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Head Impact Exposure in Youth Soccer and Variation by Age and Sex

Chrisman, Sara P. D., MD, MPH*,†,‡; Ebel, Beth E., MD, MSc, MPH†,‡; Stein, Elizabeth, BA*; Lowry, Sarah J., MPH*; Rivara, Frederick P., MD, MPH*,†,‡

Clinical Journal of Sport Medicine: January 2019 - Volume 29 - Issue 1 - p 3–10
doi: 10.1097/JSM.0000000000000497
Original Research

Objective: To examine variation in head impact exposure (HIE) by age and sex in youth soccer.

Design: Prospective cohort study.

Setting and Participants: Youth soccer athletes (11-14 years old) in local clubs.

Exposures: Age and sex.

Outcome Measures: Head impact exposure measured using adhesive-mounted accelerometers during 1 month of soccer.

Results: Forty-six youth athletes (54% female) participated. No athlete reported a concussion during the study. More males than females had at least 1 head impact ≥15 g (P = 0.02). Of those who sustained a head impact above the 15-g threshold (57%), females sustained HIE of greater magnitude than males (median 47.4 g vs 33.3 g, P = 0.04). Eighty-five percent of athletes on U14 teams had at least 1 head impact ≥15 g compared with 15% of athletes on U12 teams (P < 0.001). Poisson regression stratified by sex and controlling for team-suggested age effects were significant only for females (P = 0.02). There was significant variation in HIE by team. There were no decrements in concussion symptoms, health-related quality of life, or neuropsychological testing after 1 month of soccer play.

Conclusions: There is significant variation in HIE in youth soccer, which seems to be influenced by age and sex. Further studies are needed to better understand potential significance for injury prevention.

*Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington;

Department of Pediatrics, University of Washington, Seattle, Washington; and

Harborview Injury Prevention and Research Center, Seattle, Washington.

Corresponding Author: Sara P. D. Chrisman, MD, MPH, CW8/6, PO Box 5371, Seattle, WA 98145 (

Supported by the Seattle Children's Hospital Academic Enrichment Fund and the Seattle Pediatric Concussion Research Collaborative.

The authors report no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

This study was approved by the Western Institutional Review Board, #20140764. All youth subjects completed assent and parents completed parental permission forms.

Received March 29, 2017

Accepted July 06, 2017

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