Characterizing Concussion in Boys High School Lacrosse: Epidemiological, Biomechanical and Neuropsychological Dimensions.

Project Title: Epidemiology of MTBI in Boys’ and Girls’ High School Lacrosse Players


Investigators, Title, Institution, and Role on Project:

Andrew E. Lincoln, ScD, MedStar Research Institute, Hyattsville, Md, Principal Investigator

Jon L. Almquist, ATC, VATL, Fairfax County Public Schools, Falls Church, Va, Co-Investigator

Shane V. Caswell, PhD, ATC, George Mason University, Manassas, Va., Co-Investigator




Background: Lacrosse, having a large player population at the high school level, is among the fastest growing team sports in the United States.  The prevention of mild traumatic brain injury (MTBI) is recognized by US Lacrosse, the sport’s governing body, as a priority issue. Our recent publication describing the epidemiology of boys’ high school lacrosse injuries identified MTBI events as the second most prevalent injury scenario, with 44% of cases resulting from legal body/object contact and 23% from illegal contact.(Hinton et al., 2005)  MTBI events ranked as the fifth most prevalent injury scenario among girls. What remains unknown are the specific play scenarios associated with MTBI, and the location and direction of these impacts. A better understanding of these event characteristics is required to develop appropriate interventions and treatment recommendations for the boys’ and girls’ high school lacrosse populations.


Goals & Aims:

The aims of this study are to:

  1. Identify common hazard scenarios (player and team activity, mechanism of injury) associated with MTBI among male and female high school lacrosse players using a computerized injury surveillance system.
  2. Document the characteristics of MTBI events, specifically contact location about the skull and direction of impact, using video incident analysis.
  3. Assess whether there is a positive association between the number of fouls called and the frequency of MTBI events per game.
  4. Identify differences in mechanism of MTBI, player activity, team activity, and contact location between girls and boys.


Methods: This prospective study will follow male and female high school lacrosse players in Fairfax County (Va.) Public Schools (FCPS) over 2 years (5000 player-seasons) during 2008-2009.  Injury surveillance data will be collected by FCPS certified athletic trainers using the computer-based Sports Injury Monitoring System (SIMS, Flantech Computer Services).  The SIMS system, supplemented by a lacrosse-specific injury information form, captures data on player activity (shooting, passing, off-ball, transition), mechanism of injury (non-contact, legal contact, illegal contact), player position, location on field, and team activity (settled or unsettled offense, settled or unsettled defense).  Videotapes of concussive events in game situations will be reviewed to document the scenario characteristics associated with MTBI.  Study findings will inform clinicians, sport officials, scientists, and policy makers of the actual mechanisms most often resulting in game-related MTBI in boys’ and girls’ high school lacrosse. Such information is critical for appropriate establishment of NOCSAE standards that target MTBI.


Total Budget: $328,000 for 2 years