Background and Purpose The effect of exposing the developing brain of a high school football player to subconcussive impacts over the course of a single season is unknown. The purpose of this pilot study was to utilize MRI diffusion tensor imaging to assess white matter changes over the course of a single high school football season, and to correlate these changes with impacts measured by helmet accelerometer data and neurocognitive test scores collected over the same time period. Materials and Methods Seventeen male athletes (mean age 16 ± 0.73 years) underwent MRI scanning before and after the season. Changes in fractional anisotropy across the white matter skeleton were assessed with tract-based spatial statistics and region-of-interest (ROI) analysis. Results The mean number of impacts over a 10g threshold sustained was 414 (±291). Voxel-wise analysis failed to show significant changes in FA across the season, nor a correlation with impact frequency, after correcting for multiple comparisons. ROI analysis showed significant (p<0.05, corrected) decreases in FA in the fornix – stria terminalis (FXST) and cingulum hippocampus (CGH), which were related to impact frequency. The effects were strongest in the FXST, where decreases in FA correlated with worsening visual memory. Conclusion Our findings suggest that subclinical neurotrauma related to participation in American football may result in white matter injury, and that alterations in white matter tracts within the limbic system may be detectable after only one season of play at the high school level.

academic years.Design: Descriptive epidemiology study. Setting: Convenience sample of NCAA programs in 11 sports (men's football, women's field hockey, women's volleyball, men's baseball, women's softball, men's and women's basketball, men's and women's lacrosse, and men's and women's soccer) during the 2009-2010 through 2014-2015 academic years.Patients or Other Participants: Collegiate student-athletes participating in 11 sports.Main Outcome Measure(s): Ball-contact-injury rates, proportions, rate ratios, and proportion ratios with 95% confidence intervals were based on data from the NCAA Injury Surveillance Program during the 2009-2010 through 2014-2015 academic years.Results: During the 2009-2010 through 2014-2015 academic years, 1123 ball-contact injuries were reported, for an overall rate of 3.54/10 000 AEs. The sports with the highest rates were women's softball (8.82/10 000 AEs), women's field hockey (7.71/10 000 AEs), and men's baseball (7.20/10 000 AEs). Most ball-contact injuries were to the hand/wrist (32.7%) and head/face (27.0%) and were diagnosed as contusions (30.5%), sprains (23.1%), and concussions (16.1%). Among sex-comparable sports (ie, baseball/softball, basketball, and soccer), women had a larger proportion of ball-contact injuries diagnosed as concussions than men (injury proportion ratio ¼ 2.33; 95% confidence interval ¼ 1.63, 3.33). More than half (51.0%) of ball-contact injuries were non-time loss (ie, participation-restriction time ,24 hours), and 6.6% were severe (ie, participation-restriction time !21 days). The most common severe ball-contact injuries were concussions (n ¼ 18) and finger fractures (n ¼ 10).Conclusion: Ball-contact-injury rates were the highest in women's softball, women's field hockey, and men's baseball. Although more than half were non-time-loss injuries, severe injuries such as concussions and fractures were reported.

Chest compression and ventilation delivery are compromised in equipment-intense conditions when compared to conditions whereby equipment was mostly or entirely removed. Emergency medical personnel should remove the helmet and shoulder pads from all football athletes who require cardiopulmonary resuscitation, while maintaining appropriate cervical spine stabilization when injury is suspected. Further research is needed to confirm our findings supporting full equipment removal for chest compression and ventilation delivery.

This study describes concussions and concussion-related outcomes sustained by high school soccer players by head impact location, sex, and injury mechanism. Data were obtained for the 2012/13-2015/16 school years from the National High School Sports-Related Injury Surveillance System, High School RIO™. This Internet-based sports injury surveillance system captures data reported by athletic trainers from an annual average of 162 US high schools. Data were analyzed to describe circumstances of soccer concussion (e.g., symptomology, symptom resolution and return-to-play time) by impact location [i.e., front- (face included), back-, side-, and top-of-the-head] and sex. Most concussions were from front-of-the-head impacts (boys: 30.5%; girls: 34.0%). Overall, 4.1±2.2 and 4.6±2.3 symptoms were reported in boys and girls, respectively. In boys, symptom frequency was not associated with head impact location (P=0.66); an association was found in girls (p=0.02), with the highest symptom frequency reported in top-of-the-head impacts (5.4±2.2). Head impact location was not associated with symptom resolution time (boys P=0.21; girls P=0.19) or return-to-play time (boys P=0.18; girls P=0.07). Heading was associated with 28.0% and 26.5% of concussions in boys and girls, respectively. Most player-player contact concussions during heading occurred from side-of-the-head impacts (boys: 49.4%; girls: 43.2%); most heading-related ball contact concussions occurred from front-of-the-head (boys: 41.4%; girls: 42.6%) and top-of-the-head (boys: 34.5%; girls: 36.9%) impacts. Head impact location was generally independent of symptom resolution time, return-to-play time, and recurrence among high school soccer concussions. However, impact location may be associated with reported symptom frequency. Further, many of these clinical concussion descriptors were associated with sex.

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