Youth Football Injuries: A Prospective Cohort

Abstract

Background:There are approximately 2.8 million youth football players between the ages of 7 and 14 years in the United States. Rates of injury in this population are poorly described. Recent studies have reported injury rates between 2.3% and 30.4% per season and between 8.5 and 43 per 1000 exposures.Hypothesis:Youth flag football has a lower injury rate than youth tackle football. The concussion rates in flag football are lower than in tackle football.Study Design:Cohort study; Level of evidence, 3.Methods:Three large youth (grades 2-7) football leagues with a total of 3794 players were enrolled. Research personnel partnered with the leagues to provide electronic attendance and injury reporting systems. Researchers had access to deidentified player data and injury information. Injury rates for both the tackle and flag leagues were calculated and compared using Poisson regression with a log link. The probability an injury was severe and an injury resulted in a concussion were modeled using logistic regression. For these 2 responses, best subset model selection was performed, and the model with the minimum Akaike information criterion value was chosen as best. Kaplan-Meier curves were examined to compare time loss due to injury for various subgroups of the population. Finally, time loss was modeled using Cox proportional hazards regression models.Results:A total of 46,416 exposures and 128 injuries were reported. The mean age at injury was 10.64 years. The hazard ratio for tackle football (compared with flag football) was 0.45 (95% CI, 0.25-0.80; P = .0065). The rate of severe injuries per exposure for tackle football was 1.1 (95% CI, 0.33-3.4; P = .93) times that of the flag league. The rate for concussions in tackle football per exposure was 0.51 (95% CI, 0.16-1.7; P = .27) times that of the flag league.Conclusion:Injury is more likely to occur in youth flag football than in youth tackle football. Severe injuries and concussions were not significantly different between leagues. Concussion was more likely to occur during games than during practice. Players in the sixth or seventh grade were more likely to suffer a concussion than were younger players.

Concussion Incidence, Duration, and Return to School and Sport in 5- to 14-Year-Old American Football Athletes

“…We report a higher incidence of concussion in this youth football sample (5.1%); the reported rate in prior studies ranged from 0.9% 12,14 to 4.4%. 13 These differences seem to be explained by data collection methods.…”

“…Peterson et al relied on team managers to provide injury reports, resulting in a very low reported concussion incidence of 0.9% per season. 14 Dompier et al analyzed data from the Youth Football Surveillance System, which used athletic trainer report, and they described concussion rates for 5-to 14-year old youth of 3.1%-3.5% annually. 12 Kontos et al collected data on 8-to 12-yearold youth using research coordinators present at games and coach contact weekly, and reported concussion rates more similar to ours (4.4%).…”

Defining Exposures in Professional Football: Professional American-Style Football Players as an Occupational Cohort

“…59 Examples of substitution or elimination controls in professional football could include replacing tackle football with the less injurious flag football. 26,62…”

Quantitative and qualitative analysis of head and body impacts in American 7v7 non-tackle football

“…At site 2, we observed two definitive injuries (clavicle fracture and a lower limb injury) and two instances where a player struck their head (one H2G, one H2B) and appeared shaken but returned to play on the next set. The lack of H2H contacts and the relatively low-peak impact severities (ΔV R ) would suggest that non-tackle football incurs a lower risk of head injury compared with other contact sports, confirming prior epidemiological studies 3 6 8. However, future work should incorporate systematic medical reporting to identify the risk of head injury and the associated injurious head biomechanics.…”

“…Head and face injuries in adult non-tackle football have been reported to account for 12%–55% of injuries 2–6. Concussion rates range from 2% to 23% of all injuries,2 3 6–8 with an incidence rate of 1.78 concussions per 1000 athlete exposures (AE, defined as one athlete participating in one game) 3. Peterson et al 8 determined that youth flag football players experienced a concussion incidence of 1.33 per 1000 AEs, which was more than tackle football players in the same study, similar to rates reported for youth tackle players elsewhere9–12 and less than youth rugby athletes 13–17.…”