{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T12:34:00Z","timestamp":1792758840198,"version":"4.5.0"},"reference-count":96,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2021,12,11]],"date-time":"2021-12-11T00:00:00Z","timestamp":1639180800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2021,12,11]],"date-time":"2021-12-11T00:00:00Z","timestamp":1639180800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sports Med"],"published-print":{"date-parts":[[2022,6]]},"DOI":"10.1007\/s40279-021-01609-4","type":"journal-article","created":{"date-parts":[[2021,12,11]],"date-time":"2021-12-11T10:02:33Z","timestamp":1639216953000},"page":"1259-1272","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":36,"title":["Head Games: A Systematic Review and Meta-analysis Examining Concussion and Head Impact Incidence Rates, Modifiable Risk Factors, and Prevention Strategies in Youth Tackle Football"],"prefix":"10.1007","volume":"52","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2343-1893","authenticated-orcid":false,"given":"Mark Patrick","family":"Pankow","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. A.","family":"Syrydiuk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. T.","family":"Kolstad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. K.","family":"Hayden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. R.","family":"Dennison","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Mrazik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B. E.","family":"Hagel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. A.","family":"Emery","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,12,11]]},"reference":[{"key":"1609_CR1","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1111\/j.1746-1561.2006.00132.x","volume":"76","author":"R Bailey","year":"2006","unstructured":"Bailey R. Physical education and sport in schools: a review of benefits and outcomes. J Sch Health. 2006;76:397\u2013401.","journal-title":"J Sch Health"},{"key":"1609_CR2","unstructured":"The Aspen Institute. Project Play\u2014State of Play 2020. Washingston; 2020. Im Internet: https:\/\/www.aspenprojectplay.org\/state-of-play-2020\/introduction"},{"key":"1609_CR3","doi-asserted-by":"crossref","unstructured":"Emery CA, Meeuwisse WH, McAllister JR. Survey of sport participation and sport injury in Calgary and area high schools. Clin J Sport Med 2006; 16:20\u201326. Im Internet: http:\/\/ovidsp.ovid.com\/ovidweb.cgi?T=JS&PAGE=reference&D=med5&NEWS=N&AN=16377971","DOI":"10.1097\/01.jsm.0000184638.72075.b7"},{"key":"1609_CR4","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1136\/bjsports-2017-097699","volume":"51","author":"P McCrory","year":"2017","unstructured":"McCrory P, Meeuwisse W, Dvorak J, et al. Consensus statement on concussion in sport\u2014the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sport Med. 2017;51:838\u201347.","journal-title":"Br J Sport Med"},{"key":"1609_CR5","doi-asserted-by":"publisher","first-page":"978","DOI":"10.1136\/bjsports-2016-097452","volume":"51","author":"CA Emery","year":"2017","unstructured":"Emery CA, Black AM, Kolstad A, et al. What strategies can be used to effectively reduce the risk of concussion in sport? A systematic review. Br J Sports Med. 2017;51:978\u201384. https:\/\/doi.org\/10.1136\/bjsports-2016-097452.","journal-title":"Br J Sports Med"},{"key":"1609_CR6","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1001\/jamapediatrics.2018.5498","volume":"173","author":"CA Emery","year":"2019","unstructured":"Emery CA. Are rule changes the low-hanging fruit for concussion prevention in youth sport? JAMA Pediatr. 2019;173:309\u201310. https:\/\/doi.org\/10.1001\/jamapediatrics.2018.5498.","journal-title":"JAMA Pediatr"},{"key":"1609_CR7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1542\/peds.2019-2180","volume":"144","author":"ZY Kerr","year":"2019","unstructured":"Kerr ZY, Chandran A, Nedimyer AK, et al. Concussion incidence and trends in 20 high school sports. Pediatrics. 2019;144:1.","journal-title":"Pediatrics"},{"key":"1609_CR8","doi-asserted-by":"publisher","first-page":"292","DOI":"10.1136\/bjsports-2015-094978","volume":"50","author":"T Pfister","year":"2016","unstructured":"Pfister T, Pfister K, Hagel B, et al. The incidence of concussion in youth sports: a systematic review and meta-analysis. Br J Sports Med. 2016;50:292\u20137. https:\/\/doi.org\/10.1136\/bjsports-2015-094978.","journal-title":"Br J Sports Med"},{"key":"1609_CR9","doi-asserted-by":"publisher","first-page":"958","DOI":"10.1177\/0363546510392326","volume":"39","author":"AE Lincoln","year":"2011","unstructured":"Lincoln AE, Caswell SV, Almquist JL, et al. Trends in concussion incidence in high school sports: a prospective 11-year study. Am J Sports Med. 2011;39:958\u201363. https:\/\/doi.org\/10.1177\/0363546510392326.","journal-title":"Am J Sports Med"},{"key":"1609_CR10","doi-asserted-by":"publisher","first-page":"914","DOI":"10.1016\/j.amepre.2017.05.017","volume":"53","author":"ZY Kerr","year":"2017","unstructured":"Kerr ZY, Cortes N, Caswell AM, et al. Concussion rates in US Middle School Athletes, 2015\u20132016 School Year. Am J Prev Med. 2017;53:914\u20138. https:\/\/doi.org\/10.1016\/j.amepre.2017.05.017.","journal-title":"Am J Prev Med"},{"key":"1609_CR11","doi-asserted-by":"crossref","unstructured":"Choudhury R, Kolstad A, Prajapati V, et al. Loss and recovery after concussion: adolescent patients give voice to their concussion experience. Heal Expect 2020.","DOI":"10.1111\/hex.13138"},{"key":"1609_CR12","doi-asserted-by":"publisher","first-page":"647","DOI":"10.1001\/jamapediatrics.2016.0073","volume":"170","author":"ZY Kerr","year":"2016","unstructured":"Kerr ZY, Zuckerman SL, Wasserman EB, et al. Concussion symptoms and return to play time in youth, high school, and college american football athletes. JAMA Pediatr. 2016;170:647\u201353. https:\/\/doi.org\/10.1001\/jamapediatrics.2016.0073.","journal-title":"JAMA Pediatr"},{"key":"1609_CR13","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1227\/01.neu.0000489743.00212.e6","volume":"63","author":"SL Zuckerman","year":"2016","unstructured":"Zuckerman SL, Totten D, Rubel K, et al. Mechanisms of injury as a diagnostic predictor of sport-related concussion severity in football, basketball, and soccer: results from a regional concussion registry. Clin Neurosurg. 2016;63:169. https:\/\/doi.org\/10.1227\/01.neu.0000489743.00212.e6.","journal-title":"Clin Neurosurg"},{"key":"1609_CR14","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1097\/JES.0b013e318201f53e","volume":"39","author":"KM Guskiewicz","year":"2011","unstructured":"Guskiewicz KM, Mihalik JP. Biomechanics of sport concussion: quest for the elusive injury threshold. Exerc Sport Sci Rev. 2011;39:4\u201311.","journal-title":"Exerc Sport Sci Rev"},{"key":"1609_CR15","doi-asserted-by":"publisher","first-page":"2069","DOI":"10.1089\/neu.2011.1825","volume":"28","author":"SP Broglio","year":"2011","unstructured":"Broglio SP, Eckner JT, Martini D, et al. Cumulative head impact burden in high school football. J Neurotrauma. 2011;28:2069\u201378. https:\/\/doi.org\/10.1089\/neu.2011.1825.","journal-title":"J Neurotrauma"},{"key":"1609_CR16","doi-asserted-by":"publisher","first-page":"976","DOI":"10.1007\/s10439-012-0530-7","volume":"40","author":"RW Daniel","year":"2012","unstructured":"Daniel RW, Rowson S, Duma SM. Head impact exposure in youth football. Ann Biomed Eng. 2012;40:976\u201381. https:\/\/doi.org\/10.1007\/s10439-012-0530-7.","journal-title":"Ann Biomed Eng"},{"key":"1609_CR17","doi-asserted-by":"crossref","unstructured":"Schnebel B, Gwin JT, Anderson S, et al. In vivo study of head impacts in football: a comparison of National Collegiate Athletic Association Division I versus high school impacts. Neurosurgery 2007; 60:490\u2013496. http:\/\/ovidsp.ovid.com\/ovidweb.cgi?T=JS&PAGE=reference&D=med5&NEWS=N&AN=17327793","DOI":"10.1227\/01.NEU.0000249286.92255.7F"},{"key":"1609_CR18","doi-asserted-by":"publisher","first-page":"1473","DOI":"10.1136\/bjsports-2015-095645","volume":"51","author":"DK Schneider","year":"2017","unstructured":"Schneider DK, Grandhi RK, Bansal P, et al. Current state of concussion prevention strategies: a systematic review and meta-analysis of prospective, controlled studies. Br J Sports Med. 2017;51:1473\u201382.","journal-title":"Br J Sports Med"},{"key":"1609_CR19","doi-asserted-by":"publisher","first-page":"206","DOI":"10.4085\/1062-6050.52.2.05","volume":"52","author":"KL O\u2019Connor","year":"2017","unstructured":"O\u2019Connor KL, Rowson S, Duma SM, et al. Head-impact-measurement devices: a systematic review. J Athl Train. 2017;52:206\u201327. https:\/\/doi.org\/10.4085\/1062-6050.52.2.05.","journal-title":"J Athl Train"},{"key":"1609_CR20","doi-asserted-by":"publisher","first-page":"2877","DOI":"10.1177\/0363546513502458","volume":"41","author":"SP Broglio","year":"2013","unstructured":"Broglio SP, Martini D, Kasper L, et al. Estimation of head impact exposure in high school football: implications for regulating contact practices. Am J Sports Med. 2013;41:2877\u201384. https:\/\/doi.org\/10.1177\/0363546513502458.","journal-title":"Am J Sports Med"},{"issue":"4","key":"1609_CR21","first-page":"W65","volume":"15","author":"A Liberati","year":"2009","unstructured":"Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Annu Int Med. 2009;15(4):W65.","journal-title":"Annu Int Med"},{"key":"1609_CR22","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1136\/jech.52.6.377","volume":"52","author":"SH Downs","year":"1998","unstructured":"Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Heal. 1998;52:377\u201384.","journal-title":"J Epidemiol Community Heal"},{"key":"1609_CR23","doi-asserted-by":"crossref","unstructured":"Schulz MR, Marshall SW, Mueller FO, et al. Incidence and risk factors for concussion in high school athletes, North Carolina, 1996\u20131999. Am J Epidemiol 2004; 160:937\u2013944. http:\/\/ovidsp.ovid.com\/ovidweb.cgi?T=JS&PAGE=reference&D=med5&NEWS=N&AN=15522850","DOI":"10.1093\/aje\/kwh304"},{"key":"1609_CR24","doi-asserted-by":"publisher","first-page":"2684","DOI":"10.1089\/neu.2017.5032","volume":"34","author":"RC Lynall","year":"2017","unstructured":"Lynall RC, Campbell KR, Wasserman EB, et al. Concussion mechanisms and activities in youth, high school, and college football. J Neurotrauma. 2017;34:2684\u201390. https:\/\/doi.org\/10.1089\/neu.2017.5032.","journal-title":"J Neurotrauma"},{"key":"1609_CR25","unstructured":"Gessel LM, Fields SK, Collins CL, et al. Concussions among United States high school and collegiate athletes. J Athl Train 2007; 42:495\u2013503. http:\/\/ovidsp.ovid.com\/ovidweb.cgi?T=JS&PAGE=reference&D=med5&NEWS=N&AN=18174937"},{"key":"1609_CR26","doi-asserted-by":"publisher","first-page":"747","DOI":"10.1177\/0363546511435626","volume":"40","author":"M Marar","year":"2012","unstructured":"Marar M, McIlvain NM, Fields SK, et al. Epidemiology of concussions among United States high school athletes in 20 sports. Am J Sports Med. 2012;40:747\u201355. https:\/\/doi.org\/10.1177\/0363546511435626.","journal-title":"Am J Sports Med"},{"key":"1609_CR27","doi-asserted-by":"publisher","first-page":"175","DOI":"10.4085\/1062-6050-52.1.15","volume":"52","author":"KL O\u2019Connor","year":"2017","unstructured":"O\u2019Connor KL, Baker MM, Dalton SL, et al. Epidemiology of sport-related concussions in high school athletes: National Athletic Treatment, Injury and Outcomes Network (NATION), 2011\u20132012 Through 2013\u20132014. J Athl Train. 2017;52:175\u201385. https:\/\/doi.org\/10.4085\/1062-6050-52.1.15.","journal-title":"J Athl Train"},{"key":"1609_CR28","doi-asserted-by":"crossref","unstructured":"Guskiewicz KM, Weaver NL, Padua DA, et al. Epidemiology of concussion in collegiate and high school football players. Am J Sports Med 2000; 28:643\u2013650. http:\/\/ovidsp.ovid.com\/ovidweb.cgi?T=JS&PAGE=reference&D=med4&NEWS=N&AN=11032218","DOI":"10.1177\/03635465000280050401"},{"key":"1609_CR29","doi-asserted-by":"publisher","first-page":"738","DOI":"10.4085\/1062-6050-144-17","volume":"53","author":"ZY Kerr","year":"2018","unstructured":"Kerr ZY, Wilkerson GB, Caswell SV, et al. the first decade of web-based sports injury surveillance: descriptive epidemiology of injuries in United States High School Football (2005\u20132006 through 2013\u20132014) and National Collegiate Athletic Association Football (2004\u20132005 Through 2013\u20132014). J Athl Train. 2018;53:738\u201351. https:\/\/doi.org\/10.4085\/1062-6050-144-17.","journal-title":"J Athl Train"},{"key":"1609_CR30","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1111\/j.1600-4469.2004.00259.x","volume":"20","author":"JF Wisniewski","year":"2004","unstructured":"Wisniewski JF, Guskiewicz K, Trope M, et al. Incidence of cerebral concussions associated with type of mouthguard used in college football. Dent Traumatol. 2004;20:143\u20139.","journal-title":"Dent Traumatol"},{"key":"1609_CR31","unstructured":"Schulz MR. Athletic injuries among North Carolina high school athletes: The epidemiology of concussion and cheerleading injuries. Athl Inj Among North Carolina High Sch Athletes Epidemiol Concussion Cheerleading Inj 2002. http:\/\/ezproxy.lib.ucalgary.ca\/login?url=http:\/\/search.ebscohost.com\/login.aspx?direct=true&db=rzh&AN=109842707&site=ehost-live NS -"},{"key":"1609_CR32","doi-asserted-by":"publisher","first-page":"2470","DOI":"10.1177\/0363546514541926","volume":"42","author":"TA McGuine","year":"2014","unstructured":"McGuine TA, Hetzel S, McCrea M, et al. Protective equipment and player characteristics associated with the incidence of sport-related concussion in high school football players: a multifactorial prospective study. Am J Sports Med. 2014;42:2470\u20138. https:\/\/doi.org\/10.1177\/0363546514541926.","journal-title":"Am J Sports Med"},{"key":"1609_CR33","doi-asserted-by":"publisher","first-page":"717","DOI":"10.1016\/j.jpeds.2013.04.011","volume":"163","author":"AP Kontos","year":"2013","unstructured":"Kontos AP, Elbin RJ, Fazio-Sumrock VC, et al. Incidence of sports-related concussion among youth football players aged 8\u201312 years. J Pediatr. 2013;163:717\u201320. https:\/\/doi.org\/10.1016\/j.jpeds.2013.04.011.","journal-title":"J Pediatr"},{"key":"1609_CR34","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1080\/15438620802678495","volume":"17","author":"EE Yard","year":"2009","unstructured":"Yard EE, Comstock RD. Effects of field location, time in competition, and phase of play on injury severity in high school football. Res Sports Med. 2009;17:35\u201349. https:\/\/doi.org\/10.1080\/15438620802678495.","journal-title":"Res Sports Med"},{"key":"1609_CR35","doi-asserted-by":"publisher","first-page":"732","DOI":"10.3109\/02699052.2012.660091","volume":"26","author":"JG Beckwith","year":"2012","unstructured":"Beckwith JG, Greenwald RM, Chu JJ, et al. Timing of concussion diagnosis is related to head impact exposure prior to injury. Brain Inj. 2012;26:732\u20133. https:\/\/doi.org\/10.3109\/02699052.2012.660091.","journal-title":"Brain Inj"},{"key":"1609_CR36","first-page":"44","volume":"29","author":"ED Zemper","year":"1994","unstructured":"Zemper ED. Analysis of cerebral concussion frequency with the most commonly used models of football helmets. J Athl Train. 1994;29:44\u201350.","journal-title":"J Athl Train"},{"key":"1609_CR37","doi-asserted-by":"publisher","first-page":"354","DOI":"10.1123\/jab.2017-0207","volume":"34","author":"S Bellamkonda","year":"2018","unstructured":"Bellamkonda S, Woodward SJ, Campolettano E, et al. Head impact exposure in practices correlates with exposure in games for youth football players. J Appl Biomech. 2018;34:354\u201360. https:\/\/doi.org\/10.1123\/jab.2017-0207.","journal-title":"J Appl Biomech"},{"key":"1609_CR38","doi-asserted-by":"publisher","first-page":"94501","DOI":"10.1115\/1.4027872","volume":"136","author":"RW Daniel","year":"2014","unstructured":"Daniel RW, Rowson S, Duma SM. Head impact exposure in youth football: middle school ages 12\u201314 years. J Biomech Eng. 2014;136:94501. https:\/\/doi.org\/10.1115\/1.4027872.","journal-title":"J Biomech Eng"},{"key":"1609_CR39","doi-asserted-by":"publisher","first-page":"2474","DOI":"10.1007\/s10439-013-0861-z","volume":"41","author":"JE Urban","year":"2013","unstructured":"Urban JE, Davenport EM, Golman AJ, et al. Head impact exposure in youth football: high school ages 14\u201318 years and cumulative impact analysis. Ann Biomed Eng. 2013;41:2474\u201387. https:\/\/doi.org\/10.1007\/s10439-013-0861-z.","journal-title":"Ann Biomed Eng"},{"key":"1609_CR40","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1089\/neu.2015.4308","volume":"34","author":"BB Reynolds","year":"2017","unstructured":"Reynolds BB, Patrie J, Henry EJ, et al. Comparative analysis of head impact in contact and collision sports. J Neurotrauma. 2017;34:38\u201349. https:\/\/doi.org\/10.1089\/neu.2015.4308.","journal-title":"J Neurotrauma"},{"key":"1609_CR41","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.clineuro.2013.11.036","volume":"118","author":"RH Wong","year":"2014","unstructured":"Wong RH, Wong AK, Bailes JE. Frequency, magnitude, and distribution of head impacts in Pop Warner football: the cumulative burden. Clin Neurol Neurosurg. 2014;118:1\u20134. https:\/\/doi.org\/10.1016\/j.clineuro.2013.11.036.","journal-title":"Clin Neurol Neurosurg"},{"key":"1609_CR42","doi-asserted-by":"publisher","first-page":"511","DOI":"10.4085\/1062-6050-51.7.04","volume":"51","author":"SP Broglio","year":"2016","unstructured":"Broglio SP, Williams RM, O\u2019Connor KL, et al. Football players\u2019 head-impact exposure after limiting of full-contact practices. J Athl Train. 2016;51:511\u20138. https:\/\/doi.org\/10.4085\/1062-6050-51.7.04.","journal-title":"J Athl Train"},{"key":"1609_CR43","doi-asserted-by":"publisher","first-page":"2463","DOI":"10.1007\/s10439-013-0867-6","volume":"41","author":"BR Cobb","year":"2013","unstructured":"Cobb BR, Urban JE, Davenport EM, et al. Head impact exposure in youth football: elementary school ages 9\u201312 years and the effect of practice structure. Ann Biomed Eng. 2013;41:2463\u201373. https:\/\/doi.org\/10.1007\/s10439-013-0867-6.","journal-title":"Ann Biomed Eng"},{"key":"1609_CR44","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1542\/peds.2014-0770","volume":"134","author":"ZY Kerr","year":"2014","unstructured":"Kerr ZY, Collins CL, Mihalik JP, et al. Impact locations and concussion outcomes in high school football player-to-player collisions. Pediatrics. 2014;134:489\u201396. https:\/\/doi.org\/10.1542\/peds.2014-0770.","journal-title":"Pediatrics"},{"key":"1609_CR45","doi-asserted-by":"publisher","first-page":"416","DOI":"10.1097\/JSM.0000000000000055","volume":"24","author":"TJ Young","year":"2014","unstructured":"Young TJ, Daniel RW, Rowson S, et al. Head impact exposure in youth football: elementary school ages 7\u20138 years and the effect of returning players. Clin J Sport Med. 2014;24:416\u201321. https:\/\/doi.org\/10.1097\/JSM.0000000000000055.","journal-title":"Clin J Sport Med"},{"key":"1609_CR46","doi-asserted-by":"publisher","first-page":"755","DOI":"10.1249\/MSS.0b013e3182798758","volume":"45","author":"D Martini","year":"2013","unstructured":"Martini D, Eckner J, Kutcher J. Subconcussive head impact biomechanics: comparing differing offensive schemes. Med Sci Sports Exerc. 2013;45:755\u201361. https:\/\/doi.org\/10.1249\/MSS.0b013e3182798758.","journal-title":"Med Sci Sports Exerc"},{"key":"1609_CR47","doi-asserted-by":"crossref","unstructured":"Meyers MC, Barnhill BS. Incidence, causes, and severity of high school football injuries on FieldTurf versus natural grass: a 5-year prospective study. Am J Sports Med 2004; 32:1626\u20131638. http:\/\/ovidsp.ovid.com\/ovidweb.cgi?T=JS&PAGE=reference&D=med5&NEWS=N&AN=15494326","DOI":"10.1177\/0363546504266978"},{"key":"1609_CR48","doi-asserted-by":"publisher","first-page":"489","DOI":"10.3171\/2017.5.PEDS16627","volume":"20","author":"ME Kelley","year":"2017","unstructured":"Kelley ME, Kane JM, Espeland MA, et al. Head impact exposure measured in a single youth football team during practice drills. J Neurosurg Pediatr. 2017;20:489\u201397. https:\/\/doi.org\/10.3171\/2017.5.PEDS16627.","journal-title":"J Neurosurg Pediatr"},{"key":"1609_CR49","doi-asserted-by":"publisher","first-page":"381","DOI":"10.3171\/2018.9.PEDS18314","volume":"23","author":"ME Kelley","year":"2018","unstructured":"Kelley ME, Espeland MA, Flood WC, et al. Comparison of head impact exposure in practice drills among multiple youth football teams. J Neurosurg Pediatr. 2018;23:381\u20139. https:\/\/doi.org\/10.3171\/2018.9.PEDS18314.","journal-title":"J Neurosurg Pediatr"},{"key":"1609_CR50","unstructured":"Schmidt JD. The influence of the cervical musculature, visual performance, and anticipation on head impact severity in high school and collegiate football. ProQuest Diss Theses 2013. http:\/\/ezproxy.lib.ucalgary.ca\/login?url=https:\/\/search.proquest.com\/docview\/1439914159?accountid=9838"},{"key":"1609_CR51","doi-asserted-by":"publisher","first-page":"1162","DOI":"10.1123\/jpah.2014-0356","volume":"12","author":"H King","year":"2015","unstructured":"King H, Campbell S, Herzog M, et al. Epidemiology of injuries in high school football: does school size matter? J Phys Act Health. 2015;12:1162\u20137. https:\/\/doi.org\/10.1123\/jpah.2014-0356.","journal-title":"J Phys Act Health"},{"key":"1609_CR52","doi-asserted-by":"publisher","first-page":"1382","DOI":"10.1177\/0363546516629626","volume":"44","author":"CL Collins","year":"2016","unstructured":"Collins CL, McKenzie LB, Ferketich AK, et al. Concussion characteristics in high school football by helmet age\/recondition status, manufacturer, and model: 2008\u20132009 through 2012\u20132013 academic years in the United States. Am J Sports Med. 2016;44:1382\u201390. https:\/\/doi.org\/10.1177\/0363546516629626.","journal-title":"Am J Sports Med"},{"key":"1609_CR53","doi-asserted-by":"crossref","unstructured":"Collins M, Lovell MR, Iverson GL, et al. Examining concussion rates and return to play in high school football players wearing newer helmet technology: a three-year prospective cohort study. Neurosurgery 2006; 58:275\u2013286. http:\/\/ovidsp.ovid.com\/ovidweb.cgi?T=JS&PAGE=reference&D=med5&NEWS=N&AN=16462481","DOI":"10.1227\/01.NEU.0000200441.92742.46"},{"key":"1609_CR54","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1177\/1941738116639027","volume":"8","author":"DA Greenhill","year":"2016","unstructured":"Greenhill DA, Navo P, Zhao H, et al. Inadequate helmet fit increases concussion severity in American high school football players. Sports Health. 2016;8:238\u201343. https:\/\/doi.org\/10.1177\/1941738116639027.","journal-title":"Sports Health"},{"key":"1609_CR55","doi-asserted-by":"publisher","first-page":"2294","DOI":"10.1177\/0363546519860120","volume":"47","author":"AY Pfaller","year":"2019","unstructured":"Pfaller AY, Brooks MA, Hetzel S, et al. Effect of a new rule limiting full contact practice on the incidence of sport-related concussion in high school football players. Am J Sports Med. 2019;47:2294\u20139.","journal-title":"Am J Sports Med"},{"key":"1609_CR56","doi-asserted-by":"publisher","first-page":"232596711560397","DOI":"10.1177\/2325967115603979","volume":"3","author":"ZY Kerr","year":"2015","unstructured":"Kerr ZY, Marshall SW, Simon JE, et al. Injury rates in age-only versus age-and-weight playing standard conditions in American youth football. Orthop J Sport Med. 2015;3:2325967115603979. https:\/\/doi.org\/10.1177\/2325967115603979.","journal-title":"Orthop J Sport Med"},{"key":"1609_CR57","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1177\/2325967115610545","volume":"3","author":"ZY Kerr","year":"2015","unstructured":"Kerr ZY, Yeargin SW, Valovich McLeod TC, et al. Comprehensive coach education reduces head impact exposure in American Youth Football. Orthop J Sport Med. 2015;3:1. https:\/\/doi.org\/10.1177\/2325967115610545.","journal-title":"Orthop J Sport Med"},{"key":"1609_CR58","doi-asserted-by":"publisher","DOI":"10.1097\/JSM.0000000000000711","author":"E Shanley","year":"2019","unstructured":"Shanley E, Thigpen C, Kissenberth M, et al. Heads up football training decreases concussion rates in high school football players. Clin J Sport Med. 2019. https:\/\/doi.org\/10.1097\/JSM.0000000000000711.","journal-title":"Clin J Sport Med"},{"key":"1609_CR59","doi-asserted-by":"publisher","first-page":"232596711664844","DOI":"10.1177\/2325967116648441","volume":"4","author":"ZY Kerr","year":"2016","unstructured":"Kerr ZY, Dalton SL, Roos KG, et al. Comparison of Indiana High School Football Injury Rates by Inclusion of the USA Football \u201eHeads Up Football\u201c Player Safety Coach. Orthop J Sport Med. 2016;4:2325967116648441. https:\/\/doi.org\/10.1177\/2325967116648441.","journal-title":"Orthop J Sport Med"},{"key":"1609_CR60","doi-asserted-by":"crossref","unstructured":"Schussler E, Jagacinski RJ, White SE, et al. The effect of tackling training on head accelerations in Youth American Football. Int J Sports Phys Ther 2018; 13:229\u2013237. http:\/\/ovidsp.ovid.com\/ovidweb.cgi?T=JS&PAGE=reference&D=prem2&NEWS=N&AN=30090681","DOI":"10.26603\/ijspt20180229"},{"key":"1609_CR61","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsams.2019.05.018","author":"EE Swartz","year":"2019","unstructured":"Swartz EE, Myers JL, Cook SB, et al. A helmetless-tackling intervention in American football for decreasing head impact exposure: a randomized controlled trial. J Sci Med Sport. 2019. https:\/\/doi.org\/10.1016\/j.jsams.2019.05.018.","journal-title":"J Sci Med Sport"},{"key":"1609_CR62","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0000000000002046","author":"AA Champagne","year":"2019","unstructured":"Champagne AA, DiStefano V, Boulanger M-M, et al. Data-informed intervention improves football technique and reduces head impacts. Med Sci Sports Exerc. 2019. https:\/\/doi.org\/10.1249\/MSS.0000000000002046.","journal-title":"Med Sci Sports Exerc"},{"key":"1609_CR63","doi-asserted-by":"publisher","first-page":"232596711559457","DOI":"10.1177\/2325967115594578","volume":"3","author":"ZY Kerr","year":"2015","unstructured":"Kerr ZY, Yeargin S, Valovich McLeod TC, et al. Comprehensive coach education and practice contact restriction guidelines result in lower injury rates in youth American football. Orthop J Sport Med. 2015;3:2325967115594578. https:\/\/doi.org\/10.1177\/2325967115594578.","journal-title":"Orthop J Sport Med"},{"key":"1609_CR64","doi-asserted-by":"publisher","first-page":"1710","DOI":"10.1177\/0363546514530091","volume":"42","author":"JA Rosenthal","year":"2014","unstructured":"Rosenthal JA, Foraker RE, Collins CL, et al. national high school athlete concussion rates from 2005\u20132006 to 2011\u20132012. Am J Sports Med. 2014;42:1710\u20135. https:\/\/doi.org\/10.1177\/0363546514530091.","journal-title":"Am J Sports Med"},{"key":"1609_CR65","unstructured":"Parachute. Canadian Guideline on Concussion in Sport. Toronto, Ont.; 2017. Im Internet: https:\/\/parachute.ca\/wp-content\/uploads\/2019\/06\/Canadian-Guideline-on-Concussion-in-Sport.pdf"},{"key":"1609_CR66","doi-asserted-by":"crossref","unstructured":"Ferdinand Pennock K, McKenzie B, McClemont Steacy L, et al. Under-reporting of sport-related concussions by adolescent athletes: a systematic review. Int Rev Sport Exerc Psychol 2020: 1\u201327","DOI":"10.1080\/1750984X.2020.1824243"},{"key":"1609_CR67","doi-asserted-by":"crossref","unstructured":"McCrea M, Hammeke T, Olsen G, et al. Unreported concussion in high school football players: implications for prevention. Clin J Sport Med 2004; 14:13\u201317. http:\/\/ovidsp.ovid.com\/ovidweb.cgi?T=JS&PAGE=reference&D=med5&NEWS=N&AN=14712161","DOI":"10.1097\/00042752-200401000-00003"},{"key":"1609_CR68","doi-asserted-by":"publisher","first-page":"663","DOI":"10.1136\/bjsports-2020-102967","volume":"55","author":"J van Ierssel","year":"2021","unstructured":"van Ierssel J, Osmond M, Hamid J, et al. What is the risk of recurrent concussion in children and adolescents aged 5\u201318 years? A systematic review and meta-analysis. Br J Sports Med. 2021;55:663\u20139.","journal-title":"Br J Sports Med"},{"key":"1609_CR69","doi-asserted-by":"crossref","unstructured":"Marshall SW, Guskiewicz KM, Shankar V, et al. Epidemiology of sports-related concussion in seven US high school and collegiate sports. Inj Epidemiol 2015; 2:13. http:\/\/ovidsp.ovid.com\/ovidweb.cgi?T=JS&PAGE=reference&D=prem&NEWS=N&AN=27747745","DOI":"10.1186\/s40621-015-0045-4"},{"key":"1609_CR70","doi-asserted-by":"publisher","first-page":"232596712090329","DOI":"10.1177\/2325967120903294","volume":"8","author":"AV Austin","year":"2020","unstructured":"Austin AV, Sasser P, Tanabe K, et al. Video analysis of concussion exposures in a national collegiate athletic association division I football team. Orthop J Sport Med. 2020;8:2325967120903294. https:\/\/doi.org\/10.1177\/2325967120903294.","journal-title":"Orthop J Sport Med"},{"key":"1609_CR71","first-page":"221","volume":"42","author":"R Dick","year":"2007","unstructured":"Dick R, Ferrara MS, Agel J, et al. Descriptive epidemiology of collegiate men\u2019s football injuries: National Collegiate Athletic Association Injury Surveillance System, 1988\u20131989 through 2003\u20132004. J Athl Train. 2007;42:221\u201333.","journal-title":"J Athl Train"},{"key":"1609_CR72","doi-asserted-by":"publisher","first-page":"2086","DOI":"10.1007\/s10439-019-02309-x","volume":"47","author":"ET Campolettano","year":"2019","unstructured":"Campolettano ET, Rowson S, Duma SM, et al. Factors affecting head impact exposure in college football practices: a multi-institutional study. Ann Biomed Eng. 2019;47:2086\u201393. https:\/\/doi.org\/10.1007\/s10439-019-02309-x.","journal-title":"Ann Biomed Eng"},{"key":"1609_CR73","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1001\/jamaneurol.2020.5193","volume":"78","author":"MA McCrea","year":"2021","unstructured":"McCrea MA, Shah A, Duma S, et al. Opportunities for prevention of concussion and repetitive head impact exposure in college football players: a Concussion Assessment, Research, and Education (CARE) Consortium study. JAMA Neurol. 2021;78:346\u201350.","journal-title":"JAMA Neurol"},{"key":"1609_CR74","first-page":"e00095","volume":"6","author":"F O\u2019Leary","year":"2020","unstructured":"O\u2019Leary F, Acampora N, Hand F, et al. Association of artificial turf and concussion in competitive contact sports: a systematic review and meta-analysis. BMJ Open Sport Exerc Med. 2020;6:e00095.","journal-title":"BMJ Open Sport Exerc Med"},{"key":"1609_CR75","doi-asserted-by":"publisher","first-page":"232596711663922","DOI":"10.1177\/2325967116639222","volume":"4","author":"DW Lawrence","year":"2016","unstructured":"Lawrence DW, Comper P, Hutchison MG. Influence of extrinsic risk factors on national football league injury rates. Orthop J Sport Med. 2016;4:2325967116639222. https:\/\/doi.org\/10.1177\/2325967116639222.","journal-title":"Orthop J Sport Med"},{"key":"1609_CR76","doi-asserted-by":"publisher","first-page":"2269","DOI":"10.1177\/0363546516645070","volume":"44","author":"Z Houck","year":"2016","unstructured":"Houck Z, Asken B, Bauer R, et al. Epidemiology of sport-related concussion in an NCAA Division I football bowl subdivision sample. Am J Sports Med. 2016;44:2269\u201375. https:\/\/doi.org\/10.1177\/0363546516645070.","journal-title":"Am J Sports Med"},{"key":"1609_CR77","doi-asserted-by":"publisher","first-page":"1134","DOI":"10.1177\/0363546515570622","volume":"43","author":"ZY Kerr","year":"2015","unstructured":"Kerr ZY, Hayden R, Dompier TP, et al. Association of equipment worn and concussion injury rates in National Collegiate Athletic Association football practices: 2004\u20132005 to 2008\u20132009 academic years. Am J Sports Med. 2015;43:1134\u201341.","journal-title":"Am J Sports Med"},{"key":"1609_CR78","doi-asserted-by":"publisher","first-page":"933","DOI":"10.1177\/0363546518825361","volume":"47","author":"ZY Kerr","year":"2019","unstructured":"Kerr ZY, Cortes N, Ambegaonkar JP, et al. The epidemiology of injuries in Middle School Football, 2015\u20132017: the advancing healthcare initiatives for underserved students project. Am J Sports Med. 2019;47:933\u201341. https:\/\/doi.org\/10.1177\/0363546518825361.","journal-title":"Am J Sports Med"},{"key":"1609_CR79","doi-asserted-by":"publisher","first-page":"919","DOI":"10.3171\/2014.1.JNS13916","volume":"120","author":"S Rowson","year":"2014","unstructured":"Rowson S, Duma SM, Greenwald RM, et al. Can helmet design reduce the risk of concussion in football? Technical note J Neurosurg. 2014;120:919\u201322. https:\/\/doi.org\/10.3171\/2014.1.JNS13916.","journal-title":"Technical note J Neurosurg"},{"key":"1609_CR80","unstructured":"DeArdo B. VICIS creates the first football helmet designed specifically to better protect linemen. CBS Sport 2021. Im Internet: https:\/\/www.cbssports.com\/nfl\/news\/vicis-creates-the-first-football-helmet-designed-specifically-to-better-protect-linemen\/"},{"key":"1609_CR81","doi-asserted-by":"crossref","unstructured":"Chisholm DA, Black AM, Palacios-Derflingher L, et al. Mouthguard use in youth ice hockey and the risk of concussion: nested case\u2013control study of 315 cases. Br J Sports Med 2020.","DOI":"10.1136\/bjsports-2019-101011"},{"key":"1609_CR82","doi-asserted-by":"publisher","first-page":"2035","DOI":"10.1001\/jama.2018.14165","volume":"320","author":"DJ Wiebe","year":"2018","unstructured":"Wiebe DJ, D\u2019Alonzo BA, Harris R, et al. Association between the experimental kickoff rule and concussion rates in Ivy League football. JAMA. 2018;320:2035\u20136.","journal-title":"JAMA"},{"key":"1609_CR83","unstructured":"Maske M. Concussions were down this past season on NFL kickoffs. Washington Post 2019. Im Internet: https:\/\/www.washingtonpost.com\/sports\/2019\/03\/01\/concussions-were-down-this-past-season-nfl-kickoffs\/"},{"key":"1609_CR84","doi-asserted-by":"publisher","first-page":"955","DOI":"10.4085\/1062-6050-52.7.06","volume":"52","author":"ZY Kerr","year":"2017","unstructured":"Kerr ZY, Yeargin SW, Djoko A, et al. Examining play counts and measurements of injury incidence in youth football. J Athl Train. 2017;52:955\u201365. https:\/\/doi.org\/10.4085\/1062-6050-52.7.06.","journal-title":"J Athl Train"},{"key":"1609_CR85","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1177\/03635465020300040201","volume":"30","author":"S Lyman","year":"2002","unstructured":"Lyman S, Fleisig GS, Andrews JR, et al. Effect of pitch type, pitch count, and pitching mechanics on risk of elbow and shoulder pain in youth baseball pitchers. Am J Sports Med. 2002;30:463\u20138.","journal-title":"Am J Sports Med"},{"key":"1609_CR86","doi-asserted-by":"publisher","first-page":"1140","DOI":"10.1136\/bjsports-2016-097434","volume":"51","author":"MD Hislop","year":"2017","unstructured":"Hislop MD, Stokes KA, Williams S, et al. Reducing musculoskeletal injury and concussion risk in schoolboy rugby players with a pre-activity movement control exercise programme: a cluster randomised controlled trial. Br J Sports Med. 2017;51:1140\u20136. https:\/\/doi.org\/10.1136\/bjsports-2016-097434.","journal-title":"Br J Sports Med"},{"key":"1609_CR87","unstructured":"Morrow P, Johnston D. Football Makes Bold Pivot. Sport Inf Resour Cent 2020. https:\/\/sirc.ca\/blog\/football-makes-bold-pivot\/. Stand: 13.10.2020"},{"key":"1609_CR88","doi-asserted-by":"crossref","unstructured":"Waltzman D, Sarmiento K, Devine O, et al. Head impact exposures among youth tackle and flag American football athletes. Sports Health 2021: 1941738121992324","DOI":"10.1177\/1941738121992324"},{"key":"1609_CR89","doi-asserted-by":"publisher","first-page":"206","DOI":"10.1097\/JSM.0000000000000214","volume":"26","author":"BL Anderson","year":"2016","unstructured":"Anderson BL, Gittelman MA, Mann JK, et al. High school football players\u2019 knowledge and attitudes about concussions. Clin J Sport Med. 2016;26:206\u20139. https:\/\/doi.org\/10.1097\/JSM.0000000000000214.","journal-title":"Clin J Sport Med"},{"key":"1609_CR90","unstructured":"Perry DN. Relationship of docosahexaenoic acid (DHA) intake to concussion incidence and recovery in the adolescent athlete population. ProQuest Diss Theses 2016. Im Internet: http:\/\/ezproxy.lib.ucalgary.ca\/login?url=https:\/\/search.proquest.com\/docview\/1806539430?accountid=9838"},{"key":"1609_CR91","doi-asserted-by":"publisher","unstructured":"J.W. P. Traumatic brain injury in high school athletes. J Am Med Assoc 1999; 282:958\u2013963. https:\/\/doi.org\/10.1001\/jama.282.10.958","DOI":"10.1001\/jama.282.10.958"},{"key":"1609_CR92","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1080\/15438620390231175","volume":"11","author":"ED Zemper","year":"2003","unstructured":"Zemper ED. A two-year prospective study of cerebral concussion in american football. Res Sport Med. 2003;11:157\u201372. https:\/\/doi.org\/10.1080\/15438620390231175.","journal-title":"Res Sport Med"},{"key":"1609_CR93","doi-asserted-by":"publisher","first-page":"3498","DOI":"10.1177\/0363546519882034","volume":"47","author":"J Alois","year":"2019","unstructured":"Alois J, Bellamkonda S, Campolettano ET, et al. Do American youth football players intentionally use their heads for high-magnitude impacts? Am J Sports Med. 2019;47:3498\u2013504.","journal-title":"Am J Sports Med"},{"key":"1609_CR94","doi-asserted-by":"publisher","first-page":"604","DOI":"10.3171\/2017.5.PEDS17185","volume":"20","author":"ET Campolettano","year":"2017","unstructured":"Campolettano ET, Gellner RA, Rowson S. High-magnitude head impact exposure in youth football. J Neurosurg Pediatr. 2017;20:604\u201312. https:\/\/doi.org\/10.3171\/2017.5.PEDS17185.","journal-title":"J Neurosurg Pediatr"},{"key":"1609_CR95","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3171\/2019.2.PEDS18176","volume":"1","author":"RA Gellner","year":"2019","unstructured":"Gellner RA, Campolettano ET, Smith EP, et al. Are specific players more likely to be involved in high-magnitude head impacts in youth football? J Neurosurg Pediatr. 2019;1:1\u20137. https:\/\/doi.org\/10.3171\/2019.2.PEDS18176.","journal-title":"J Neurosurg Pediatr"},{"key":"1609_CR96","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3171\/2019.2.PEDS18558","volume":"1","author":"JE Urban","year":"2019","unstructured":"Urban JE, Flood WC, Zimmerman BJ, et al. Evaluation of head impact exposure measured from youth football game plays. J Neurosurg Pediatr. 2019;1:1\u201310. https:\/\/doi.org\/10.3171\/2019.2.PEDS18558.","journal-title":"J Neurosurg Pediatr"}],"container-title":["Sports Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s40279-021-01609-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s40279-021-01609-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s40279-021-01609-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,14]],"date-time":"2024-09-14T07:24:44Z","timestamp":1726298684000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s40279-021-01609-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,11]]},"references-count":96,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2022,6]]}},"alternative-id":["1609"],"URL":"https:\/\/doi.org\/10.1007\/s40279-021-01609-4","relation":{},"ISSN":["0112-1642","1179-2035"],"issn-type":[{"value":"0112-1642","type":"print"},{"value":"1179-2035","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,11]]},"assertion":[{"value":"21 November 2021","order":1,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 December 2021","order":2,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"We acknowledge support from the Hotchkiss Brain Institute and Alberta Children\u2019s Hospital Research Institute. Carolyn A. Emery holds a Canada Research Chair in Concussion.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Funding"}},{"value":"None of the authors have any conflicts of interest to declare.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of Interests"}},{"value":"The corresponding extracted data from this systematic review and meta-analysis (beyond what has been included in the electronic supplementary material) are available from the corresponding author upon request.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Availability of Data and Material"}},{"value":"MPP, RAS, AK, AH, CD, MM, BH, and CE contributed to the study proposal development. AH guided the development of the search strategy and the resulting search process. MPP, RAS, and AK led data extraction and methodological quality review as well as title, abstract, and full-text review. MPP led the data analysis and first manuscript draft, and MPP, RAS, AK, AH, CD, MM, BH, and CE contributed to interpretation of study results and critical review and editing of the manuscript before submission.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Author Contributions"}}]}}