Game-related Concussion Impact Location Among High School Versus College Football Athletes

Despite numerous studies conducted on concussions in football, minimal research has addressed head impact location during high school competition. PURPOSE: To quantify concussion and head impact location during high school and college football games. METHODS: A sum of 104 high schools and 41 universities in the contiguous US participated over 14 (2010-23) and 16 (2006-21) seasons, respectively. Outcomes of interest were injury severity, head impact location, injury category, types of mouthguard/use, injury situation and mechanism, player and skill position, environment, and surface type. Injury incidence rates (IIR) were calculated as injuries per 10 games. RESULTS: Of the 4557 high school and 2864 college games analyzed, 1451 injuries were reported with 751 in high school and 700 in college. MANOVAs indicated a significant competitive effect by injury severity (F1,1449 = 201.896; P < .001), head impact location (F4,1446 = 5.429; P < .001), injury category (F1,1449 = 8.851; P < .001), injury situation (F12,1438 = 141.137; P < .001) and mechanism (F9,1441 = 47.094; P < .001), player (F2,1448 = 1347.485; P < .001) and skill position (F7,1443 = 52.598; P < .001), environment (F2,1448 = 26.119; P < .001), weather (F3,1447 = 4.639; P < .001), and surface type (F1,1449 = 10.454; P < .001). Post hoc analyses [IIR, (95% CI)] indicated significantly lower (p < .05) incidence of frontal [0.9, (0.8-1.0) vs 1.4, (1.3-1.5)] and parietal impact location [0.1, (0.0-0.1) vs 0.2, (0.2-0.3)]; player collisions [1.4, (1.3-1.5) vs 2.2, (2.1-2.4)], rushing [0.7, (0.6-0.8) vs 0.8, (0.7-0.9)], receiver [0.2, (0.1-0.2) vs 0.3, (0.3-0.4)], pass catching [0.2, (0.1-0.2) vs 0.3, (0.3-0.4)], tackled [0.3, (0.3-0.4) vs 0.5, (0.5-0.6)], blocking [0.2, (0.2-0.3) vs 0.4, (0.4-0.5)], pass defense [0.2, (0.1-0.2) vs 0.4, (0.3-0.5)], being blocked [0.3, (0.2-0.3) vs 0.4, (0.3-0.5)], tackling [0.5, (0.4-0.5) vs 0.8, (0.7-0.9)], secondary [0.2, (0.2-0.2) vs 0.5, (0.4-0.6)], and special teams [0.3, (0.3-0.4) vs 0.6, (0.5-0.7)] during high school vs college games, respectively. CONCLUSION: Occipital and temporal impacts are excessive at the high school level of play. To reduce the potential long-term decrease in health-related quality of life, addressing high school-specific helmets for optimal padding and safety is recommended.