High School Football Research Articles

Sequential Vertical Shear Fractures of the Medial Malleolus in a High School Football Player: A Case Report and Literature Review

We report a case of bilateral vertical shear (pilon variant) medial malleolar fractures in a high school football player that occurred 1 year apart. The player was able to return to his sport after surgical fixation. Treatment of ankle fractures sustained in the athletic setting is dictated by the fracture location and morphology with vertical shear injuries of the medial malleolus commonly requiring surgical plate stabilization. Appropriate knowledge of risk factors and optimal management of these injuries is imperative, given that delayed union or nonunion may result in debilitating consequences for young athletes with extensive time away from sports participation.

Heat Policy Revision for Georgia High School Football Practices Based on Data-Driven Research.

Interscholastic heat policies for football have not been evidence based. Therefore, their effectiveness in mitigating exertional heat illness has not been assessed. To discuss the development of the Georgia High School Association heat policy and assess the effectiveness of revised guidelines. Descriptive epidemiology study. Georgia high schools. Interscholastic football players in grades 9 through 12. Heat syncope and heat exhaustion (HS/HE) illness rates (IRs) were calculated per 1000 athlete-exposures (AEs), and relative risk (RR) was calculated as a ratio of postpolicy (POST) IR divided by prepolicy (PRE) IR. A total of 214 HS/HE cases (172 PRE, 42 POST) and 341 348 AEs (178 230 PRE, 163 118 POST) were identified. During the first 5 days of the PRE period, approximately 50% of HS/HE illnesses occurred; HS/HE IRs doubled when practice sessions increased from 2 to 2.5 hours and tripled for practices ≥3 hours. The HS/HE IRs in the PRE period increased from 0.44/1000 AEs for wet-bulb globe temperatures (WBGTs) of <82°F (<27.8°C) to >2.0/1000 AEs for WBGTs from 87°F (30.6°C) to 89.9°F (32.2°C). The RRs comparing PRE and POST policy periods were 0.29 for WBGTs of <82.0°F (<27.80°C), 0.65 for WBGTs from 82.0°F (27.8°C) to 86.9°F (30.5°C), and 0.23 for WBGTs from 87.0°F (30.6°C) to 89.9°F (32.2°C). No HS/HE illnesses occurred in the POST period for WBGTs at >90°F (>32.3°C). Results from the PRE period guided the Georgia High School Association to revise its heat and humidity policy to include a mandated 5-day acclimatization period when no practices may exceed 2 hours and the use of WBGT-based activity-modification categories. The new policy reduced HS/HE IRs by 35% to 100%, depending on the WBGT category. Our results may be generalizable to other states with hot and humid climates similar to that of Georgia.

Editors' note: Acute elevation of serum inflammatory markers predicts symptom recovery after concussion

In the article “Acute elevation of serum inflammatory markers predicts symptom recovery after concussion,” Drs. Nitta et al. studied serum inflammatory markers in 41 high school and collegiate football players with sports-related concussion (SRC) and 43 matched control athletes, and they collected symptom severity scores at a preinjury baseline and at several time points up to 45 days postconcussion. They found that interleukin-6 (IL-6) and IL-1RA were significantly elevated in SRC at 6 hours vs preinjury and other postinjury visits. These inflammatory markers discriminated concussed from control athletes at that time point, with IL-6 levels at 6 hours also being significantly associated with symptom duration. In response, Dr. Sethi asks whether the levels of serum inflammatory markers correlated with the severity of the concussion and whether the normalization of such markers correlated with symptom resolution. He notes that an ideal SRC marker would not only accurately identify a concussed athlete but also help guide return-to-play decisions. Responding to these comments, Drs. Meier and Nitta note that no concussed athletes reported loss of consciousness in their sample and only 2 reported posttraumatic amnesia; therefore, they could not relate the markers to such gradations of severity. They indicate that levels of IL-1RA and IL-6 returned to baseline levels by the 24–48 hours visit despite symptom severity scores remaining elevated and thus appeared to show prognostic promise only when collected within 6 hours postinjury. This discussion highlights enduring challenges in the search for clinically relevant biomarkers for SRC, and it is likely that a panel of markers will be needed to make various predictions following SRC. In the article “Acute elevation of serum inflammatory markers predicts symptom recovery after concussion,” Drs. Nitta et al. studied serum inflammatory markers in 41 high school and collegiate football players with sports-related concussion (SRC) and 43 matched control athletes, and they collected symptom severity scores at a preinjury baseline and at several time points up to 45 days postconcussion. They found that interleukin-6 (IL-6) and IL-1RA were significantly elevated in SRC at 6 hours vs preinjury and other postinjury visits. These inflammatory markers discriminated concussed from control athletes at that time point, with IL-6 levels at 6 hours also being significantly associated with symptom duration. In response, Dr. Sethi asks whether the levels of serum inflammatory markers correlated with the severity of the concussion and whether the normalization of such markers correlated with symptom resolution. He notes that an ideal SRC marker would not only accurately identify a concussed athlete but also help guide return-to-play decisions. Responding to these comments, Drs. Meier and Nitta note that no concussed athletes reported loss of consciousness in their sample and only 2 reported posttraumatic amnesia; therefore, they could not relate the markers to such gradations of severity. They indicate that levels of IL-1RA and IL-6 returned to baseline levels by the 24–48 hours visit despite symptom severity scores remaining elevated and thus appeared to show prognostic promise only when collected within 6 hours postinjury. This discussion highlights enduring challenges in the search for clinically relevant biomarkers for SRC, and it is likely that a panel of markers will be needed to make various predictions following SRC.

Promoting quality education by addressing ethical challenges in high school football at circuit level in Durban, South Africa

Promoting quality education by addressing ethical challenges in high school football at circuit level in Durban, South Africa

Contribution Leg Muscle Strength, Dynamic Balance and Hip Joint Flexibility to the Accuracy of Football Shooting

The purpose of this study was to determine the meaning of the contribution of each independent variable (leg muscle strength, dynamic balance and hip joint flexibility) to the accuracy of football shooting and to find out how meaningful the contribution of the independent variables together to the accuracy of football shooting. This study uses a quantitative descriptive correlational approach with regression analysis design. The sample was extracurricular high school football students in Sidareja with a total of 65 from a total population of 65. Data analysis techniques used regression analysis with the help of SPSS 20. The results of the analysis showed that: (1) X1 made a significant contribution to Y. (2) X2 made a contribution which is significant to Y. (3) X3 gives a significant contribution to Y. (4) X4 gives a significant contribution to Y. In this study it can be concluded that the leg muscle strength variable contributed 22.96%, the variable of diamonic balance is 24 , 28%, the hip joint flexibility variable was 41.26%, while all the independent variables contributed 96.5% to the accuracy of football shooting.

Acute Subdural Hematoma in a High School Football Player Requiring Emergent Decompressive Craniectomy

The purpose of this report is to present the case of a high school football player who sustained an injury during a game, resulting in an acute subdural hematoma (SDH). The patient underwent an emergent decompressive craniectomy. The uniqueness of the case is due to both rare pathology and treatment. The athlete had a positive outcome due to prompt on-field assessment and advanced surgical treatments. Athletic trainers should know how to recognize symptoms of emergent traumatic brain injuries and be prepared to implement an emergency action plan when necessary.

INTRAPERSONAL FACTORS AFFECTING CONCUSSION REPORTING BEHAVIORS ACCORDING TO THE THEORY OF PLANNED BEHAVIOR IN HIGH SCHOOL FOOTBALL PLAYERS

The diagnosis of a sports-related concussion (SRC) relies heavily on self-report from the athlete; therefore, the true percentage of those sustaining an SRC is not readily known. Concussed athletes are at higher risk for permanent or more catastrophic injury, especially without a diagnosis. Limited research has been done to determine the factors associated with concussion reporting behaviors in high school athletes. To determine the intrapersonal factors affecting concussion reporting behavior in high school athletes based on the Theory of Planned Behavior (TPB). Cross-sectional design. A convenience sample of 40 high school football players (age: 15.6 ± 1.0 years) who played during the fall 2017 season and had not been diagnosed with a sports-related concussion two weeks prior to data collection completed a previously validated questionnaire. Of these, 58% were underclassmen and 65% were skill players. An ordinal regression was used to analyze the association between the intention to report and four variables (attitudes of reporting, reporting self-efficacy, symptoms and behavior, subjective norms, and concussion knowledge). Before data collection, it was hypothesized that these factors could be used to form a model to determine the athletes' intention to report, which can then be related to their reporting behavior. Self-efficacy was the only TPB variable significantly associated with reporting intention. Reporting self-efficacy was significantly associated with intention to report, where participants with a high self-efficacy score were 3.15 times more likely to report an SRC than those with a lower score. Freshmen athletes had higher reporting intentions than juniors, and participants that identified as 'white' had higher intentions than those who identified as 'other'. Concussion knowledge, subjective norms, attitudes of reporting, and symptoms and behavior were not significantly associated with intention to report. 2b, retrospective cohort study.

Worst to First: Turnaround Leadership Through the Lens of Successful High School Football Coaches

Turnaround leadership is a topic of particular interest within sports, as newly hired coaches are often expected to transform struggling teams into “winners.” The present study qualitatively examined American high school football coaches (N = 11) who led a dramatic turnaround within their school’s football program. After being hired, these participants experienced relatively quick success, as they achieved a winning record (M = 1.73 years) and reached the state playoffs within a short period of time (M = 1.82 years). Steps of the turnaround process included assembling a staff of quality assistants, creating a vision for program success, formulating a strong plan that supported the vision, generating buy-in from players and key members of the program, creating and celebrating early achievements, sustaining success through the establishment of new goals and benchmarks, and fighting the urge to become complacent once new levels of success were reached (i.e., making change stick). As a part of their coaching turnarounds, all of the participants talked about the importance of incorporating a quality strength and conditioning program into their team’s training regimen. Meanwhile, the majority of the participants identified “educational athletics” as the core of their coaching philosophy, in which they viewed their jobs as coaches as an extension of the classroom. Moreover, most participants implemented character education into their programs and used football as a platform for teaching life lessons to their players. Yet, the most recurrent theme of the process, and the most recommended approach for achieving a coaching turnaround, was establishing positive coach–athlete relationships.

Head Impact Telemetry System's Video-based Impact Detection and Location Accuracy.

This study aimed to quantify the Head Impact Telemetry (HIT) System's impact detection and location measurement accuracy using an impact biomechanics data set paired with video of high school football special teams plays. The head impact biomechanics data set and video were collected from 22 high school football players, wearing HIT System instrumented helmets, competing in 218 special teams plays over a single high school football season. We used two separate video analysis approaches. To quantify the impact detection accuracy, we evaluated the video for head impacts independently of the impact data collection triggers collected by the HIT System. Video-observed impacts matched to valid and invalid head impacts by the HIT System algorithm were categorized as true positives, false positives, false negatives, and true negatives. To quantify impact location accuracy, we analyzed video-synchronized head impacts for impact location independent of the HIT System's impact location measurement and quantified the estimated percent agreement of impact location between the HIT System recorded impact location and the impact location observed on video. The HIT System's impact-filtering algorithm had 69% sensitivity, 72% specificity, and 70% accuracy in categorizing true and non-head impact data collection triggers. The HIT System agreed with video-observed impact locations on 64% of the 129 impacts we analyzed (unweighted k = 0.43, 95% confidence interval = 0.31-0.54). This work provides data on the HIT System's impact detection and location accuracy during high school football special teams plays using game video analysis that has not been previously published. Based on our data, we believe that the HIT System is useful for estimating population-based impact location distributions for special teams plays.

Toward Exodus from Bondage: Examining Resourcefulness of an Academically and Athletically High-Achieving Black Male Student who Plays High School Football

This study utilizes ethnographic methods, in-depth interviews, and observations to investigate the neighborhood and high school experiences of Terry, an academically and athletically high-achiever. Originating from a multiple case study methodology that examined the experiences, perceptions, and aspirations of Black male students who played high school sports, this research draws from examinations that investigated the experiences of Black males in their neighborhood, school, and athletic settings. The findings highlight how Terry escaped from “bondage” by displaying characteristics of resourcefulness. Although he experienced violence in his neighborhood, the combination of support from family members, exposure to an advanced academic curriculum, and sports participation at an early age protected Terry from becoming a victim or a participant in violent crimes. Furthermore, Terry received an athletic scholarship to attend college but aspired to use his athletic skills as a platform to earn a business degree and a PhD. This study has implications for expanding the understanding of the perceptions and aspirations of Black male students who play sports in urban neighborhoods and at urban schools. Furthermore, it provides policymakers and administrators insights that can further develop programming and activities that support the social and academic advancement of Black male students who play sports.

THE EFFECTS OF INTERNAL JUGULAR VEIN COMPRESSION FOR PRESERVING WHITE MATTER INTEGRITY IN HIGH SCHOOL FOOTBALL PLAYERS COMPARISON OF HIGH VS LOW

Background:Repetitive head impacts experienced during competitive sports contribute to neurologic changes over the course of a season. Internal jugular vein compression, by means of an externally worn neck collar device has shown efficacy in mitigating white matter (WM) alterations following repeated head impact exposure. However, its relative effectiveness in high versus low head impact exposures is unknown.Hypothesis/Purpose:The purpose of this study was to investigate the effectiveness of an externally worn neck collar device in limiting WM alterations over a season of high school football in players who receive high and low cumulative head impact exposures over 90 g.Methods:213 male high-school football athletes were prospectively assigned to two study groups: a control group (non-collar; n=106) and an experimental group who wore the jugular vein compression collar during all practices and games (collar; n=107). MRI data was collected from all participants pre- and post-season. Fractional anisotropy (FA), and mean, axial and radial diffusivity (MD/AD/RD) were calculated to assess WM integrity at both time points. Cumulative head impact exposure was monitored by accelerometers attached to each athlete’s left mastoid process during every exposure. Participants were dichotomized into subgroups based on accumulated exposures to hits over 90 g, which divided the entire cohort into four subgroups, using a cut-off of 40 hits : (1) non-collar group (≥40 hits, n=57); (2) collar group (≥40 hits, n=51); (3) non-collar group (<40 hits, n=49); (4) collar group (<40 hits, n=56).Results:As seen in Table 1, in athletes with ≥40 hits, both the non-collar and collar group showed significant pre- to post- season reductions in MD, AD, and/or RD. The non-collar group with ≥40 hits also showed a significant increase in FA, MD, and AD. RD, FA, and MD changes were greater in the non-collar group compared to the control group with ≥40 hits, while AD changes were greater in the collar group compared to the non-collar group with ≥ 40 hits. The non-collar group with <40 hits presented significant pre- to post-season reductions in MD, AD, and RD that were greater than the collar group with < 40 hits (whom did not show pre-to post-season changes).Discussion & Conclusion:The present results provide support for internal jugular vein compression to protect the brain from both low- and high-level repeated head impact exposure. However, less consistent changes were observed for athletes exposed to repeated, high-level head impacts, warranting further investigation.Table 1.Number of WM voxels (1x1x1mm) with significant (p < .05 after correcting for multiple comparisons) pre- to post-season DTI changes and/or significant group difference (red indicates group difference for non-collar group; blue indicates group difference for collar group) for high and low head impact exposure FA ↓ MD↓ AD↓ RD↓ FA↑ MD↑ AD↑ RD↑ #hits ≥ 40 Noncollar,n= 5701390381 702965186110Collar, n=51013313350 0000Grp_diff-011511 24660-#hits <40 Noncollar,n= 4905925956340 0000Collar, n=560000 0000Grp_diff-308627611 ----

Female “Lone Wolves”: The Anti‐Social Heroine in Recent Television Series

Female “Lone Wolves”: The Anti‐Social Heroine in Recent Television Series

A NECK STRENGTH TRAINING PROTOCOL IN HIGH SCHOOL FOOTBALL PLAYERS FOR CONCUSSION RISK REDUCTION

Background:Increased neck strength may be a protective factor for reducing concussions in youth athletes. However, little research exists regarding validated neck strength training methods among this demographic.Purpose:To determine whether a 7-week neck strength training period is sufficient to achieve significant gains in neck strength and size amongst high school football players. Additionally, to assess if increased neck strength influences concussion outcomes.Methods:This study enrolled 54 male high school football players, ages 14-17, in a 7-week strength training protocol in which neck exercises were incorporated into preseason strength and conditioning workouts (figure 1). Pre- and post-neck strength was assessed in four directions: forward flexion (FF), extension (EXT), right lateral flexion (RLF) and left lateral flexion (LLF). Strength was measured as maximal isometric head pressure applied into a pre-inflated sphygmomanometer cuff (figure 2). Concussion totals from the subsequent 2018 season were compared with totals from the 2017 and 2016 seasons per data obtained from the team’s athletic trainer.Results:Fifty athletes in total were analyzed; 4/54 athletes did not complete final testing due to scheduling conflicts. A two sample t-test of neck circumferences revealed a statistically significant increase of 0.37 cm from pre- to post-neck strength training (p=0.0025, figure 3). Single sample strength t-test analysis (corrected for cuff pre-inflation) demonstrated a statistically significant post-test strength increase of 19.8% (FF), 11.0% (EX), 18.8% (RLF), and 18.0% (LLF) (p<0.001, figure 3). The team suffered 4 concussions in the 2018 season, 2 of which were sustained by athletes who did not participate in preseason neck training, compared to 12 concussions in 2017 and 7 concussions in 2016 (figure 3).ConclusionThis study demonstrates that increases in neck size and strength can be achieved amongst high school athletes using easily implemented training methods during a 7-week preseason training period. The additional observation of reduced concussion outcomes is not conclusive, though these initial results are promising. Additional research is needed to investigate the potential of neck strengthening in modifying concussion risk. Funding provided by the Stanford Medical Scholars Fellowship Program Figure 1.Neck ExercisesFigure 2.Strength TestingFigure 3.Results

NASPGHAN Distinguished Service Award 2019: Neal S. LeLeiko.

NASPGHAN Distinguished Service Award 2019: Neal S. LeLeiko.

ARTHROSCOPIC SHOULDER STABILIZATION IN HIGH SCHOOL FOOTBALL PLAYERS: RECURRENT INSTABILITY WITH RETURN TO CONTACT SPORT

Background:The etiology of recurrent shoulder instability after arthroscopic surgery in the high school American football population remains unknown.Purpose/Hypothesis:To determine the risk of recurrent instability after shoulder arthroscopy upon return to competitive football. The hypothesis was that the rate of recurrence would be greater in high school players with more years of eligibility remaining (YER), suggesting greater likelihood of return to football after surgery.Methods:Consecutive male high school football players with at least one year of eligibility remaining who sustained traumatic in-season shoulder instability episode(s) and underwent arthroscopic labral stabilization by two Orthopaedic Sports surgeons at Rady Children’s Hospital San Diego between 2012 and 2017 were identified. 64 subjects aged 14-17 met inclusion criteria of which 45 were able to be contacted and included in analyses. Average follow up period was 4.06 years. Patients and/or families were contacted by phone to discuss (1) recurrent instability episodes and (2) return to competitive sport and/or recreational athletic activity. Statistics were conducted using chi square analysis to compare recurrence of instability with return to sport.Results:Surgery itself was career ending in 50% of cases due to reported fear of recurrent football-related injury. The hypothesis that career longevity in terms of years of eligibility remaining (YER) affects return to game play in this young active population remains unclear although preliminary results suggest positive exponential correlation. Comparative analysis demonstrates a statistically significant difference between rate of recurrence in high school football players that return to contact sports vs transition to non-contact activity after arthroscopic shoulder stabilization. Interestingly, football players who concurrently played baseball during high school demonstrated decreased risk of postoperative instability episodes.Conclusion:Risk of recurrent instability after shoulder arthroscopy is increased in high school football players who return to competitive contact sports whereas transition to non-contact and/or recreational activity likely confers protective effect. High school football players who play baseball may derive functional benefit from cross training.Figure.Proportion of recurrent shoulder instability after arthroscopic stabilization in high school football players stratified by years of eligibility remaining (YER) demonstrating positive exponential correlation relationship.

Causal Inference With Two Versions of Treatment

Causal effects are commonly defined as comparisons of the potential outcomes under treatment and control, but this definition is threatened by the possibility that either the treatment or the control condition is not well defined, existing instead in more than one version. This is often a real possibility in nonexperimental or observational studies of treatments because these treatments occur in the natural or social world without the laboratory control needed to ensure identically the same treatment or control condition occurs in every instance. We consider the simplest case: Either the treatment condition or the control condition exists in two versions that are easily recognized in the data but are of uncertain, perhaps doubtful, relevance, for example, branded Advil versus generic ibuprofen. Common practice does not address versions of treatment: Typically, the issue is either ignored or explicitly stated but assumed to be absent. Common practice is reluctant to address two versions of treatment because the obvious solution entails dividing the data into two parts with two analyses, thereby (a) reducing power to detect versions of treatment in each part, (b) creating problems of multiple inference in coordinating the two analyses, and (c) failing to report a single primary analysis that uses everyone. We propose and illustrate a new method of analysis that begins with a single primary analysis of everyone that would be correct if the two versions do not differ, adds a second analysis that would be correct were there two different effects for the two versions, controls the family-wise error rate in all assertions made by the several analyses, and yet pays no price in power to detect a constant treatment effect in the primary analysis of everyone. Our method can be applied to analyses of constant additive treatment effects on continuous outcomes. Unlike conventional simultaneous inferences, the new method is coordinating several analyses that are valid under different assumptions, so that one analysis would never be performed if one knew for certain that the assumptions of the other analysis are true. It is a multiple assumptions problem rather than a multiple hypotheses problem. We discuss the relative merits of the method with respect to more conventional approaches to analyzing multiple comparisons. The method is motivated and illustrated using a study of the possibility that repeated head trauma in high school football causes an increase in risk of early onset cognitive decline.

The association between adolescent football participation and early adulthood depression.

Concerned about potentially increased risk of neurodegenerative disease, several health professionals and policy makers have proposed limiting or banning youth participation in American-style tackle football. Given the large affected population (over 1 million boys play high school football annually), careful estimation of the long-term health effects of playing football is necessary for developing effective public health policy. Unfortunately, existing attempts to estimate these effects tend not to generalize to current participants because they either studied a much older cohort or, more seriously, failed to account for potential confounding. We leverage data from a nationally representative cohort of American men who were in grades 7–12 in the 1994–95 school year to estimate the effect of playing football in adolescent on depression in early adulthood. We control for several potential confounders related to subjects’ health, behavior, educational experience, family background, and family health history through matching and regression adjustment. We found no evidence of even a small harmful effect of football participation on scores on a version of the Center for Epidemiological Studies Depression scale (CES-D) nor did we find evidence of adverse associations with several secondary outcomes including anxiety disorder diagnosis or alcohol dependence in early adulthood. For men who were in grades 7–12 in the 1994–95 school year, participating or intending to participate in school football does not appear to be a major risk factor for early adulthood depression.

Prospective study of the effects of sport-related concussion on serum kynurenine pathway metabolites

Reports of neurodegenerative and psychiatric disease in former athletes have increased public concern about the acute and chronic effects of sport-related concussions (SRC). The biological factors underlying individual differences in the psychiatric sequalae of SRC and their role in potential long-term negative outcomes have not been determined. One understudied biological consequence of the known inflammatory response to concussion is the activation of a key immunoregulatory pathway, the kynurenine pathway (KP). Activation of the KP produces several neuroactive metabolites that have been associated with psychiatric and neurodegenerative diseases. We tested the hypothesis that SRC results in an elevation of serum KP metabolites with neurotoxic properties (quinolinic acid [QuinA], 3-hydroxykynurenine [3HK]) together with a reduction in the neuroprotective metabolite kynurenic acid (KynA), and that these metabolites would predict post-concussion psychological symptoms. Additionally, because brain injury is thought to prime the immune system, a secondary goal was to test the hypothesis that athletes with acute SRC and a history of prior SRC would have elevated neurotoxic relative to neuroprotective KP metabolites compared to athletes that were concussed for the first time. High school and collegiate football players (N = 1136) were enrolled at a preseason baseline visit that included clinical testing and blood specimen collection. Athletes that suffered a SRC (N = 59) completed follow-up visits within 6-hours (early-acute), at 24–48 h (late-acute) and at 8, 15, and 45 days post-injury. Uninjured contact sport (CC; N = 54) and non-contact sport athletes completed similar visits and served as controls (NCC; N = 30). SRC athletes had significantly elevated psychological symptoms, assessed using the Brief Symptom Inventory-18 (BSI), acutely following injury relative to both control groups. There was a group-by-visit interaction on the ratio of KynA to 3HK in serum, a neuroprotective index, with elevated KynA/3HK in athletes with SRC at the early-acute visit relative to later visits. Importantly, athletes with greater elevation in this neuroprotective index at the early-acute visit reported fewer depressive symptoms at the late-acute visit. Finally, SRC athletes with prior concussion had significantly lower serum KynA/QuinA at all visits compared to SRC athletes with no prior concussion, an effect driven by elevated QuinA in SRC athletes with prior concussion. These results suggest that early-acute activation of the KynA branch of the KP may protect against the development of depressive symptoms following concussion. Furthermore, they highlight the potential of serum QuinA as a biomarker for repetitive head injury and provide insight into possible mechanisms linking prior concussion with subsequent injury.

Epidemiology of Injuries Sustained in Boys' High School Contact and Collision Sports, 2008-2009 Through 2012-2013.

Background:Injury epidemiology for boys’ high school contact and collision sport has been described in several overlapping but fragmented studies. Comprehensive comparisons of injuries sustained in boys’ soccer, wrestling, football, ice hockey, and lacrosse are lacking.Purpose:To describe patterns of injury by severity, body site, and diagnosis among high school boys’ contact and collision sports in the United States.Study Design:Descriptive epidemiology study.Methods:Injury rates and rate ratios (RRs) were calculated for injuries sustained in boys’ high school soccer, wrestling, football, ice hockey, and lacrosse through use of the High School RIO (Reporting Information Online) surveillance data from 2008-2009 through 2012-2013. Injury patterns were described by site, diagnosis, time loss, and severity. Severe injury was defined as an injury that resulted in 21 days or more of time loss from sport participation. Risk of sustaining a concussion was compared between sports.Results:The risk of sustaining an injury was higher in competition compared with practice overall (RR, 4.01; 95% CI, 3.90-4.12); the same pattern was true for severe injuries (RR, 4.61; 95% CI, 4.34-4.90). Football players experienced the highest injury rate (3.87 per 1000 athlete-exposures [AEs]) and the highest severe injury rate (0.80 per 1000 AEs). Overall, the most commonly injured body site was the head/face (22.5%), and the most prevalent injury diagnosis was ligament sprain not requiring surgery (23.5%). The most frequently injured body site from severe injury was the knee (24.6%), and fracture or avulsion was the most prevalent severe injury diagnosis (37.0%). Football players had a significantly higher risk of sustaining a concussion compared with other contact or collision sport athletes (P < .05).Conclusion:Injuries rates were higher in competition than those in practice for boys’ high school contact and collision athletes. Football players sustained the highest injury rate, the highest severe injury rate, and the highest concussion rate among the sports included in this analysis. Understanding these patterns of injury can generate policy and rule changes to make sports safer and maintain high levels of participation.

Regional differences in exertional heat illness rates among Georgia USA high school football players.

Many high school associations in recent years are developing policies to improve player safety regarding exertional heat illnesses (EHIs). A question is whether states with diverse climates need multiple sets of guidelines with different activity modification thresholds. We examine this question in the state of Georgia, which has a diverse climate. Our study leverages a multi-year dataset of exertional heat illnesses (EHIs) among high school football players to test the hypothesis that EHI rates under similar wet bulb globe temperatures (WBGTs) will be greater among athletes in the cooler, northern region versus warmer, southern region of the state. The focus of this study is on a 3-year period (2012-2014) when uniform heat safety polices, including acclimatization and activity modification guidelines, were implemented across the state. Results show that athletes in the northern region acclimatize to cooler conditions. Almost 68% of practices have WBGTs < 27.8°C (82°F) compared to the southern region where athletes receive many times the exposures to hotter WBGTs in the 27.8-30.5°C and 30.6-32.2°C categories. In the post-acclimatization period, we observed statistically significantly (p < .05) greater EHI rates among athletes in the northern region of the state, even when controlling for meteorological conditions. Our findings suggest that differential acclimatization between football players in the northern and southern regions of the state is impacting EHI rates and that regional heat safety guidelines may be needed in Georgia and other states with similarly diverse climates.