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Powell JW, Barber-Foss KD. Traumatic Brain Injury in High School Athletes. JAMA. 1999;282(10):958–963. doi:10.1001/jama.282.10.958
Author Affiliations: Med Sports Systems, Iowa City, Iowa. Dr Powell is now with the Department of Kinesiology, Michigan State University, Lansing.
Context The potential seriousness of mild traumatic brain injury (MTBI) is increasingly
recognized; however, information on the frequency of MTBI among high school
athletes is limited.
Objective To identify the type, frequency, and severity of MTBI in selected high
school sports activities.
Design Observational cohort study.
Setting and Participants Two hundred forty-six certified athletic trainers recorded injury and
exposure data for high school varsity athletes participating in boys' football,
wrestling, baseball and field hockey, girls' volleyball and softball, boys'
and girls' basketball, and boys' and girls' soccer at 235 US high schools
during 1 or more of the 1995-1997 academic years.
Main Outcome Measures Rates of reported MTBI, defined as a head-injured player who was removed
from participation and evaluated by an athletic trainer or physician prior
to returning to participation. National incidence figures for MTBI also were
Results Of 23,566 reported injuries in the 10 sports during the 3-year study
period, 1219 (5.5%) were MTBIs. Of the MTBIs, football accounted for 773 (63.4%)
of cases; wrestling, 128 (10.5%); girls' soccer, 76 (6.2%); boys' soccer,
69 (5.7%); girls' basketball, 63 (5.2%); boys' basketball, 51 (4.2%); softball,
25 (2.1%); baseball, 15 (1.2%); field hockey, 13 (1.1%); and volleyball, 6
(0.5%). The injury rates per 100 player-seasons were 3.66 for football, 1.58
for wrestling, 1.14 for girls' soccer, 1.04 for girls' basketball, 0.92 for
boys' soccer, 0.75 for boys' basketball, 0.46 for softball, 0.46 for field
hockey, 0.23 for baseball, and 0.14 for volleyball. The median time lost from
participation for all MTBIs was 3 days. There were 6 cases of subdural hematoma
and intracranial injury reported in football. Based on these data, an estimated
62,816 cases of MTBI occur annually among high school varsity athletes participating
in these sports, with football accounting for about 63% of cases.
Conclusions Rates of MTBI vary among sports and none of the 10 popular high school
sports we studied is without the occurrence of an MTBI. Continued involvement
of high school sports sponsors, researchers, medical professionals, coaches,
and sports participants is essential to help minimize the risk of MTBI.
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