FRIDAY, July 6 (HealthDay News) -- The number of catastrophic head injuries in high school football far exceeds the number of such injuries in college football, a new study finds.
In addition, the number of high school players who receive such head injuries and then play with residual effects is "unacceptably high," according to the report in the July issue of The American Journal of Sports Medicine.
Catastrophic brain trauma can include brain bleeding and swelling. While rare, it can result in permanent brain damage, experts warn.
But they also note that better headgear means the rate of football-linked brain trauma has fallen over generations.
"These injuries were much more common in the 1950s and '60s," said lead researcher Dr. Barry P. Boden of the Orthopedic Center in Rockville, Md. "With the advent of the modern helmet, the number of these injuries have gone down," Boden said.
Playing with a head injury can be dangerous, however. "Players should never go back to participating in football with any kind of neurological symptoms," advised Boden, who is also an associate professor at the Uniform Services University of the Health Sciences in Bethesda, Md.
In the study, the researchers studied 94 cases of severe football head injuries that occurred among U.S. athletes between September 1989 and June 2002.
They found that there is about one such injury for every 150,000 high school football players. This translates to seven catastrophic head injuries each year.
High school players have more than triple the risk of sustaining catastrophic head trauma compared to college players, the researchers found. High school athletes suffered 0.67 such injuries per 100,000 players compared with 0.21 injuries per 100,000 for college players.
There may be several reasons for this, Boden said. The brain of the high school player may not be fully developed or his skull bone may be thinner, making injury more likely, he said.
"It is also possible because there is less medical coverage at high school games, so that players are not being evaluated properly," Boden said. "It is also known that younger players take longer to recover from a concussion, and it is possible that some of these players are going back to play too soon and are vulnerable to more serious catastrophic injury," he said.
Boden's group contacted or reviewed the medical records of 59 of the players who had had a catastrophic head injury. Among these, 59 percent had a history of previous head injury and, for 71 percent, the earlier injury happened during the same season as the catastrophic injury.
About 40 percent of the injured players continued to play even though they had symptoms from the earlier head injury. Catastrophic head injuries resulted in 8 deaths, 46 permanent brain injuries and 36 serious injuries where the patient had a full recovery, the researchers found.
Boden believes high school football players should be discouraged from "leading with the head" -- using their heads to tackle. Of all the catastrophic head injuries, 81 percent resulted from helmet-to-helmet collisions and helmet-to-body collisions, he noted.
One expert agreed that players need to be more cautious.
"While the incidence of catastrophic head injuries in football appears to have decreased since the 1960s, they continue to occur and are particularly tragic," said Dr. James Linakis, a research associate at the Injury Prevention Center at Rhode Island Hospital and a pediatric emergency physician at Hasbro Children's Hospital in Providence.
But the study also leaves many unanswered questions, Linakis said. "Why is this type of injury so much more common in high school than in college players? Is there a developmental factor involved? Are high school athletes less emotionally mature and therefore less likely to report residual symptoms to the coaching staff? Are high school coaches and trainers less prepared to recognize signs and symptoms of potentially serious injury?" he wondered.
Linakis, who is also an associate professor of emergency medicine and pediatrics at Brown Medical School, agreed that "leading with the head" should be discouraged. "In addition, players who have received a concussion should be encouraged to report symptoms to the training staff and should be withheld from play until medically cleared," he said.
Many catastrophic head injuries resulted not from a major blow to the head but from multiple minor collisions, Linakis added. "Efforts to reduce this type of repetitive injury to the brain may also be important in reducing the incidence of catastrophic head injuries in high school football players," he said.
For more information on head injury, visit the U.S. National Institute of Neurological Disorders and Stroke.
SOURCES: Barry P. Boden, M.D., physician, Orthopedic Center, Rockville, Md., and adjunct associate professor, Uniform Services University of the Health Sciences, Bethesda, Md.; James G. Linakis, M.D., Ph.D., research associate, Injury Prevention Center, Rhode Island Hospital, pediatric emergency physician, Hasbro Children's Hospital, associate professor of emergency medicine and pediatrics, Brown Medical School, Providence, R.I; July 2007, The American Journal of Sports Medicine