN HIGH SCHOOL THE
MAJORITY OF RTP DECISIONS ARE MADE WITH LITTLE INVOLVEMENT BY
THE PHYSICIAN. THESE RTP DECISIONS, AS THE DATA HAS SHOWN, INCREASE
A PLAYERS' PROPENCITY TO SUSTAIN A SECOND CONCUSSION.
 DISCUSSION

• THE EXPONENTIAL RISE IN CONCUSSION INJURIES, AS WELL AS OTHER INJURIES, BEING

SUSTAINED IN ALL LEVELS OF FOOTBALL AND OTHER SPORTS CAN BE ATTRIBUTED TO
THE INCREASE IN KNOWLEDGE ABOUT HOW TO MAKE PLAYERS BIGGER, FASTER, AND
MORE SKILLED. THIS LEADS TO BIGGER HITS AND MORE FORCEFUL IMPACTS. EVEN WITH
THE IMPROVEMENT IN HELMETS AND PROTECTIVE EQUIPTMENT, CONCUSSION RATES
CONTINUE TO RISE AT ALL LEVELS OF THE SPORT. RTP DECISIONS ARE ALSO GRAVELY
AFFECTING REPEAT-INJURIES. WHILE THE RECOMMENDATION IS THAT PLAYERS WITH A
GRADE 1 CONCUSSION RETURN TO PLAY ONLY AFTER 15-20 ASYMPTOMATIC MINUTES,
THE AVERAGE RTP WAS 13 MINUTES ACROSS ALL LEVELS. ALSO, FOR GRADE 2
CONCUSSIONS, THE RECOMMENDATION IS NO RTP THE SAME DAY, BUT IN THIS STUDY
30% OF GRADE 2 CONCUSSIONS RETURNED TO PLAY THE SAME GAME OR PRACTICE. ALL
OF THESE DECISIONS ARE HEAVILY IMPACTED BY THE POLITICAL NATURE OF THE GAME.
CONTINUING RESEARCH
(CTE)

• CONTINUING RESEARCH HAS INCLUDED STUDIES INTO THE

LONG TERM EFFECTS OF HEAD TRAUMA, PATRICULARY IN
FOOTBALL PLAYERS. ONE SPECIFIC CONDITION BEING
STUDIED IS CHRONIC TRAUMATIC ENCEPHALOPATHY (CTE).
CTE IS A PROGRESSIVE DISEASE RESULTING FROM REPEATED
HEAD TRAUMA THAT EVENTUALLY LEADS TO DEMENTIA AND
BRAIN DEGRADATION. CTE IS A CONDITION OBSERVED IN
MANY RETIRED PROFESSIONAL FOOTBALL PLAYERS. CTE
CANNOT BE DEFINITIVELY DIAGNOESED WHILE A PATIENT IS
LIVING, BUT SYMPTOMS INCLUDE MEMORY LOSS,
CONFUSION, AGGRESSION, ISSUES WITH BALANCE AND
WALKING, DEPRESSION, AND SUICIDAL THOUGHTS.
CONTINUING RESEARCH COULD INCLUDE SPECIFYING HOW
OFTEN CTE DEVELOPED IN PLAYERS WHO SUSTAINED
MULTIPLE CONCUSSIONS IN ONE SEASON, OR THOSE WHO
RETURNED TO PLAY AFTER A CONCUSSION AT LEAST TWICE
IN THEIR FOOTBALL CAREER. THESE STUDIES WOULD BE
CONDUCTED AT THE COLLEGIATE LEVEL AND BEYOND
THANK YOU!