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The prevention of catastrophic head and spine injuries in high school and college sports
  1. R C Cantu1,2,
  2. F O Mueller3
  1. 1
    Boston University School of Medicine, Boston, Massachusetts, USA
  2. 2
    Emerson Hospital, Concord, Massachusetts, USA
  3. 3
    University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  1. Correspondence to Dr R C Cantu, 131 ORNAC, John Cuming Building, Suite 820, Concord, MA 01742, USA; rcantu{at}

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The incidence of catastrophic injuries in sports at the high school and college levels is low, <0.5 per 100 000 participants, but even one is too many.1 Permanent paralysis, brain damage and death should not be associated with teenagers and young adults participating in high school and college athletics. Catastrophic injury is devastating not only to the injured athlete, but also to the athlete’s family, school and community.

Many of these injuries can be prevented by utilising proper data collection and proper medical care and safety precautions such as implementing safer rules, proper conditioning and coaching techniques.

While there are some sports with a higher incidence of catastrophic injury than others, there are also some sports with higher injury rates per 100 000 participants. For example, American football has the greatest number of catastrophic injuries, but it also has the greatest number of participants. Gymnastics, ice hockey, and cheerleading have higher rates per 100 000 participants than American football, but fewer participants and thus fewer total injuries. Table 1 gives the participation numbers for high school and college sports from the autumn of 1982 to the spring of 2008, and table 2 gives the injury rates per 100 000 participants.

View this table:
Table 1

Participation figures for 1982–3 and 2007–8

View this table:
Table 2

Direct injuries per 100 000 participants

Emphasis should be placed on the fact that no matter how low the incidence levels or rates per number of participants are, an increased effort should be placed on prevention of catastrophic injuries.


The collection of American football death data began in 1931, when the American Football Coaches Association initiated the first Annual Survey of Football Fatalities.2 The research has been carried out on a national level every year except for 1942 and has been conducted at the University of North Carolina, Chapel Hill since 1965. The title of the survey …

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  • Funding This research is supported by the National Collegiate Athletic Association, the National Federation of State High School Associations and the American Football Coaches Association.

  • Competing interests None.

  • Provenance and Peer review Not commissioned; externally peer reviewed.