title: Catastrophic head injuries in high school and college football players.
abstract: BACKGROUND
  Catastrophic head injuries in football are rare but tragic events.
  
  
  OBJECTIVE
  To update the profile of catastrophic head injuries in high school and college football players and to describe relevant risk factors.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  We reviewed 94 incidents of severe football head injuries reported to the National Center for Catastrophic Sports Injury Research during 13 academic years (September 1989 through June 2002).
  
  
  RESULTS
  In the study period there were an average of 7.23 (standard deviation = 2.05) direct high school and college catastrophic head injuries in scholastic football participants per year. There were 0.67 injuries per 100 000 (95% confidence interval: 0.54, 0.81 per 100 000) high school and 0.21 injuries per 100 000 (95% confidence interval: 0.0, 0.49 per 100 000) college participants for a risk ratio of 3.28 (95% confidence interval: 0.81, 13.3). The injuries resulted in subdural hematoma in 75 athletes, subdural hematoma with diffuse brain edema in 10 athletes, diffuse brain edema in 5 athletes, and arteriovenous malformation or aneurysm in 4 athletes. Fifty-nine percent of the contacts reported that the athlete had a history of a previous head injury, of which 71% occurred within the same season as the catastrophic event. Thirty-nine percent of the athletes (21 of 54) were playing with residual neurologic symptoms from the prior head injury. There were 8 (9%) deaths as a result of the injury, 46 (51%) permanent neurologic injuries, and 36 (40%) serious injuries with full recovery. Most players sustained a major impact to the head either from tackling or being tackled.
  
  
  CONCLUSIONS
  The incidence of catastrophic head injuries in football has remained low since the advent of the modern day football helmet in the early 1970s. The incidence of catastrophic head injuries in football is dramatically higher at the high school level than at the college level. Although the reason for this discrepancy is unclear, an unacceptably high percentage of high school players were playing with residual symptoms from a prior head injury. Coaches, athletes, athletic trainers, and medical personnel need to adhere to the guideline that an athlete with any neurologic symptoms from a head injury should be strongly discouraged from returning to play.
authors.affiliation: The Orthopaedic Center, 9711 Medical Center Dr., #201, Rockville, MD 20850, USA. bboden@starpower.net
authors.forename: Barry P
authors.initials: BP
authors.lastname: Boden
authors.forename: Robin L
authors.initials: RL
authors.lastname: Tacchetti
authors.forename: Robert C
authors.initials: RC
authors.lastname: Cantu
authors.forename: Sarah B
authors.initials: SB
authors.lastname: Knowles
authors.forename: Frederick O
authors.initials: FO
authors.lastname: Mueller
mesh_terms: D000293:Adolescent; D001265:Athletic Injuries / Q000453:epidemiology* / Q000401:mortality; D006259:Craniocerebral Trauma / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D005538:Football / Q000293:injuries*; D006408:Hematoma, Subdural / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D015994:Incidence; D008297:Male; D011159:Population Surveillance; D012189:Retrospective Studies; D012574:Schools; D013334:Students / Q000706:statistics & numerical data*; D015599:Trauma Severity Indices; D014481:United States / Q000453:epidemiology; D014495:Universities