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TABLE 1

Summary of Studies Describing Incidence of Injuries in American Football

StudyPopulationDefinition of InjuryMethodsResults
Shankar et al 200718  High school (and college) football players from 100 high schools Occurred during organized practice or game Prospective cohort study Overall injury incidence 4.4/1000 AEs (higher rate observed for college players; 8.6/1000 AEs) 
  Required medical attention from athletic trainer or team physician Injuries reported by athletic trainers Game time incidence higher than practice (12.0 vs 2.6/1000 AEs) 
  Resulted in ≥1 d of restriction beyond day of injury   
Badgeley et al 201317  High school football players from 100 high schools Occurred during organized practice or game Prospective cohort study Overall injury incidence 4.08/1000 AEs 
  Required medical attention from athletic trainer or team physician Injuries reported by athletic trainers Game time incidence higher than practice (12.61 vs 2.35/1000AEs) 
  Resulted in ≥1 d of restriction beyond day of injury   
  Included all fractures, concussions, and dental injuries   
Knowles et al 2006114  High school athletes from 100 high schools Resulted from participation in high school sport Prospective cohort study Overall injury incidence rate of 2.08/1000 AEs 
  Limited full participation day following injury or required medical attention Injuries reported by athletic trainers or athletic directors Football had the highest incidence of injury 
  Included all concussions, fractures, and eye injuries   
Turbeville et al 200314  Middle school football players, grades 6–8, aged 10-15 y, N = 646 Resulted in a player missing ≥1 practices/games Prospective cohort study Game time incidence of overall injuries higher than practice (8.84 vs 0.97/1000 AEs) 
  Included all head injuries resulting in alteration of consciousness requiring the player to leave practice/game Football coach or athletic trainer reported injuries Head was site of injury for 2% of all injuries 
    Neck/spine was site of injury for 3% of all injuries 
    Concussion accounted for 12.5% of all injuries 
Dompier et al 200715  Youth football players aged 9–14 y; N = 779 Non–time-loss injuries did not require removal from participation Prospective cohort study Overall injury incidence of 17.8/1000 AEs 
  Time-loss injuries required removal from session or subsequent session Athletic trainers present for practices and games, reported injuries Time-loss injury only incidence 7.4/1000 AEs 
  Included all fractures, dental injuries, concussions, and injuries requiring referral  Injury rate increased with grade in school (4.3/1000 AEs for fourth/fifth graders, 14.4/1000 AEs for eighth graders) 
    Neck and head were sites of injury for 4.6% and 6.5% of injuries, respectively) 
Malina et al 200622  Youth football players Caused cessation of participation and prevented return to that session Prospective cohort study Overall injury incidence 10.4/1000 AEs 
 Aged 9–14 y; N = 678 Included all fractures, dental injuries, and concussions Athletic trainers reported injuries No significant association between incidence of injury and height, weight, BMI, or estimated maturity status 
    Incidence of injury increased with grade in school 
Stuart et al 200213  Youth football players, aged 9–13 y; N = 915 Occurred during a game, kept the player out for remainder of game, and required attention of a physician Injuries reported by orthopedist in medical tent adjacent to the playing field Game time incidence 8.47/1000 AEs (only assessed game time AEs) 
  Included all concussions, dental injuries, eye injuries, and nerve injuries  Older players in the higher grades more susceptible to injuries 
    Running backs at highest risk 
Radelet et al 200221  Youth athletes in several sports, aged 7–13 y; N = 1659 Brought coach on the field to check condition of a player, required removal from play, or required first aid Coaches kept records, contacted weekly by researchers Overall injury incidence in football was 15/1000 AEs 
    Overall injury incidence comparable to baseball and boys’ soccer, but lower than girls’ soccer 
    Authors note, however, the reporting of injuries may have differed by sport, possibly underreported in football 
    8- to 10-y-old players injured more frequently than 5- to 7-y-old and 11- to 13-y-old players 
Kontos et al 201323  Youth football players aged 8–12 y, N = 468 Concussion defined as any mild closed head injury involving altered cognitive functioning or signs or symptoms or brief loss of consciousness after a blow to the head Prospective cohort study Concussion incidence was 1.8/1000 AEs 
   Coaches referred suspected concussions to medical professional for diagnosis Game time incidence higher than practices (6.2 vs 0.24/1000 AEs) 
    Concussion incidence rate lower for the 8- to 10-y-old players than 11- to 12-y-old players (0.93 vs 2.53/1000 AEs) 
Linder et al 199524  High school football players, aged 11–15 y; N = 340 “Any sports-related mishap” occurring during practice or games, resulting in removal from practice or game and/or missing subsequent practice or game Injuries recorded by coaches; data collected weekly by authors 16% of participants were injured 
    Proportion of participants injured increased with Tanner stage 
StudyPopulationDefinition of InjuryMethodsResults
Shankar et al 200718  High school (and college) football players from 100 high schools Occurred during organized practice or game Prospective cohort study Overall injury incidence 4.4/1000 AEs (higher rate observed for college players; 8.6/1000 AEs) 
  Required medical attention from athletic trainer or team physician Injuries reported by athletic trainers Game time incidence higher than practice (12.0 vs 2.6/1000 AEs) 
  Resulted in ≥1 d of restriction beyond day of injury   
Badgeley et al 201317  High school football players from 100 high schools Occurred during organized practice or game Prospective cohort study Overall injury incidence 4.08/1000 AEs 
  Required medical attention from athletic trainer or team physician Injuries reported by athletic trainers Game time incidence higher than practice (12.61 vs 2.35/1000AEs) 
  Resulted in ≥1 d of restriction beyond day of injury   
  Included all fractures, concussions, and dental injuries   
Knowles et al 2006114  High school athletes from 100 high schools Resulted from participation in high school sport Prospective cohort study Overall injury incidence rate of 2.08/1000 AEs 
  Limited full participation day following injury or required medical attention Injuries reported by athletic trainers or athletic directors Football had the highest incidence of injury 
  Included all concussions, fractures, and eye injuries   
Turbeville et al 200314  Middle school football players, grades 6–8, aged 10-15 y, N = 646 Resulted in a player missing ≥1 practices/games Prospective cohort study Game time incidence of overall injuries higher than practice (8.84 vs 0.97/1000 AEs) 
  Included all head injuries resulting in alteration of consciousness requiring the player to leave practice/game Football coach or athletic trainer reported injuries Head was site of injury for 2% of all injuries 
    Neck/spine was site of injury for 3% of all injuries 
    Concussion accounted for 12.5% of all injuries 
Dompier et al 200715  Youth football players aged 9–14 y; N = 779 Non–time-loss injuries did not require removal from participation Prospective cohort study Overall injury incidence of 17.8/1000 AEs 
  Time-loss injuries required removal from session or subsequent session Athletic trainers present for practices and games, reported injuries Time-loss injury only incidence 7.4/1000 AEs 
  Included all fractures, dental injuries, concussions, and injuries requiring referral  Injury rate increased with grade in school (4.3/1000 AEs for fourth/fifth graders, 14.4/1000 AEs for eighth graders) 
    Neck and head were sites of injury for 4.6% and 6.5% of injuries, respectively) 
Malina et al 200622  Youth football players Caused cessation of participation and prevented return to that session Prospective cohort study Overall injury incidence 10.4/1000 AEs 
 Aged 9–14 y; N = 678 Included all fractures, dental injuries, and concussions Athletic trainers reported injuries No significant association between incidence of injury and height, weight, BMI, or estimated maturity status 
    Incidence of injury increased with grade in school 
Stuart et al 200213  Youth football players, aged 9–13 y; N = 915 Occurred during a game, kept the player out for remainder of game, and required attention of a physician Injuries reported by orthopedist in medical tent adjacent to the playing field Game time incidence 8.47/1000 AEs (only assessed game time AEs) 
  Included all concussions, dental injuries, eye injuries, and nerve injuries  Older players in the higher grades more susceptible to injuries 
    Running backs at highest risk 
Radelet et al 200221  Youth athletes in several sports, aged 7–13 y; N = 1659 Brought coach on the field to check condition of a player, required removal from play, or required first aid Coaches kept records, contacted weekly by researchers Overall injury incidence in football was 15/1000 AEs 
    Overall injury incidence comparable to baseball and boys’ soccer, but lower than girls’ soccer 
    Authors note, however, the reporting of injuries may have differed by sport, possibly underreported in football 
    8- to 10-y-old players injured more frequently than 5- to 7-y-old and 11- to 13-y-old players 
Kontos et al 201323  Youth football players aged 8–12 y, N = 468 Concussion defined as any mild closed head injury involving altered cognitive functioning or signs or symptoms or brief loss of consciousness after a blow to the head Prospective cohort study Concussion incidence was 1.8/1000 AEs 
   Coaches referred suspected concussions to medical professional for diagnosis Game time incidence higher than practices (6.2 vs 0.24/1000 AEs) 
    Concussion incidence rate lower for the 8- to 10-y-old players than 11- to 12-y-old players (0.93 vs 2.53/1000 AEs) 
Linder et al 199524  High school football players, aged 11–15 y; N = 340 “Any sports-related mishap” occurring during practice or games, resulting in removal from practice or game and/or missing subsequent practice or game Injuries recorded by coaches; data collected weekly by authors 16% of participants were injured 
    Proportion of participants injured increased with Tanner stage 
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