Introduction

Concussions occur at higher rates in high school football as compared to all other high school sports. In 2014 the National Federation of State High School Associations (NFHS) implemented rules defining illegal contact against a defenseless player above the shoulders to reduce concussions in football players. To our knowledge, rates of emergency department (ED) diagnosed concussions of high school football players before and after the 2014 rule implementation have not been compared. Accordingly, this study analyzes the rates of emergency department (ED) diagnosed concussions of high school football players after 2014 NFHS rule implementation.

Methods

Data from the National Electronic Injury Surveillance System were analyzed for high school football players 14 to 18 years old sustaining a concussion from January 1, 2009 to December 31, 2019. Data were collected on mechanism of injury, setting, loss of consciousness (LOC), and concomitant fracture.

Results

Between 2009 and 2019, an estimated 154,221 high school football concussions were diagnosed in United States EDs. 59.6% of concussions occurred during competition compared to 40.4% during practice. Overall rates of concussions decreased from +10.7% between 2009-2013 to -6.2% from 2015-2019 (p<0.05). Rate of change of helmet-to-helmet concussions decreased from +17.6% to -5.6% before and after 2014, respectively (p<0.05). There were no significant changes between other mechanisms of concussion before and after the 2014 rule implementation.

Conclusion

This study is the first to identify a decreased trend in overall and helmet-to-helmet related high school concussions diagnosed in the ED following implementation of the targeting rule. This study adds to the growing literature regarding the importance and efficacy of rule implementation in reducing sports-related concussions.