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Media Contact: Tom Grant

Published on August 03, 2007

Concussions in High School Football Players Can Lead to Greater Risks

Study finds "unacceptably high percentage" of high schoolers who sustain catastrophic head injury play with residual effects of a prior head injury

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Rockville, Md. - As high school football teams return to practice this month, a new study led by a doctor at Shady Grove Adventist Hospital identifies concussions as a serious risk factor for catastrophic head injuries in young athletes. The study comes at the same time when concussions for football players are gaining national attention due to a recent study linking concussions to depression in professional football players.

The new study, published in the July issue of The American Journal of Sports Medicine, compared the occurrence of and risk factors for catastrophic head injuries among high school football players and collegiate football players.

"High school football players have more than three times the risk of catastrophic head injury than their college peers," says lead author Barry P. Boden, M.D., an orthopaedic surgeon at Shady Grove Adventist Hospital, Rockville, Md.

Catastrophic head injuries, which include brain bleeding and swelling, are rare and can be devastating. Athletes with major brain injuries may be left with permanent brain damage.

Boden and his co-authors also found a high percentage of high school athletes playing with neurologic symptoms from a previous head injury at the time they sustained a catastrophic injury.

Football has more direct catastrophic injuries than any other sport tracked by the National Center for Catastrophic Sports Injury Research (NCCSIR).

The researchers reviewed 94 incidents of severe football head injuries reported to NCCSIR during 13 football seasons (Sept. 1989 through June 2002).

Catastrophic injury was classified in the following manner: direct, resulting from playing the sport, or indirect, resulting from systemic failure secondary to play. Each classification was then further sub classified in the following manner:

  • Fatal
  • Nonfatal (injury causing permanent neurological damage)
  • Serious (while severely injured, the player's injury is immediately relieved, there is no permanent function disability, and the player recovers completely.)

The researchers found that there is approximately one catastrophic head injury per every 150,000 athletes playing, or 7 catastrophic injuries yearly. There were 0.67 injuries per 100,000 players at the high school level and 0.21 injuries per 100,000 for college level football players.

"The incidence of injury is higher at the high school level compared to the college level, which may indicate that the younger brain is more susceptible to a brain injury," explains Dr. Boden. "Many of the players who had a severe head injury were playing with minor or neurological symptoms from a previous head injury, such as a concussion."

From the 94 cases studied, 59 contacts and/or medical records revealed information on prior head injuries. Fifty-nine percent (35/59) of the injured football players had a history of previous head injury of which 71 percent (25/35) occurred during the same season as the catastrophic event. Nearly 40 percent (21/54) of the injured athletes were playing with residual neurologic symptoms from prior head injury. The catastrophic injuries resulted in 8 deaths, 46 permanent neurologic injuries, and 36 serious injuries with full recovery.

Dr. Boden suggests that players should be discouraged from using their heads to tackle, since 81 percent of the injuries were caused by helmet-to-helmet collisions and helmet-to-body collisions.

"The single most important piece of advice that I can give is to never let an athlete play football if he has any neurological symptoms whatsoever," says Dr. Boden. "Those symptoms may include amnesia, dizziness, headache, irritability, and personality change."

Of the difference in catastrophic head injuries between high school and college players, Boden theorizes: "High school students might take longer to recover from a concussion than college players. Another possible reason for these reported injuries may be that there aren't as many team physicians covering high school games as college games. Consequently, some high school athletes may not be properly evaluated or receive medical attention. Therefore, they are returning to play before full recovery, leaving them susceptible to a more significant injury."

Because of the risk for greater, secondary injury, the Center for Disease Control and Prevention (CDC) announced in June it has updated concussion information in its multimedia tool kit. The revised tool kit includes a new patient evaluation tool for physicians and symptom facts sheets for players, parents and coaches to improve early diagnosis. The tool kit is accessible at

"Football is a very macho sport. Athletes are taught to play through pain," concludes Dr. Boden. "But concussions range in severity and symptoms, so all a player may experience is a headache several hours after impact. High school players need to be educated in these symptoms and encouraged to self report."

Barry P. Boden, M.D., is a Board Certified Orthopaedic Surgeon with fellowship training in sports medicine and arthroscopic knee and shoulder surgery. A native of Rockville, Maryland, Dr. Boden completed medical school, a general surgery internship, and an orthopaedic residency at Temple University in Philadelphia. Dr. Boden continued his training with a fellowship in sports medicine at Duke University, where he served as the assistant team physician for the varsity athletes. At Duke, he worked with some of the leaders in the sports medicine field, publishing several chapters and original articles on topics such as anterior cruciate ligament injuries, shoulder abnormalities, soccer injuries, sports related head injuries and preventive sports medicine.

Since returning to the Washington D.C. area, he has been active in many community services. He is currently the team physician for the athletes at Montgomery College. In addition, he directs a sports medicine clinic at the University of Maryland. He is a consultant at NIH and an Adjunct Associate Professor at the Uniformed Services University of the Health Sciences where he is involved in teaching and research projects with the sports medicine fellows. He is currently involved in several multi-center funded studies evaluating head injuries in athletes and the etiology of ACL injuries. Dr. Boden remains active in soccer and is a member of the medical staff for U.S. Soccer. He has served as team physician for the Under-20 national team during tournaments in Germany and Mexico and the Under-17 team for competition in Belgium and England.

Related Health Information & Resources
Concussion Symptoms Concussion Tool Kit (CDC)
Concussion Brochure (NFHS)
Medical Experts Find an Orthopedic Surgeon, Neurologist, or Pediatric Specialist
Sports Safety

National Center for Injury Prevention and Control (NCIPC)

National Federation of State High School Associations

National Operating Committee on Standards for Athletic Equipment NOCSAE)

U.S. Consumer Product safety Commission (CPSC)

National Center for Catastrophic Sport Injury Research (NCCSIR)

Shady Grove Adventist Hospital, is a not-for-profit, acute care facility with 275 licensed beds that is located in Rockville, Md. The hospital offers a broad range of health services and is recognized for excellence in emergency care; high-risk obstetrical and neonatal care; cardiac and vascular interventional care; as well as a broad range of surgical specialties. Also, Shady Grove Adventist Hospital for Children, which is located within Shady Grove Adventist Hospital encompasses a broad range of specialized services for children, including the first Pediatric Emergency Department in Montgomery County and the only Pediatric Intensive Care Unit in the county. The Shady Grove Adventist Emergency Center in Germantown opened in 2006 and is providing increased access to emergency medical care for upcounty residents. Shady Grove Adventist Hospital is part of Rockville, Maryland-based Adventist HealthCare, an integrated health care delivery system that is one of the largest employers in the state of Maryland.

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