{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T16:24:38Z","timestamp":1791908678232,"version":"4.3.4"},"reference-count":30,"publisher":"SAGE Publications","issue":"10","license":[{"start":{"date-parts":[[2021,10,1]],"date-time":"2021-10-01T00:00:00Z","timestamp":1633046400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Journal of Sports Medicine"],"published-print":{"date-parts":[[2021,10,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Concussions occur at higher rates in high school football as compared with all other high school sports. In 2014, the National Federation of State High School Associations implemented rules defining illegal contact against a defenseless player above the shoulders to reduce concussions in football players in the United States. To the best of our knowledge, rates of emergency department (ED)\u2014diagnosed concussions of high school football players before and after the 2014 rule implementation have not been compared.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Hypothesis:<\/jats:title>\n                    <jats:p>It was hypothesized that (1) there would be lower rates of helmet-to-helmet and helmet-to-body-part concussions after rule implementation and (2) alternative mechanisms of concussion would not differ, as these would be less influenced by rule implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Cohort study; Level of evidence, 3.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Data from the National Electronic Injury Surveillance System (NEISS) 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, and loss of consciousness. Raw data were used to calculate national estimates\u00a0based on the assigned statistical sample weight of each hospital by the NEISS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A total of 4983 (national estimate = 154,221) high school football concussions were diagnosed in US EDs; 58.8% of concussions occurred during competition and 41.2% during practice. Between 2009 and 2013 the rate of concussions diagnosed in EDs rose 10.7% as compared with a 6.2% decrease between 2015 and 2019 ( P = .04). Between 2009 and 2013, the rate of helmet-to-helmet concussions rose 17.6% as compared with a 5.6% decrease between 2015 and 2019 ( P = .03). There were no significant changes between other mechanisms of concussion before and after the 2014 rule implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>We identified a decreased trend in overall and helmet-to-helmet high school football concussions diagnosed in the ED after 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23259671211031191","type":"journal-article","created":{"date-parts":[[2021,10,15]],"date-time":"2021-10-15T13:32:51Z","timestamp":1634304771000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":23,"title":["Targeting Rule Implementation Decreases Concussions in High School Football: A National Concussion Surveillance Study"],"prefix":"10.1177","volume":"9","author":[{"given":"Kyle K.","family":"Obana","sequence":"first","affiliation":[{"name":"Division of Orthopaedic Surgery, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA."},{"name":"Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John D.","family":"Mueller","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan M.","family":"Saltzman","sequence":"additional","affiliation":[{"name":"Sports Medicine Center, OrthoCarolina, Charlotte, North Carolina, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas S.","family":"Bottiglieri","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher S.","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert L.","family":"Parisien","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Boston Medical Center, Boston University, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David P.","family":"Trofa","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2021,10,15]]},"reference":[{"key":"bibr1-23259671211031191","doi-asserted-by":"publisher","DOI":"10.4085\/1062-6050-51.5.02"},{"key":"bibr2-23259671211031191","doi-asserted-by":"publisher","DOI":"10.1177\/2325967117740887"},{"key":"bibr3-23259671211031191","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2014.3582"},{"key":"bibr4-23259671211031191","doi-asserted-by":"publisher","DOI":"10.4085\/1062-6050-44.4.342"},{"key":"bibr5-23259671211031191","doi-asserted-by":"publisher","DOI":"10.1007\/s10439-019-02382-2"},{"key":"bibr6-23259671211031191","author":"Colgate B","journal-title":"National Federation of State High School Associations"},{"key":"bibr7-23259671211031191","doi-asserted-by":"publisher","DOI":"10.1097\/00006123-200211000-00011"},{"key":"bibr8-23259671211031191","doi-asserted-by":"publisher","DOI":"10.4085\/1062-6050-45.5.467"},{"key":"bibr9-23259671211031191","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2018-3074"},{"key":"bibr10-23259671211031191","doi-asserted-by":"publisher","DOI":"10.1177\/2325967120903699"},{"key":"bibr11-23259671211031191","doi-asserted-by":"publisher","DOI":"10.1177\/0363546516645070"},{"key":"bibr12-23259671211031191","doi-asserted-by":"publisher","DOI":"10.1177\/2325967113517860"},{"key":"bibr13-23259671211031191","doi-asserted-by":"publisher","DOI":"10.1177\/0009922810390513"},{"key":"bibr14-23259671211031191","doi-asserted-by":"publisher","DOI":"10.1097\/JNN.0b013e31823858a6"},{"key":"bibr15-23259671211031191","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2015.04.011"},{"key":"bibr16-23259671211031191","doi-asserted-by":"publisher","DOI":"10.1097\/00001199-200609000-00001"},{"issue":"4","key":"bibr17-23259671211031191","first-page":"e592","volume":"8","author":"Lundberg GD","year":"2016","journal-title":"Cureus"},{"key":"bibr18-23259671211031191","doi-asserted-by":"publisher","DOI":"10.1097\/00042752-200401000-00003"},{"key":"bibr19-23259671211031191","doi-asserted-by":"publisher","DOI":"10.1097\/JSM.0b013e318291d3b3"},{"key":"bibr20-23259671211031191","unstructured":"National Federation of State High School Associations. High School Football Rules Changes Continue Focus on Risk Minimization. National Federation of State High School Associations. Published August 19, 2015. Accessed May 11, 2020. https:\/\/www.nfhs.org\/articles\/high-school-football-rules-changes-continue-focus-on-risk-minimization\/"},{"key":"bibr21-23259671211031191","doi-asserted-by":"publisher","DOI":"10.1177\/0363546519860120"},{"key":"bibr22-23259671211031191","unstructured":"Pielke R. The decline of football is real and it\u2019s accelerating. Forbes. January 28, 2020. Accessed September 29, 2020. http:\/\/www.forbes.com\/sites\/rogerpielke\/2020\/01\/28\/the-decline-of-football-is-real-and-its-accelerating"},{"key":"bibr23-23259671211031191","doi-asserted-by":"publisher","DOI":"10.1001\/jama.282.10.958"},{"key":"bibr24-23259671211031191","doi-asserted-by":"publisher","DOI":"10.4085\/1062-6050-43.2.197"},{"key":"bibr25-23259671211031191","unstructured":"Sondheimer E. \u201cTargeting\u201d is defined in high school football rule change. Los Angeles Times. February 13, 2014. 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