Epidemiology

Mild traumatic brain injury (TBI) is estimated to affect 55.9 million people each year, with 4.6 million mild TBIs sustained in the United States of America (US) and Canada.[8] Mild TBI, which represents approximately 90% of all TBIs, increasingly affects aging populations who experience falls, and increasing incidence may also reflect rising numbers of road traffic collisions in low- and middle-income countries and widespread concerns regarding long-term effects of sports-related concussion.[9][10]

Between 1.1 and 1.9 million sports-related and recreation-related concussions occur annually in the US in children age ≤18 years, with a subset of approximately 400,000 sports-related concussions in high school athletes.[11][12]​ Between 2% and 15% of athletes of all ages participating in organized sports will suffer a concussion during one season.[3]

Concussions continue to be a problem in American football despite the increased awareness and changes to rules and equipment. Annual football concussion rates, including recreational, high school, collegiate, and professional levels, indicate that players have an annual concussion incidence estimated to be 4% to 20%.[13][14]​ Collegiate and high school American football players who sustain an initial concussion are three times more likely to sustain a second concussion in the same season.[15] One study found that 70.4% of American football players reported having experienced symptoms of a concussion during the previous year; only 23.4% of concussed football players realized they had suffered a concussion.[16]​ Concussion incidence rates appear to be significantly higher in females than in males for several team sports, including soccer, ice hockey, and basketball.[17][18][19] ​Women typically report more complex symptomatology and slower recovery in both sports-related and non-sports-related concussion.[2][20][21]​​[22]​​

Risk factors

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head injury

A mild traumatic brain injury results from a closed head injury due to a direct blow to the head or deceleration of the head from an impulsive force.[1]

previous brain trauma

Previous brain traumas lower the impact threshold, making mild traumatic brain injury more likely regardless of the force of impact and therefore increasing the chances of future brain trauma. This is an important risk factor in assessing outcome.[33]

alcohol and drug misuse

Alcohol and drug misuse is associated with a significantly higher risk for all forms of traumatic brain injury, but this is confounded by a higher overall risk for all forms of external injury.[34][35]

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poor neck strength

Poor overall neck strength has been associated with an increased risk of concussion in high school sports.[36][37]

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