Concussion in professional football: repeat injuries--part 4.
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.


CONCLUSIONS
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.
Mild Traumatic Brain Injury Committee, National Football League, New York, New York, USA.
Elliot J
EJ
Pellman
David C
DC
Viano
Ira R
IR
Casson
Andrew M
AM
Tucker
Joseph F
JF
Waeckerle
John W
JW
Powell
Henry
H
Feuer
D001265:Athletic Injuries / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy; D001924:Brain Concussion / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology* / Q000628:therapy; D003625:Data Collection / Q000379:methods; D005538:Football; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D015995:Prevalence; D012008:Recurrence