Risk of Concussion After a Targeting Foul in Collegiate American Football

Douglas F Aukerman; Adam D Bohr; Sourav K Poddar; Russell Romano; David J Petron; Jamshid Ghajar; Christopher C Giza; Angela Lumba-Brown; Matthew B McQueen; Kimberly G Harmon

doi:10.1177/23259671221074656

Risk of Concussion After a Targeting Foul in Collegiate American Football

Orthop J Sports Med. 2022 Feb 4;10(2):23259671221074656. doi: 10.1177/23259671221074656. eCollection 2022 Feb.

Authors

Affiliations

¹ Sports Medicine, Samaritan Health Services, Corvallis, Oregon, USA.
² Oregon State University, Corvallis, Oregon, USA.
³ Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA.
⁴ Family Medicine and Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA.
⁵ Athletic Medicine, University of Southern California, Los Angeles, California, USA.
⁶ Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA.
⁷ Neurosurgery, Brain Performance Center, Stanford University, Stanford, California, USA.
⁸ Pediatrics and Neurosurgery, University of California, Los Angeles, California, USA.
⁹ Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA.
¹⁰ Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington, USA.

Abstract

Background: The targeting rule was adopted by the National Collegiate Athletic Association (NCAA) in 2008 to discourage dangerous contact during collegiate American football competition. Although targeting rules have been emphasized as a means to reduce concussion rates, there is currently no evidence that targeting plays are higher risk for concussion than other plays in American football.

Purpose: To compare the rate of concussion occurring during targeting versus nontargeting plays in American collegiate football.

Study design: Cross-sectional study.

Methods: Concussions occurring in games in the 2016-2019 Pac-12 Conference were classified as having occurred during either (1) a play where a targeting penalty was called or (2) all other plays. Targeting plays were further categorized to either those in which the call was upheld or those overturned by the on-field official after replay review. The number of targeting plays and the total number of plays during games were also recorded. Concussion incidence (per 1000 plays) and risk ratios were calculated.

Results: Overall, 538 games with 68,670 plays were reviewed, during which 213 concussions occurred (15 during plays where targeting was called and 198 on other plays) and 141 targeting penalties were called. The incidence of concussion was 106.4/1000 plays for targeting plays (including 141.2/1000 upheld targeting fouls and 53.6/1000 overturned targeting fouls) and 2.9/1000 plays for nontargeting plays. The risk of concussion during targeting plays was 36.9 (95% CI, 22.4-60.7) times greater than that for all other plays. The risk of concussion during targeting plays upheld was 49.0 (95% CI, 28.5-84.2) times greater than that for all other plays.

Conclusion: Concussion risk was significantly higher during plays in which targeting was called, especially those in which targeting fouls were upheld.

Clinical relevance: This study supports eliminating or reducing targeting from American football. The results of this study suggest that players should be screened for concussion after targeting plays are called.

Keywords: football (American); head injuries/concussion; injury prevention; targeting.