Repeated concussion is associated with reliable decrements in cognitive performance--even after a three month window for recent recovery.

Background:Lacrosse and ice hockey are quickly growing in popularity, while football remains the most popular sport among high school student-athletes. Injuries remain a concern, given the physical nature of these contact sports.Purpose:To describe the rates and patterns of injuries sustained as a result of intentional player contact in United States high school boys’ football, ice hockey, and lacrosse.Study Design:Descriptive epidemiology study.Methods:We conducted a secondary analysis of High School RIO (Reporting Information Online) data, including exposure and injury data collected from a large sample of high schools in the United States from 2005-2006 through 2015-2016. Data were analyzed to calculate rates, assess patterns, and evaluate potential risk factors for player-to-player contact injuries.Results:A total of 34,532 injuries in boys’ football, ice hockey, and lacrosse occurred during 9,078,902 athlete-exposures (AEs), for a rate of 3.80 injuries per 1000 AEs in the 3 contact sports of interest. The risk of injuries was found to be greater in competition compared with practice for all 3 sports, with the largest difference in ice hockey (rate ratio, 8.28) and the smallest difference in lacrosse (rate ratio, 3.72). In all 3 contact sports, the most commonly injured body site in competition and practice caused by both tackling/checking and being tackled/checked was the head/face. However, a significantly greater proportion of concussions sustained in football were the result of tackling compared with being tackled (28.2% vs 24.1%, respectively). In addition, a significantly greater proportion of concussions were sustained in competition compared with practice for all 3 sports.Conclusion:This study is the first to collectively compare injury rates and injury patterns sustained from intentional player-to-player contact in boys’ high school football, ice hockey, and lacrosse. Notably, there was a relatively high risk of injuries and concussions during football practices.

Objectives:Lacrosse and ice hockey are fast growing youth sports in the United States. Football remains the most popular and is the leading cause of sports-related injuries among high school students. Injuries remain a concern given the physical nature of these three contact sports. The objective of this study was to compare the rates and patterns of injury in boys’ football, ice hockey, and lacrosse.Methods:We conducted a secondary analysis of High School RIO (Reporting Information Online) data including exposure and injury data collected from a large sample of high schools in the United States from 2005/2006-2015/2016. In High School RIO, athletic trainers submitted exposure and injury information weekly. In this study data was analyzed to calculate rates, assess patterns, and evaluate potential risk factors for player-player contact injuries.Results:A total of 34,532 injuries in boys’ football, ice hockey, and lacrosse occurred during 9,078,902 exposures for a rate of 3.80 injuries per 1,000 AE in the three contact sports of interest. The rate of injury was found to be higher in competition compared to practice for all three sports, with the largest difference in ice hockey (RR = 8.28; 95% CI = 7.74-8.86). In football, 46.6% of injuries were due to tackling or being tackled, 41.1% of injuries in ice hockey and 15.3% of injuries in lacrosse were due to checking or being checked. In football and lacrosse, a greater percentage of injuries were due to being tackled or checked, respectively. Similarly, in ice hockey, a greater percentage of injuries occurred due to being checked compared to checking, but surprisingly the proportion was much higher (81.6% vs 18.4%). In addition, a smaller proportion of hockey athletes injured while being checked were able to return to play in less than a week compared with both being tackled in football (IPR = 0.41) and being checked in lacrosse (IPR = 0.47). A significantly greater proportion of concussions sustained in football were the result of tackling compared to being tackled (28.3% vs 24.8%; IPR = 1.17; 95% CI = 1.11-1.24). Conversely, in ice hockey, a greater proportion of concussions were sustained while being checked compared to checking (33.8% vs. 20.5%; IPR = 1.65; 95% CI = 1.04-2.61). There was a significantly higher concussion rate in competition compared to practice for all three sports with no concussions sustained in ice hockey practice due to checking.Conclusion:While all three sports studied were similar in regards to a higher injury rate associated with being on the receiving end of intentional contact (being tackled or checked), the proportion was much higher in ice hockey and the injured ice hockey players were less likely to return to play in less than one week. Also of note, concussions were sustained equally while tackling and being tackled, however in ice hockey, no concussions were sustained while checking opposing players during practice. Future studies are needed to further investigate these patterns in high school contact athletes, with particular emph...