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Author Notes:

Kristy B. Arbogast, PhD, Children’s Hospital of Philadelphia, 2716 South Street, Philadelphia, PA 19146, USA Email: arbogast@chop.edu

The authors thank members of the research team for their contributions to data collection: Ronni Kessler, Fairuz Mohammed, Shelly Sharma, Ari Fish, and Julia Vanni. In addition, the authors thank the students and parents from the Shipley School for their participation.

AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.


Research Funding:

Research reported in this publication was supported by the Pennsylvania Department of Health and the National Institute of Neurologic Disorders and Stroke of the National Institutes of Health (RO1NS097549)


  • Science & Technology
  • Life Sciences & Biomedicine
  • Orthopedics
  • Sport Sciences
  • head injuries
  • concussion
  • pediatric sports medicine
  • injury prevention
  • football (soccer)
  • basketball
  • lacrosse

Sport- and Gender-Based Differences in Head Impact Exposure and Mechanism in High School Sports


Journal Title:



Volume 9, Number 3


, Pages 2325967120984423-2325967120984423

Type of Work:

Article | Final Publisher PDF


Background: Repeated head impacts sustained by athletes have been linked to short-term neurophysiologic deficits; thus, there is growing concern about the number of head impacts sustained in sports. Accurate head impact exposure data obtained via head impact sensors may help identify appropriate strategies across sports and between genders to mitigate repetitive head impacts. Purpose: To quantify sport- and gender-based differences in head impact rate and mechanism for adolescents. Study Design: Cohort study; Level of evidence, 2. Methods: High school female and male varsity soccer, basketball, lacrosse, and field hockey (female only) teams were instrumented with headband-mounted impact sensors during games over 2 seasons of soccer and 1 season of basketball, lacrosse, and field hockey. Video review was used to remove false-positive sensor-recorded events, and the head impact rate per athlete-exposure (AE) was calculated. Impact mechanism was categorized as equipment to head, fall, player to head, or head to ball (soccer only). Results: Male players had significantly higher head impact rates as compared with female players in soccer (3.08 vs 1.41 impacts/AE; rate ratio, 2.2 [95% CI, 1.8-2.6]), basketball (0.90 vs 0.25; 3.6 [2.6-4.6]), and lacrosse (0.83 vs 0.06; 12.9 [10.1-15.8]). Impact mechanism distributions were similar within sports between boys and girls. In soccer, head to ball represented 78% of impacts, whereas at least 88% in basketball were player-to-player contact. Conclusion: Across sports for boys and girls, soccer had the highest impact rate. Male high school soccer, basketball, and lacrosse teams had significantly higher head impact rates than did female teams of the same sport. For girls, basketball had a higher head impact rate than did lacrosse and field hockey, and for boys, basketball had a similar impact rate to lacrosse, a collision sport. Sport differences in the distribution of impact mechanisms create sport-specific targets for reducing head impact exposure.

Copyright information:

© The Author(s) 2021

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (https://creativecommons.org/licenses/by-nc-nd/4.0/rdf).
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