Although the collision sports of football and boys' lacrosse had the highest number of concussions and football the highest concussion rate, concussion occurred in all other sports and was observed in girls' sports at rates similar to or higher than those of boys' sports. The increase over time in all sports may reflect actual increased occurrence or greater coding sensitivity with widely disseminated guidance on concussion detection and treatment. The high-participation collision sports of football and boys' lacrosse warrant continued vigilance, but the findings suggest that focus on concussion detection, treatment, and prevention should not be limited to those sports traditionally associated with concussion risk.
ONCERN EXISTS ABOUT THE cardiovascular health implications of large size among professional football players and those players who aspire to professional status. An estimated 4.3 million youth ages 6 to 17 years participated in football in 2000 in the United States, including tackle, touch, and flag football. 1 A 2005-2006 high school participation survey estimated that 1.1 million students participated in US football in that year, 2 and participation levels continue to increase. 3 Approximately 14% of male students in grades 9 through 12 in the United States participate in football. 1 Studies have suggested that fitness may provide protection against the health risks of obesity, 4 although other studies have found that physical activity is beneficial but does not eliminate these risks. 5 This issue is of interest in large, active athletes. A significant increase in body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) for offensive and defensive linemen has been noted during the past 30 years, 6 and BMI fitting the category of class II obesity was reported in more than a quarter of National Football League (NFL) players in 2003. 7 In See also Patient Page.
Consistent with an earlier NFL cohort and other elite athlete populations, the overall and cardiovascular mortality risk of this NFL cohort was significantly lower than that of the general US male population, likely attributable to a healthy worker effect and less smoking.However, players with the highest playing-time BMI exhibited elevated cardiovascular mortality risk.
Player-to-player contact was the mechanism for all concussions. Most commonly, injured players were unaware of the pending contact, and the striking player used his head to initiate contact. Further investigation of preventive measures such as education of coaches and officials and enforcement of rules designed to prevent intentional head-to-head contact is warranted to reduce the incidence of concussions in boys' lacrosse.
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