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Loss of consciousness (LOC) occurs with approximately 8 percent of concussions in professional American football and has been associated with severity of injury (1, 2). However it is unknown how LOC relates to severity of head impact responses. The purpose of this study was to compare the head accelerations and brain tissue deformation between cases of concussions with and without LOC in elite American football to inform prevention strategies.    Methods  Concussive injuries with and without LOC from helmet-to-helmet and shoulder collisions as well as falls in elite American football were reconstructed in laboratory using hybrid III headform to obtain peak linear and rotational acceleration and maximum principal strain, cumulative strain damage at 10%, and strain rate metrics in 5 brain regions associated with loss of consciousness.    Results  Impact velocity, peak linear and rotational acceleration were greater in the LOC group than the no LOC group. The brain tissue deformation metrics were greater in the LOC group than the no LOC group. Linear acceleration was most predictive for cases of helmet-to-helmet collisions whereas shoulder collisions were best predicted by rotational acceleration. The best overall predictor was impact velocity.    Discussion/conclusion  The presence of a loss of consciousness in concussive impacts is a result of greater magnitude of brain tissue trauma. This was primarily caused by greater impact velocities in head impacts leading to LOC. Rules aiming at mitigating this aspect of the game would decrease the risk of a loss of consciousness in this sport. Each type of events resulted in different values of kinematic data and brain tissue deformation, which suggests that studies evaluating risk of concussions based 1 type of event cannot be generalized.

Biomechanical comparison of concussions with and without a loss of consciousness in elite American football