Abstract
Current methods used to estimate concussion risk in American football generally do not account for within-season variation in exposure between individual players. Thus, utilizing individual snap count data to quantify exposure may be beneficial for epidemiologic studies evaluating concussion risk in football. PURPOSE: To determine the association between football exposure, quantified using snap count data, and concussion within the regular season in the National Football League (NFL), and how this varies by playing position. METHODS: Weekly snap count and injury report data were obtained for every player who participated in the 2012 through 2017 NFL regular seasons, using the Football Outsiders database. Exposure was quantified as the cumulative total number of snaps that a player participated in for a given season, and used as the time-dependent variable in a Cox proportional hazard model. Concussion status (concussed vs. not-concussed) served as the event variable. If an individual received multiple concussions within a season, only the first within a season was included in the model. The effect of playing position on time to concussion were independently assessed as a categorical covariate. Hazard ratios (HR) were computed, with special teams positions (kicker, punter, and long snapper) as the reference category. RESULTS: A total 5,289,149 player-snaps were analyzed from of 4231 distinct players, representing 12,004 player-seasons. Position was significantly associated with concussion hazard (p<0.001), with defensive backs [HR (95% confidence interval); median (interquartile range) number of snaps to first concussion = 2.8 (1.2, 6.3); 324 (377)], running backs [3.0 (1.3, 6.9); 200 (225)], tight ends [3.5 (1.5, 8.2); 290 (334)], and wide receivers [2.7 (1.2, 6.1); 227 (251)] having significantly greater hazard than special teams players. Across positions, the median number snaps before first concussion was 295 (355). CONCLUSIONS: Survival analysis using snap count to quantify football exposure provides similar results to other epidemiological studies regarding which positions are at greatest risk of concussion. Future research should examine whether using this metric of exposure provides any additional insight into other potential risk factors for concussion or concussion-related outcomes.
Published Version
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