The NFL released its most recent injury data on January 26, 2018. The injury data is compiled and analyzed by IQVIA, an independent third-party company retained by the NFL.
The following is a transcript of a media conference call with reporters to discuss the data.
Media Conference Call with:
Jeff Miller, NFL Executive Vice President, Health and Safety Initiatives
Dr. Christina DeFilippo Mack, Senior Director of Epidemiology at IQVIA
Dr. Allen Sills, NFL Chief Medical Officer
Dr. Jeff Crandall, Director of the Center for Applied Biomechanics at The University of Virginia and Chairman of the NFL Engineering Committee
MODERATOR, BRIAN MCCARTHY: We want to thank you for joining us this afternoon to help us go over the 2017 NFL Preliminary Injury Data. I did provide each of you a list and the order of speakers along with their names and titles. I won’t repeat that. We will hear from a couple of people upfront and then we will go to Q&A. We also have Dr. Jeff Crandall who will be available for questions as well. As are going through this material, we will be posting it on PlaySmartPlaySafe.com, which is our stand-alone health and safety website. You will find this information in the News Room, where you will find a PowerPoint presentation that will be referenced throughout.
JEFF MILLER: This is Jeff Miller. My title is Executive Vice President of Health and Safety for the NFL. This is our annual pre- Super Bowl call to discuss very topline injury statistics. We have done this for a number of years, for those of you that are veterans, this is early data based on the work by a company called IQVIA, previously known as QUINTILES. It’s an epidemiological firm, they will be represented here today to help walk you through the data that we are showing. Between now and Combine, there is a great deal more work that gets done around diving into these topline numbers and trying to understand some of the causes pushing them more significantly down to specific rules and quarters and plays and positions to understand why particular players or plays are yielding certain types of injuries. Everything from turf toe and sprained ankles all the way up to concussions. We will have a lot more information after we have the chance to meet at Combine and do the analytics. There we will be with many of our medical committees and the Competition Committee. We will have the benefit of talking to the team medical staff as well as they churn through the data.
Another important point to mention here is that the work that is done here is done in collaboration with the NFLPA. IQVIA provides the same level of data to us as they do to the NFLPA. Our work with the NFLPA is important and significant in the safety spaces. We do work jointly on analyzing the data as we get closer to Combine. We discuss the data there with them as we look at the protocols and we share it with the Competition Committee. That has driven 47 rule changes over the last number of years directed towards the safety of the game. It is a data-driven process and one that we are proud of, and will continue to work on with our friends at the NFLPA.
That is the background of the data. It is preliminary, and we will give you some information in a variety of categories as we have done traditionally over the past few years. We will get down to a level of granularity after that.
Let me take a few moments to discuss a few things that we have accomplished in 2017 as it relates to health and safety and then I will introduce the people who will be giving the presentation.
First and foremost is the hiring of our Chief Medical Officer, Dr. Allen Sills. I hope many of you have had the opportunity to talk to and meet with him by now. He is a neurosurgeon from Vanderbilt with significant sports medicine expertise. He has been with us for seven months and has already led us to significant changes and has improved a lot of what we have done. We are very proud of him and that hire, and we know that is going to lead to improved health and safety for our sport.
Also on the call is Jeff Crandall, he has been leading the Engineering Roadmap that many of you are familiar with. We are beginning to see significant benefits from that just in terms of understanding what is going on the field with players suffering injuries, especially concussions. Some of that work is already being translated. For example, at Super Bowl we are hosting 1st and Future, which is a pitch competition. It’s an innovation competition with the Mayo Clinic and with Comcast Sports Ventures. One of the categories is better protective helmets including quarterback-specific helmets. The reason that is notable is because Dr. Crandall has put together a level of data that demonstrated the mechanism of injury that quarterbacks typically see when they suffer concussions. Somewhere in the neighborhood of 40% of concussions suffered by quarterbacks are when the back of their helmet hits the turf. If that is the case and continues to be the case over time, then one could think that we could look at a helmet that would better protect that mechanism from the quarterback from that injury. Overtime, the Engineering Roadmap hopes to stimulate these specific changes to player equipment, including helmets that would be specific to each individual player. This may be the first indication of that.
The last thing that I will mention is that we continue to invest heavily in scientific research. Many of you know that we have invested $40 million with the Scientific Advisory Board, an independent group of experts who has put out a request for proposals for good scientific research. They are reviewing those now and coming up with their recommendations for the NFL to fund. In the past couple of months, we have funded significant amounts of money towards the Department of Defense and other National Institute of Health funded studies to advance brain science.
Let’s get to the main event. I will introduce the three other people on the call. Dr. Christina Mack is the Senior Director of Epidemiology at IQVIA. She will speak to you first and walk you through the data that Brian mentioned is on the website. Dr. Allen Sills, our Chief Medical Officer, will then offer some of his perspective on that data. Then we will take your questions. Jeff Crandall, who is the Director of the Center for Applied Biomechanics at the University of Virginia and the leader of our Engineering Roadmap and Engineering Committee is also be available to answer questions should you have any that relate to protective equipment and the work that he is doing.
I will turn it over to Dr. Mack for her review of the injury data.
DR. CHRISTINA MACK: This is Christina Mack, I am an epidemiologist at IQVIA, which is a provider of information, technology and clinical research. We are focused on using data and research to make better healthcare decisions. In the case, our injury surveillance and analytics team collects the injury data from the NFL through an enriched electronic medical record. We work closely with the medical staff to standardize and create a high-quality data set so that we can do this injury reporting. As Jeff said, this is the first cut of data leading up to the Combine, where we will do a lot more analyses and a lot more in-depth analyses to apply science and support more in-depth discussion of injuries with the medical advisors. I am going to walk you through the data that you see posted on the website and then I will pass it off to Dr. Sills.
The data provided covers the preseason and the regular season, not inclusive of post season which is still ongoing. In the 2017 pre- and regular season, 281 concussions were reported, compared to 243 in 2016 and a five-year average of 243, which is a 15.6% increase.
In terms of what can be done to reduce the injuries going forward, it is important to look at them by season, so we will look at them in two sections.
We will focus on preseason first. There were 91 concussions reported in the preseason, half of which were in practices. This is a 26% increase in practices over the five-year average. To this end, understanding the setting in which these are occurring is going to be a high point of emphasis and already has been. They are largely occurring in the first half of preseason. We will continue to work with the teams and the league to understand the factors and the activities in which these are happening and communicate to the teams overall and individually through reports to each club.
179 concussions occurred in regular season games, which is an 8% increase from 2016. The increase in those concussions numbers is a high point of emphasis for research as well as intervention. Concussion protection, especially in games, is a point of focus. You are aware of the UNC and that program, which is a key part of this. This year we saw an average of two UNC’s evaluations on players per game, which is similar to last season. We also saw by looking at the data that players are self-reporting on the field more now than in prior years. We saw 26%* evaluations done by UNC’s were based on players self-report, which is an increase from 2016. (We saw 26%* evaluations done by UNC’s were based on players self-report, which is an increase from 2016. *The number was corrected later in the call: Just following up, was it 28% of evaluations generated or 26% of evaluations generated by self-reporting? DR. MACK: 28% of evaluations were generated by self-report only. 18.6% were generated by self-report plus team or league medical staff. Together, 47% had a self-report component.) Between now and the medical meetings at the Combine, we will closely analyze this data and look at each concussion in collaboration with engineers on Dr. Crandall’s team as well as medical advisors so that we can better understand the type of play, position and mechanism of every injury.
Going on in the data to slides three and four, we track knee injuries of all types and level of severity season over season in detail. We are also focusing on what player and what setting. What we provided today is a high-level look at the incidents of ACL and MCL tears. Both injuries have fluctuated since 2012 but remained relatively stable in terms of occurrence. This year there were 54 ACL tears, 69% of which occurred in-game, and 147 MCL tears, 81% of which occurred in-game. In the last slide, another aspect of the data that we regularly study is the injury for games played on Thursdays, where players may have had four days of rest since their last game. From 2014-2017, we looked at the blended rates and the rates of injuries occurring during Thursday games have not exceeded those suffered by players with more days of rest. This season, for the first time, we saw a one-year shift, where injury rates on Thursdays were slightly higher than games played on Saturday, Sunday, and Monday. The four-year aggregate rates are the strongest metrics due to the small number of games played on Thursdays and in general when we look at these rates, so the one-year sample size of the Thursday data is more variable. The difference was not statistically significant. That said, again coming up to the Combine, we are going to continue looking at and analyzing these data to understand what the impact of intervals between games and rest is with focus on Thursday night in a broader context. I’ll pass it over to Dr. Allen Sills to comment.
DR. ALLEN SILLS: Good afternoon, everyone. It’s Allen Sills here. First and foremost, I want to express my thanks to Dr. Mack and the staff at IQVIA. It’s an incredible amount of detailed work they do to generate this data. It’s a very labor-intensive process but one that is vital to our ability to improve health and safety. I also want to commend all of our clubs and the medical staff who generate this data. I think we have an extremely detailed injury surveillance system and it’s one that we’re very proud of, and I believe that now we’re able to integrate that with many aspects of game operations with video and with other statistics to get a more complete picture of our injury situation.
The second thing I’d like to emphasize is to echo what Jeff Miller and Dr. Mack also said, which is that this is preliminary data, meaning that we’re going to have a lot more detail put around this in a few weeks’ time as we approach the Combine, and we will be taking a much, much deeper look into all aspects of the injury data in terms of mechanisms, in terms of relevance, in terms of relationship to games, and we’ll do that in conjunction with our medical committees that will be meeting at the Combine.
A couple of general comments before we get to your questions. Certainly, we’re disappointed that the concussion numbers are up. It is something which challenges us now to roll up our sleeves and continue to work hard to see that number come down. And I believe we will attack that problem in a number of ways. We will attack it by sharing with individual clubs the data about the incidents, particularly with regard into preseason and the timing of those concussions. We will continue to collaborate with, communicate with, and inform the Competition Committee around the rules of the game and discussions about that. We’ll continue our work on protective equipment. So, we take this as a challenge because we’re not going to be satisfied until we drive that number much lower, and that’s going to continue to be a focus of our efforts.
I think not all the news is bad news. The really good news here is to see this increase in self-reporting. What that means is more players are coming up to us and telling us about their symptoms and initiating evaluations through their own reports. And I’m pleased to see the data show that as a substantial increase. That confirms what I’ve been hearing from the team medical staff and from the team athletic trainers, and also what I observe when I’m at games and I’m on the sidelines. I think we all have the perception that players are doing more self-reports and we think it’s a positive development and reflects the fact that that everyone has a very low threshold for doing screenings and we’re proud that we’re doing more screening exams than we’ve ever done before, so that our detections can be even more complete.
So, those are the general comments I have. Jeff, I’ll turn it back over to you and would be glad to take questions.
MODERATOR: At this time, we’ll take any questions from our friends in the media.
The number of 26 percent of concussions were self-reported. Are those, number one, just in games? And number two, you said it’s up from previous years. What was the percent last year?
JEFF MILLER: Christina, I don’t know if you have the numbers in front of you. If you want to walk through it, otherwise I can pull it.
DR. MACK: Sure. Those are based on what the Unaffiliated Neurological Consultants (UNCs) are on the field and the game, so these numbers are based on what players are telling those unaffiliated in positions during the game, so they are game numbers only.
If we look just at regular season, just to give you a scale of the number of evaluations, there were 483 evaluations in the regular season submitted by UNCs, and last year, 19% of those were player self-report only, so no other medical staff reported the concussions. The UNC said it was only the player that was reporting it, so it was 19% last year and it was 28% this year, with an absolute number from the reports of 50 additional player self-reports.
JEFF MILLER: The absolute number is 50 more?
DR. MACK: Yes, 50 more. Another interesting data point is there are also a high number of concussions that were both a player self-report as well as team leader medical staff, so if we look at the concussions that were reported only by a player, as well as the concussions that were reported by both the player and the medical staff, that’s 47% of the concussions, so that’s almost half of the concussions that the UNCs evaluated.
JEFF MILLER: Dr. Sills touched on this in his introductory comments, how positive that trend is, with the number 50 and the percentage attached to it, that there is that level of player self-reporting and collaboration with the team medical staff and, importantly of course, the unaffiliated doctors to do as good a job as possible to make sure the players who need care and need to be screened are getting that level of medical attention.
And just to be clear, the 50 that you said, they were the confirmed concussions or they were 50 of those evaluations that may have turned into concussions?
DR. MACK: Right now, we’re only talking about evaluations.
28% of these evaluations were generated by the players, though?
DR. MACK: 28% of evaluations were generated by the players’ self-reports only, as reported by the UNC, and 57% in the 2017 regular season were generated by either player self-report, either alone or in conjunction with team medical staff.
JEFF MILLER: Where that number comes from is when the UNC records the report, they have to fill in a box that says, “What generated this evaluation? Why are you doing this evaluation?” So those choices include the self-report of the player, or medical staff observation or a call-down from the ATC spotter, so someone may check more than one of those boxes, so you may have both the medical professional’s own observation plus the player’s self-report, so that’s why we’re saying that self-report is a component in the larger number. In the smaller number, that is the only driver of evaluation, the player’s self-report.
Looking at the Thursday games, the players have said over the years that they feel the Thursday games are more dangerous. The flip side of that has always been that the data says otherwise. Despite the fact that this is only one year, does that number stick out to you, just because of the fact that it’s different from what you’ve seen in the past?
DR. SILLS: What I would say an answer is, assessing the overall health and safety impact of the game is a lot more complex than just a simple injury rate. Certainly, the injury rate and the number of players injured is an important metric, but it doesn’t tell the whole story because you’ve also got to consider what players might have been injured and not played in the game on Thursday night. And what about soft tissue injuries that may not preclude a player playing in the game, but actually result in them needing treatment or, perhaps, preclude them from playing in the next game? So, I think the injury rate is certainly one important metric to track, but it does not tell the complete story. It’s a point of emphasis for us, it’s something that we want to continue to take a very deep dive into, meaning that we’re going to look at all these other data factors and try to get a more complete understanding of that question, because we know it’s an important question. It’s important to the players, and it’s also important to the medical staff, the coaches and all of us. But I think it would be somewhat naïve and superficial for us to say, because the number went up or down, that Thursday night is safer or more dangerous, if that makes sense.
When we see the number where it says, for example, 6.3 injuries per game on a Sunday game and 6.9 on a Thursday game, what qualifies as an injury under that data point?
JEFF MILLER: Christina, do you want to go into that and put a little context to those numbers?
DR. MACK: Sure. First of all, this is a much deeper analysis, and so we go through this on all the injuries in a lot more context because the rest is complicated. But, from what you see on the slide, we looked at any injury that caused the player to be removed from participation or precluded them from playing on a subsequent day, so we call those “missed time injuries.” And those are the ones that we looked at for this.
We do slice it by other injuries, but what you can see if you look at the 40-year total, the injury rates on Thursdays have 5.7 versus 6.7 per game, and if you do a statistical test on that, what we generally say is that it’s the same. These rates are the same. It’s not a statistically significant decrease on Thursday night games nor is it an increase.
You mentioned the numbers went up. What do you attribute that to?
DR. SILLS: A major part of the increase occurred in the preseason concussions, as Dr. Mack pointed out on her first slide. You can see that in 2017, there was quite a significant increase going from 32 preseason practice concussions to 56. We also have looked into that in terms of when in the preseason it is occurring, and even to the level of what types of drills that may be involved in producing that. That is an obvious point of emphasis for us, to take that data and go back to the clubs on an individual basis. One of the things that we do after all the data is complete after the Combine is to actually produce a report that we then go back and give to each club showing them their individual injury rates and how they track relative to other clubs, and also specifics to timing of that. One of the ways that we get at and understand that is going to be the timing aspect – when it’s occurring, and what we can do about that in terms of an intervention.
JEFF MILLER: Let me just add to that. Of the overall increase in concussions, such a significant part of that came from preseason practices. Obviously, that drove our attention after a couple of years where those preseason practices concussions decreased, so this is an important aspect of the work that we will be doing between now and Combine – not just with the medical experts, but how practices are run at the club-level is something that is within the control of the coaches, the GMs, and others who are on-site. One of our obligations, then, is to share this data down to the level than Allen just talked about, take a look at the different drills they are running potentially, and inform them of where we are seeing their highest level of injuries on particular drills across the league. And certainly, talk to those who may be outliers in terms of having substantial number of injuries, and bring their attention to it. Through those mechanisms and the reports that Allen mentions, hopefully we will be able to drive that number down because that preseason practice concussion number is significant in terms of the overall growth here, and obviously one where they have a great deal of focus.
DR. SILLS: One other aspect of that is Dr. Crandall and his engineering team go back and do video review of each of the concussions we have. They’ve done that for the 2015-2016 season, now they’re getting through the 2017 season. That really helps us as we try to understand what the circumstances are in the game, and what are the exact types of contact and points of contact that produce concussions. Certainly, Dr. Crandall can speak to that much more eloquently than I can, but that is another way that we try to dive into those increases and understand exactly what may be driving them. Then in response, we look at what interventions perhaps could be made to make the reductions that we are seeking.
On the issue of self-reporting, do you have the number of how many of the actual concussion diagnoses started with a self-reported symptom?
JEFF MILLER: Christine, do we have that, or is that something we are going to have to plum through over the next month or so?
DR. MACK: We don’t have that to disclose today. That will be a high point of emphasis as we continue to dig through the regular season and the postseason data.
Just following up, was it 28% of evaluations generated or 26% of evaluations generated by self-reporting?
DR. MACK: 28% of evaluations were generated by self-report only. 18.6% were generated by self-report plus team or league medical staff. Together, 47% had a self-report component.
Can you provide the self-reporting numbers for previous seasons? We’ve never had them, I don’t believe, and it would be helpful to get the perspective on previous season self-reporting.
JEFF MILLER: The reporting mechanism that is used there is that there are reports that the UNC on the sidelines files at the end of every game. That mechanism has not [previously] existed – not the report, necessarily, but that individual. Because of that, we only have so much data going back so many years. Year over year comparison we can certainly do, but how many years back we can go is going to take a little time to analyze how much we trust the data, especially in the first year of the program which wasn’t so long ago. Christine, do you have any thoughts on that?
DR. MACK: Yes. To Jeff’s point, these are sideline assessments of what is happening at the time the player is being evaluated for a concussion, so the last two years of data – this year and 2016 – are the two best years to really use the reports that come out of those UNCs to look at the data. The strong numbers there if you look at all of those reports, and we look at the percent that had a self-report component either alone or with team medical staff in 2016 it was 31.8% and this year was 46.6%, so those are the regular season numbers. That is the increase, from the 32% to the 47% if you round up. It’s an indication, it’s not the entire story. It is an indication from the UNCs’ perspective.
On the innovation side with the competition coming up, can you describe the products you’re looking for there – like sensory helmets, smarter helmets, smart mouth guards, or can you provide some examples?
JEFF MILLER: Yes, happy to do it. I can go on any length. Unfortunately, Dr. Crandall our engineer has been mute throughout this entire call, so I would be remiss if I didn’t offer him the first opportunity to talk about some of the work he’s doing and some of the innovations that he has seen and is provoking.
DR. CRANDALL: I’ll just mention one of the aspects of the 1st and Future competition coming up. As Jeff Miller alluded to earlier, it has to do with the quarterback, in particular. As Jeff mentioned, one of the things we’ve noticed is a very consistent pattern of how quarterbacks are sustaining concussions. They’re being tackled – it’s an impact to the back of the head that strikes the turf. Given that we saw about 40% of concussions were occurring from that specific mechanism, we took that as an opportunity to put out in this 1st and Future challenge to see who would have ideas for equipment modifications that could address that very specific impact location, given that we see it over and over again. Beyond that, Jeff, I don’t know if you want to talk about the other categories at 1st and Future.
JEFF MILLER: Let me also add that the point of the Engineering Roadmap – and this is the work that Jeff Crandall and the team at the University of Virginia Center for Applied Biomechanics and other engineers, including those appointed by the Players Association have been working toward for the past year and a half – is to better understand what happens on the field when a player gets injured, specifically concussions and to be able to measure it better. We’ve invested significantly in recreating all of those concussion-causing hits. Jeff and his team have analyzed this, we’ve invested in the building and production of sensors that will be able to measure with even great specificity that the sort of work that is being done through the video analysis, what happens on-field. We are sharing that information transparently through webinars, through seminars and other things, and as we build more tools – like finite element models and helmets – we are going to be sharing those as well. One aspect of the Engineering Roadmap is that we are more or less evergreen in accepting new ideas for better protective equipment, whether that be parts of helmets, new helmets, inter-liners of helmets, after-market products that could potentially mitigate force, as well as any number of material science for new ideas generally that would make contact sports safer for those who play it.
We have a group down at Duke that is taking a look at it, led by Dr. Barry Myers who is a consultant for the NFLPA. He goes through these proposals regularly. As part of our Engineering Roadmap we have already awarded close to ten or so of these companies. 1st and Future coming up at the Super Bowl next week is one related aspect of that where we are looking at anything that comes over the transom that would better protect the athletes. 1st and Future has a little bit of a wider portfolio because we are looking at working with partners like the Mayo Clinic who are interested in recovery and other medical-specific innovations. The engineering work we are doing will hopefully stimulate change and we will reward those who provide really interesting ideas. One example of that is the VICIS helmet, which we all know is on the field now. That came from a related challenge that the NFL ran with GE a couple years ago. We were able to invest a substantial amount of money that they then leveraged to raise even more. Now they have a helmet that tested the best in all of the lab testing that Dr. Crandall and his team has done.
The opportunity for new protective equipment and advances and innovations to the way protective helmets and equipment is worn on the field is really here now. These sorts of innovative ideas and mechanisms that we have to try to bring those ideas in based on Dr. Crandall’s work is something that has really been rewarding for the league and is really going to have an effect on the way that the game is played from a protective equipment perspective in the next short time period.
Brian McCarthy: We appreciate you being on the call. I will send a link to each of you, which will take you directly to the spot where you will find this data. It is www.PlaySmartPlaySafe.com and go to Newsroom/Reports. Once again, I will send that to you. We look forward to seeing many of you in Orlando, and if not, out in Minnesota. Thank you very much.