Key result
Pediatric football-related TBI carries a ~37% repeat injury rate and links to chronic headaches.
Why the study?
Does football-related TBI increase the risk of long-term neurologic and psychiatric outcomes compared to lower leg fractures in children and young adults?
Cohort (n=72,025)
Yes
Does football-related TBI increase the risk of long-term neurologic and psychiatric outcomes compared to lower leg fractures in children and young adults?
Football is a leading source of pediatric sports-related TBI and is associated with significant long-term neurologic and psychiatric sequelae.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“It's the emotional dysregulation, the depression, anxiety, the substance use, things that come up possibly years later, that really I found more surprising, because the headaches are well known. Headaches are the No. 1 symptom of post-concussion syndrome. But the emotional regulation may be a bit more subtle and something that's not necessarily picked up on without these kinds of large population studies.”
“I'm very scared of the flyers. I've seen way too many injuries. I've even seen people at the bottom of the pyramid be at risk. As a pediatric neurologist, I would never have thought of counseling a young cheerleader in middle school about the risk of concussion.”
May warrant targeted youth football concussion protocols; extends observational burden data but leaves causality and prevention impact open.
BACKGROUND AND OBJECTIVES: Sports-related traumatic brain injury (TBI) is among the most common causes of long-term neurologic and psychiatric morbidity in children and young adults. Football, in particular, has been implicated as a leading source of TBI, yet large-scale comparative studies across sports and developmental stages are limited. The objective of this study was to quantify the burden of football-related TBI in youth compared with other sports and recreational activities, and to evaluate long-term neurologic and psychiatric outcomes across developmental stages. METHODS: This retrospective cohort study used the TriNetX Research Network, encompassing >150 million patients. Children and young adults (≤25 years) with a first TBI and activity cause of morbidity recorded on the day of injury were identified based on ICD-10 codes. Patients with TBI were compared with patients with lower leg fractures in the same activity with no recorded TBI on neurologic, psychiatric, and developmental outcomes. Attributable risks were calculated between TBI and lower leg fracture patients matched 1:1 on age category and sex. Prevalent cases were excluded. Multivariate Cox proportional hazard models adjusted for age category, sex, and activity compared the risk of each outcome across activities. RESULTS: Compared with other sports, football had the greatest quantity and severity of TBIs. Football accounted for 19.4% of 72,025 identified activity-related TBIs (mean age, 13.9 years; 32% female). Repeat TBI occurred in 37% of football injuries (32% overall). Attributable risks of football TBIs included neurologic outcomes (chronic headache, 23%; visual impairment and blindness, 5%; and neurodevelopmental disorders, 0.5%) and psychiatric outcomes (anxiety disorders, 5%; depressive disorders, 3%; substance use disorders, 1%; and violence and suicidality, 0.5%). TBIs at early ages were associated with mood and developmental disorders, while TBIs at later ages were associated with substance use disorders. DISCUSSION: Football is the single leading source of pediatric sports-related TBI, associated with high recurrence rates, substantial neurologic and psychiatric sequelae, and altered developmental trajectories. These findings highlight football as a critical public health priority and support stronger preventive measures, including delaying tackle football participation and regulating institutional promotion of youth football.
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Thorman et al. (2026) conducted a cohort in Traumatic brain injury (TBI) (n=72,025). Football vs. Other sports and recreational activities / lower leg fractures was evaluated on Neurologic, psychiatric, and developmental outcomes. Football was the leading source of pediatric sports-related TBI (19.4% of cases), with a 37% repeat injury rate and significant attributable risks for chronic headache (23%) and anxiety (5%).
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