Decreased Concussion Incidence Following the Implementation of the Targeting Rules: An Updated Epidemiology of National Football League Concussions From 2017 to 2022.

The incidence of concussions in football, and the ensuing media attention, has garnered scientific investigation, prompted technological advances in protective gear, and altered the rules of the game, including the National Football League's (NFL) "Targeting" rule, which began in 2018, but the impact of these changes is unclear. This study aims to describe the epidemiology of concussions that occurred in five NFL seasons from the 2017-2018 season through the 2021-2022 season and characterize positional differences in rate and games missed. There was a significant decrease (p = 0.02) in total concussions between the 2017-2018 season (102 concussions) and the remaining four seasons (average of 73.80 concussions per year), accounting for a 38% decrease. Offensive and defensive units had decreased concussion rates and average games missed per concussion. Defensive backs (10.46 per 1,000 athlete exposures (AEs)) and tight ends (10.69 per 1,000 AEs) had the highest concussion rates, and the defensive line had the highest average games missed per concussion at 3.97. The introduction of the "Targeting" rule and other rule changes in the NFL in 2018 correlated with a decrease in total concussions per year, total games missed due to concussion, and average games missed per concussion. Offense and defense experienced similar reductions in concussion incidence and severity. Overall, the updated epidemiology of NFL concussions suggests that the incidence of concussions has decreased; however, players continue to experience concussions that require them to miss multiple games.