Let's get the head further out of the game: a proposal for reducing brain injuries in helmeted contact sports.

Sports-related brain injuries rapidly are reaching epidemic levels, with an estimated incidence range of 1.6 to 3.8 million in the United States per year (7,17). These values likely underestimate the true incidence because of underreporting by athletes (18), and the limitations of current national injury databases (7,17) have prompted Congress to mandate the U.S. Centers for Disease Control and Prevention (CDC) to determine how best to measure the rate of new cases (7). Concussion rates in 15 sports at the collegiate level have increased at an estimated rate of 7% per year over the last two decades (14). Men's football consistently has one of the highest concussion rates per athletic-exposure (AE) (5) (0.371000"^AE during fall and 0.541000"^ AE in spring). Men's ice hockey poses a similar risk of concussion injury (0.41 1000"' AE), whereas data from women's ice hockey, collected over a much shorter time period, reported rates more than twice these, at 0.911000 ^ AE (14). At the youth level, the incidence of concussion injury is not as well established, but existing data from emergency department and hospital admissions indicate that the injury rate may be several times higher among children than in the general adult population (15). New technology capable of measuring head impacts during practices and games allows head impact exposure to be defined more fully by recording the severity of each head impact, the location of the impact on the helmet, and the number of head impacts individual players receive over the course of a season, and potentially throughout their career (4).