TABLE 1

Summary of Studies Describing Incidence of Injuries in American Football

StudyPopulationDefinition of InjuryMethodsResults
Shankar et al 200718High school (and college) football players from 100 high schoolsOccurred during organized practice or gameProspective cohort studyOverall injury incidence 4.4/1000 AEs (higher rate observed for college players; 8.6/1000 AEs)
Required medical attention from athletic trainer or team physicianInjuries reported by athletic trainersGame 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 201317High school football players from 100 high schoolsOccurred during organized practice or gameProspective cohort studyOverall injury incidence 4.08/1000 AEs
Required medical attention from athletic trainer or team physicianInjuries reported by athletic trainersGame 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 2006114High school athletes from 100 high schoolsResulted from participation in high school sportProspective cohort studyOverall injury incidence rate of 2.08/1000 AEs
Limited full participation day following injury or required medical attentionInjuries reported by athletic trainers or athletic directorsFootball had the highest incidence of injury
Included all concussions, fractures, and eye injuries
Turbeville et al 200314Middle school football players, grades 6–8, aged 10-15 y, N = 646Resulted in a player missing ≥1 practices/gamesProspective cohort studyGame 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/gameFootball coach or athletic trainer reported injuriesHead 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 200715Youth football players aged 9–14 y; N = 779Non–time-loss injuries did not require removal from participationProspective cohort studyOverall injury incidence of 17.8/1000 AEs
Time-loss injuries required removal from session or subsequent sessionAthletic trainers present for practices and games, reported injuriesTime-loss injury only incidence 7.4/1000 AEs
Included all fractures, dental injuries, concussions, and injuries requiring referralInjury 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 200622Youth football playersCaused cessation of participation and prevented return to that sessionProspective cohort studyOverall injury incidence 10.4/1000 AEs
Aged 9–14 y; N = 678Included all fractures, dental injuries, and concussionsAthletic trainers reported injuriesNo 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 200213Youth football players, aged 9–13 y; N = 915Occurred during a game, kept the player out for remainder of game, and required attention of a physicianInjuries reported by orthopedist in medical tent adjacent to the playing fieldGame time incidence 8.47/1000 AEs (only assessed game time AEs)
Included all concussions, dental injuries, eye injuries, and nerve injuriesOlder players in the higher grades more susceptible to injuries
Running backs at highest risk
Radelet et al 200221Youth athletes in several sports, aged 7–13 y; N = 1659Brought coach on the field to check condition of a player, required removal from play, or required first aidCoaches kept records, contacted weekly by researchersOverall 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 201323Youth football players aged 8–12 y, N = 468Concussion 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 headProspective cohort studyConcussion incidence was 1.8/1000 AEs
Coaches referred suspected concussions to medical professional for diagnosisGame 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 199524High 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 gameInjuries recorded by coaches; data collected weekly by authors16% of participants were injured
Proportion of participants injured increased with Tanner stage