title: Impact locations and concussion outcomes in high school football player-to-player collisions.
abstract: BACKGROUND
  Little research has examined concussion outcomes in terms of impact location (ie, the area on the head in which the impact occurred). This study describes the epidemiology of concussions resulting from player-to-player collision in high school football by impact location.
  
  
  METHODS
  National High School Sports-Related Injury Surveillance Study data (2008/2009-2012/2013) were analyzed to calculate rates and describe circumstances of football concussion (eg, symptomology, symptom resolution time, return to play) resulting from player-to-player collisions by impact location (ie, front-, back-, side-, and top-of-the-head).
  
  
  RESULTS
  Most concussions resulting from player-to-player collisions occurred from front-of-the-head (44.7%) and side-of-the-head (22.3%) impacts. Number of symptoms reported, prevalence of reported symptoms, symptom resolution time, and length of time to return to play were not associated with impact location. However, a larger proportion of football players sustaining concussions from top-of-the-head impacts experienced loss of consciousness (8.0%) than those sustaining concussions from impacts to other areas of the head (3.5%) (injury proportion ratio 2.3; 95% confidence interval 1.2-4.2; P = .008). Players had their head down at the time of impact in a higher proportion of concussions caused by top-of-the-head impacts (86.4%) than concussions from impacts to other areas of the head (24.0%) (injury proportion ratio 3.6; 95% confidence interval 3.2-4.0; P < .001).
  
  
  CONCLUSIONS
  Among high school football players who sustained concussions due to player-to-player collisions, concussion outcomes were generally independent of impact location. Recommended strategies for reducing the proportion of top-of-the-head impacts include improved education regarding tackling with proper "head-up" technique.
authors.affiliation: The University of North Carolina, Chapel Hill, North Carolina; Dawn.Comstock@UCDenver.edu.
authors.forename: Zachary Y
authors.initials: ZY
authors.lastname: Kerr
authors.affiliation: The Research Institute at Nationwide Children's Hospital, Columbus, Ohio; The Ohio State University, Columbus, Ohio; and.
authors.forename: Christy L
authors.initials: CL
authors.lastname: Collins
authors.affiliation: The University of North Carolina, Chapel Hill, North Carolina;
authors.forename: Jason P
authors.initials: JP
authors.lastname: Mihalik
authors.affiliation: The University of North Carolina, Chapel Hill, North Carolina;
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Marshall
authors.affiliation: The University of North Carolina, Chapel Hill, North Carolina;
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Guskiewicz
authors.affiliation: University of Denver, Aurora, Colorado.
authors.forename: R Dawn
authors.initials: RD
authors.lastname: Comstock
mesh_terms: D000293:Adolescent; D001924:Brain Concussion / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control; D005538:Football / Q000293:injuries*; D006260:Head Protective Devices / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D011159:Population Surveillance; D012307:Risk Factors; D012574:Schools; D016896:Treatment Outcome
keywords: epidemiology; injury surveillance; traumatic brain injury