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Individual Impact Magnitude vs. Cumulative Magnitude for Estimating Concussion Odds

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Abstract

Helmeted impact devices have allowed researchers to investigate the biomechanics of head impacts in vivo. While increased impact magnitude has been associated with greater concussion risk, a definitive concussive threshold has not been established. It is likely that concussion risk is not determined by a single impact itself, but a host of predisposing factors. These factors may include genetics, fatigue, and/or prior head impact exposure. The objective of the current paper is to investigate the association between cumulative head impact magnitude and concussion risk. It is hypothesized that increased cumulative magnitudes will be associated with greater concussion risk. This retrospective analysis included participants that were recruited from regional high-schools in Illinois and Michigan from 2007 to 2014 as part of an ongoing study on concussion biomechanics. Across seven seasons, 185 high school football athletes were instrumented with the Head Impact Telemetry system. Out of 185 athletes, 31 (17%) sustained a concussion, with two athletes sustaining two concussions over the study period, yielding 33 concussive events. The system recorded 78,204 impacts for all concussed players. Linear acceleration, rotational acceleration, and head impact telemetry severity profile (HITsp) magnitudes were summed within five timeframes: the day of injury, three days prior to injury, seven days prior to injury, 30 days prior to injury, and prior in-season exposure. Logistic regressions were modeled to explain concussive events based on the singular linear acceleration, rotational acceleration, and HITsp event along with the calculated summations over time. Linear acceleration, rotational acceleration, and HITsp all produced significant models estimating concussion (p < 0.05). The strongest estimators of a concussive impact were the linear acceleration (OR = 1.040, p < 0.05), rotational acceleration (OR = 1.001, p < 0.05), and HITsp (OR = 1.003, p < 0.05) for the singular impact rather than any of the cumulative magnitude calculations. Moreover, no cumulative count measure was significant for linear or rotational acceleration. Results from this investigation support the growing literature indicating cumulative magnitude is not related to concussion likelihood. Cumulative magnitude is a simplistic measure of the total exposure sustained by a player over a given period. However, this measure is limited as it assumes the brain is a static structure unable to undergo self-repair. Future research should consider how biological recovery between impacts may influence concussion risk.

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Acknowledgments

The authors would like to acknowledge the assistance of Dr’s Douglas Martini and Richelle Williams along with the coaches, players, and staff of Unity High School (Tolono, IL), Skyline High School (Ann Arbor, MI), and Father Gabriel Richard High School (Ann Arbor, MI). This investigation was funded by the National Institutes of Health: National Institute of Neurological Disorders and Stroke (1R15NS081691-01).

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Authors and Affiliations

  1. NeuroTrauma Research Laboratory, University of Michigan School of Kinesiology, Ann Arbor, MI, USA

    Kathryn L. O’Connor

  2. Erasmus School of Economics, Postbus 1738, 3000 DR, Rotterdam, The Netherlands

    Thomas Peeters

  3. University of Michigan School of Kinesiology, Ann Arbor, MI, USA

    Stefan Szymanski

  4. NeuroTrauma Research Laboratory, University of Michigan Injury Center, University of Michigan School of Kinesiology, Ann Arbor, MI, USA

    Steven P. Broglio

Authors
  1. Kathryn L. O’Connor
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  2. Thomas Peeters
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  3. Stefan Szymanski
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  4. Steven P. Broglio
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Correspondence to Kathryn L. O’Connor.

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Associate Editor Stefan M. Duma oversaw the review of this article.

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O’Connor, K.L., Peeters, T., Szymanski, S. et al. Individual Impact Magnitude vs. Cumulative Magnitude for Estimating Concussion Odds. Ann Biomed Eng 45, 1985–1992 (2017). https://doi.org/10.1007/s10439-017-1843-3

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  • DOI: https://doi.org/10.1007/s10439-017-1843-3

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