Abstract
Recent research has suggested possible long term effects due to repetitive concussions, highlighting the importance of developing methods to accurately quantify concussion risk. This study introduces a new injury metric, the combined probability of concussion, which computes the overall risk of concussion based on the peak linear and rotational accelerations experienced by the head during impact. The combined probability of concussion is unique in that it determines the likelihood of sustaining a concussion for a given impact, regardless of whether the injury would be reported or not. The risk curve was derived from data collected from instrumented football players (63,011 impacts including 37 concussions), which was adjusted to account for the underreporting of concussion. The predictive capability of this new metric is compared to that of single biomechanical parameters. The capabilities of these parameters to accurately predict concussion incidence were evaluated using two separate datasets: the Head Impact Telemetry System (HITS) data and National Football League (NFL) data collected from impact reconstructions using dummies (58 impacts including 25 concussions). Receiver operating characteristic curves were generated, and all parameters were significantly better at predicting injury than random guessing. The combined probability of concussion had the greatest area under the curve for all datasets. In the HITS dataset, the combined probability of concussion and linear acceleration were significantly better predictors of concussion than rotational acceleration alone, but not different from each other. In the NFL dataset, there were no significant differences between parameters. The combined probability of concussion is a valuable method to assess concussion risk in a laboratory setting for evaluating product safety.
Highlights
With as many as 3.8 million sports-related concussions occurring annually in the United States and research suggesting possible long term neurodegenerative processes resulting from repetitive concussions, reducing the incidence of concussion in sports has become a public health priority.[32,42,43] While limiting the number of head impacts in sports through rule changes and improved education for coaches and players have an important role in reducing concussion incidence, incidental head impacts cannot be removed from sports.[10]
For the Head Impact Telemetry System (HITS) dataset, the area under its ROC curve (AUC) associated with the combined probability of concussion and linear acceleration were significantly different than the AUC associated with rotational acceleration (p < 0.015)
For the top 50% of HITS data, the AUCs associated with the combined probability of concussion and linear acceleration were significantly different than the AUC associated with rotational acceleration (p < 0.0076)
Summary
With as many as 3.8 million sports-related concussions occurring annually in the United States and research suggesting possible long term neurodegenerative processes resulting from repetitive concussions, reducing the incidence of concussion in sports has become a public health priority.[32,42,43] While limiting the number of head impacts in sports through rule changes and improved education for coaches and players have an important role in reducing concussion incidence, incidental head impacts cannot be removed from sports.[10] It has been suggested that the monitoring of head impacts to identify high risk events and alert medical personnel to perform a concussion evaluation may reduce the incidence and severity of concussions by preventing subsequent impacts that may cause brain injury due to impact.[21] Part of the remaining burden of reducing concussion incidence relies on the improvement of head protection. This article focuses on the kinematic parameters used to predict brain injury
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