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Concussion in Professional Football: Epidemiological Features of Game Injuries and Review of the LiteraturePart 3

Pellman, Elliot J. M.D.; Powell, John W. Ph.D.; Viano, David C. Dr. med., Ph.D.; Casson, Ira R. M.D.; Tucker, Andrew M. M.D.; Feuer, Henry M.D.; Lovell, Mark Ph.D.; Waeckerle, Joseph F. M.D.; Robertson, Douglas W. M.D.

doi: 10.1227/01.NEU.0000097267.54786.54
Clinical Studies

OBJECTIVE: A 6-year study was performed to determine the circumstances, causes, and outcomes of concussions in the National Football League.

METHODS: Between 1996 and 2001, the epidemiological features of concussions were recorded by National Football League teams with a standardized reporting form. Symptoms were reported and grouped as general symptoms, cranial nerve symptoms, memory or cognitive problems, somatic complaints, and loss of consciousness. The medical actions taken were recorded. In total, 787 game-related cases were reported, with information on the players involved, type of helmet impact, symptoms, medical actions, and days lost. Concussion risks were calculated according to player game positions.

RESULTS: There were 0.41 concussions per National Football League game. The relative risk was highest for quarterbacks (1.62 concussions/100 game-positions), followed by wide receivers (1.23 concussions/100 game-positions), tight ends (0.94 concussion/100 game-positions), and defensive secondaries (0.93 concussion/100 game-positions). The majority of concussions (67.7%) involved impact by another player’s helmet. The remainder involved impact by other body regions of the striking player (20.9%) or ground contact (11.4%). The three most common symptoms of mild traumatic brain injury were headaches (55.0%), dizziness (41.8%), and blurred vision (16.3%). The most common signs noted in physical examinations were problems with immediate recall (25.5%), retrograde amnesia (18.0%), and information-processing problems (17.5%). In 58 of the reported cases (9.3%), the players lost consciousness; 19 players (2.4%) were hospitalized. A total of 92% of concussed players returned to practice in less than 7 days, but that value decreased to 69% with unconsciousness.

CONCLUSION: The professional football players most vulnerable to concussions are quarterbacks, wide receivers, and defensive secondaries. Concussions involved 2.74 symptoms/injury, and players were generally removed from the game. More than one-half of the players returned to play within 1 day, and symptoms resolved in a short time in the vast majority of cases.

Mild Traumatic Brain Injury Committee, National Football League, New York, New York, and ProHEALTH Care Associates, Lake Success, New York

Mild Traumatic Brain Injury Committee, National Football League, New York, New York, and Departments of Kinesiology and Physical Medicine and Rehabilitation, Michigan State University, Lansing, Michigan

Mild Traumatic Brain Injury Committee, National Football League, New York, New York, and ProBiomechanics, Bloomfield Hills, Michigan

Mild Traumatic Brain Injury Committee, National Football League, New York, New York; Department of Neurology, Long Island Jewish Medical Center, New Hyde Park, New York; and Department of Neurology, New York University Medical Center, New York, New York

Mild Traumatic Brain Injury Committee, National Football League, New York, New York, and University of Maryland School of Medicine, Timonium, Maryland

Mild Traumatic Brain Injury Committee, National Football League, New York, New York, and Indianapolis Neurosurgical Group, Indianapolis, Indiana

Mild Traumatic Brain Injury Committee, National Football League, New York, New York, and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

Mild Traumatic Brain Injury Committee, National Football League, New York, New York, and Acute Care and Emergency Specialists, Leawood, Kansas

Mild Traumatic Brain Injury Committee, National Football League, New York, New York, and American Health Network, Carmel, Indiana

Reprint requests:

David C. Viano, Dr. med., Ph.D., ProBiomechanics, 265 Warrington Road, Bloomfield Hills, MI 48304-2952.

Email: dviano@comcast.net

Received, June 10, 2003.

Accepted, August 14, 2003.

Copyright © by the Congress of Neurological Surgeons