Sandra Yin

July 16, 2012

July 16, 2012 (Baltimore, Maryland) — Combined concussion rates for 3 Division I football programs for the 2010/11 season were double the previous season's, according to findings presented here at the American Orthopaedic Society for Sports Medicine (AOSSM) 2012 Annual Meeting.

"The number of concussions and the injury rates increased for each team in the 2010/11 season," reported lead author Kelly G. Kilcoyne, MD, from Walter Reed National Military Medical Center in Washington, DC. One institution saw a statistically significant increase in the overall incidence of concussion rate and an injury rate 2 times that of the previous season.

The researchers monitored concussions at 3 service academies in the 2009/10 and 2010/11 football seasons, and found that the combined number of reports rose from 23 incidents per 40,481 exposures to 42 per 36,228 exposures. The data come from practices and games at the United States Military Academy, United States Naval Academy, and the United States Air Force Academy, all Division I athletic programs.

The 2-fold increase in the combined concussion incidence rate from one season to the next "is striking," the researchers write. "While the institution of a more formalized concussion plan on the part of medical staff is one possible factor, the largest difference may have been from previous underrecognition and underreporting on the part of players and coaches," they note.

Changes were made in 2010, after the National Collegiate Athletic Association (NCAA) adopted a policy that requires member institutions to keep concussion management plans on file. It mandated that student athletes who exhibit or experience signs or symptoms of a concussion be identified, removed from practice or competition, and evaluated by a healthcare provider. The policy states that an athlete diagnosed with a concussion cannot return to the game for the remainder of the day.

Another part of the policy mandates that players and coaches notify a healthcare provider when experiencing or seeing a player with signs or symptoms of a concussion. All players must acknowledge their responsibility to comply with the concussion policy at the beginning of the season.

To determine the number of concussions that occurred on 3 collegiate Division I football teams during the 2 most recent seasons, and to compare the incidence of concussion before and after the new policy went into effect, the researchers reviewed injury reports from football teams at each service academy for each season.

They determined the number of concussions sustained in practice and in games for each team. The number of athlete exposures per season was calculated by multiplying the number of players by the number of player exposures. A player exposure is 1 athlete in 1 practice or game.

The number of concussions and the injury rates increased for each team in the 2010/11 season. At one institution, there were 11 concussions per 15,715 exposures in the 2009/10 season and an injury rate of 0.65 per 1000. For the 2010/11 season, that same institution recorded 22 concussions per 15,444 exposures and an injury rate of 1.42 per 1000 (incidence rate ratio, 2.16; P = .3), which is twice that of the previous season.

The researchers credit the second part of the new policy with the largest change in approach. "It places more responsibility on the coaches and...the student identify signs and symptoms of concussion," Dr. Kilcoyne said, adding that it "also places the responsibility on them to report their injuries and illnesses to institutional medical staff."

Additional studies will be needed to determine the true incidence of concussions in Division I football, he noted.

After the talk, John Bergfeld, MD, senior surgeon at the Cleveland Clinic in Ohio, former AOSSM president, and team physician for the Cleveland Browns from 1976 to 2003, told Medscape Medical News that it is clear that more people are paying attention to concussions.

"I think there's no question that we're much more aware of concussions than we were," he said, "and we take the reporting of them more seriously. So I wasn't surprised that at one of the academies, the reporting doubled."

He explained that in the old days, it was not unusual for someone to describe a concussion as a "ding", or to say: "He's okay, he just got his bell rung."

"We treated them maybe too casually," he said, noting that he is no longer allowed to use such slang terms that make light of the condition.

Before, if a player had a mild concussion but was cognitively functioning, he would be put back in the game, he said. Now, he would not be allowed to return to the game. There is also more awareness of the possible delayed onset of concussion. "This," he said, "is all good for sport."

The study authors and Dr. Bergfeld have disclosed no relevant financial relationships.

American Orthopaedic Society for Sports Medicine (AOSSM) 2012 Annual Meeting: Podium abstract 1. Presented July 12, 2012.


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