Hoffer, Alexander

Objectives: Soccer is one of the most popular youth sports in the United States and worldwide. Due to growing concerns regarding repeated head trauma, in 2015 the United States Soccer Federation (USSF) banned headers for athletes aged 10 and under and limited athletes aged 11 to 13 to practicing headers for 30 minutes per week. The purpose of this study was to assess whether the USSF header policy was associated with fewer soccer-related concussions that presented to emergency departments following the 2015 season. Methods: A retrospective cohort from the National Electronic Injury Surveillance System database was assessed. Age, sex, and injury type were extracted for all soccer-related emergency department visits between January 1st, 2012, and December 31st, 2023. Univariate and multivariable regression analyses were conducted to assess concussions as a percentage of all soccer-related injuries based on sex, age, and year. Results: The number of concussions as a percentage of all soccer-related injuries decreased from 8.2% in 2012-2015 to 6.1% in 2020-2023 (p<0.01). From 2012-2023, the concussion rate among 14-17-year-olds and 10-13-year-olds was higher than 6-9-year-olds (8.9% and 6.6% compared to 4.9%, p<0.01). Despite a lower soccer-related injury rate overall, females were diagnosed with a greater proportion of concussions than males (9.6% compared to 6.2%, p<0.01). In a multivariable regression analysis, injuries that occurred in the years 2020-2023 were associated with lower odds of concussion compared to 2012-2015 (OR: 0.75, 95% CI: 0.69- 0.81). The 10-13-year-old age group, 14-17-year-old age group, and female sex were associated with higher odds of concussion compared to the 6-9-year-old age group and male sex respectively (OR: 1.30, 95% CI: 1.16- 1.45; OR: 1.79, 95% CI: 1.61- 1.99; OR: 1.53, 95% CI: 1.43- 1.63). Conclusions: The USSF youth soccer header policy introduced in 2015 was associated with a 25.6% relative risk reduction to sustain a soccer-related concussion and present to the emergency department in 2020-2023 compared to 2012-2015. A header ban in players under 10 years old and limitation to 30 minutes of header practice a week in players under 13 years old may improve player safety by reducing head impacts in the youth population.

Background: Because of growing concerns regarding repeated head trauma, in 2016, the United States Soccer Federation (USSF) banned headers for athletes aged ≤10 years and limited athletes aged 11 to 13 years to practicing headers for 30 minutes per week. Purpose: To assess whether the USSF header policy was associated with fewer soccer-related concussions after the 2015 season. Study Design: Descriptive epidemiology study. Methods: A retrospective cohort from the National Electronic Injury Surveillance System database was assessed. Age, sex, and injury type were extracted for all soccer-related emergency department visits between January 1, 2012, and December 31, 2023. Univariate and multiple regression analyses were used to assess concussions as a percentage of all soccer-related injuries based on sex, age group (6-9, 10-13, and 14-17 years), and year. The following time frames were assessed: 2012-2015, 2016-2019, and 2020-2023. Results: The proportion of concussions decreased from 8.2% of all soccer-related injuries in 2012-2015 to 6.1% in 2020-2023 ( P < .01). The relative risk reduction for soccer-related concussions presenting to an emergency department in 2020-2023 compared with 2012-2015 was 25.6%. Overall, the proportion of concussions among 10- to 13-year-old and 14- to 17-year-old players was higher than for 6- to 9-year-old players (6.6% and 8.9% vs 4.9%, respectively; P < .01). Despite having a lower frequency of soccer-related injuries overall, female players had a greater proportion of concussions than male players (9.6% vs 6.2% of all soccer-related injuries; P < .01). In the multiple regression analysis, injuries that occurred in 2020-2023 were associated with lower odds of concussion compared with 2012-2015 (odds ratio [OR], 0.75 [95% CI, 0.69-0.81]). Compared with 6- to 9-year-old and male players, the 10- to 13-year-old (OR, 1.30 [95% CI, 1.16-1.45]), 14- to 17-year-old (OR, 1.79 [95% CI, 1.61-1.99]), and female players (OR, 1.53 [95% CI, 1.43-1.63]) were associated with higher odds of concussion. Conclusion: A 25.6% reduction in the relative risk of presenting to the emergency department with a soccer-related concussion was found when comparing 2020-2023 (after USSF header policy implementation) with 2012-2015 (before policy implementation). The USSF youth soccer header policy may improve player safety by reducing head impacts in the pediatric population.