Epidemiology of Sport-Related Concussions in High School Athletes: National Athletic Treatment, Injury and Outcomes Network (NATION), 2011-2012 Through 2013-2014

Abstract

Context: Sports participation is one of the leading causes of concussions among nearly 8 million US high school student-athletes.

Objective: To describe the epidemiology of sport-related concussion (SRC) in 27 high school sports during the 2011-2012 through 2013-2014 academic years.

Design: Descriptive epidemiology study.

Setting: Aggregate injury and exposure data from 27 sports in 147 high schools in the National Athletic Treatment, Injury and Outcomes Network (NATION).

Patients or other participants: Boy and girl high school athletes during the 2011-2012 through 2013-2014 academic years.

Main outcome measure(s): Sport-related concussion counts, percentages, rates per 10 000 athlete-exposures (AEs), rate ratios (RRs), and injury proportion ratios (IPRs) were reported with 95% confidence intervals (CIs). Rate ratios and IPRs with 95% CIs not containing 1.0 were considered significant.

Results: Overall, 2004 SRCs were reported among 27 high school sports, for a rate of 3.89 per 10 000 AEs. Football had the highest SRC rate (9.21/10 000 AEs), followed by boys' lacrosse (6.65/10 000 AEs) and girls' soccer (6.11/10 000 AEs). The SRC rate was higher in competition than in practice (RR = 3.30; 95% CI = 3.02, 3.60). Among sex-comparable sports, the SRC rate was higher in girls than in boys (RR = 1.56; 95% CI = 1.34, 1.81); however, the proportion of SRCs due to player-to-player contact was higher in boys than in girls (IPR = 1.48; 95% CI = 1.27, 1.73). Common symptoms reported among all athletes with SRCs were headache (94.7%), dizziness (74.8%), and difficulty concentrating (61.0%). Only 0.8% of players with SRCs returned to play within 24 hours. The majority of athletes with SRCs (65.8%) returned to play between 7 and 28 days. More players had symptoms resolve after 7 days (48.8%) than less than a week (40.7%).

Conclusions: Our findings provide updated high school SRC incidence estimates and further evidence of sex differences in reported SRCs. Few athletes with SRCs returned to play within 24 hours or a week. Most injured players returned after 7 days, despite a smaller proportion having symptoms resolve within a week.

Keywords: injury surveillance; return to play; traumatic brain injuries.

Figures

Figure 1.

Number of symptoms reported after concussions sustained by high school athletes, National Athletic Treatment, Injury and Outcomes Network (NATION), 2011–2012 through 2013–2014 academic years.

Figure 2.

Symptoms reported after concussions sustained by high school athletes, National Athletic Treatment, Injury and Outcomes Network (NATION), 2011–2012 through 2013–2014 academic years.

Figure 3.

Symptom-resolution time after concussions sustained by high school athletes, National Athletic Treatment, Injury and Outcomes Network (NATION), 2011–2012 through 2013–2014 academic years. Overall total includes sports in which both sexes participated (ie, baseball or softball, basketball, crew, cross-country, golf, lacrosse, soccer, swimming and diving, tennis, indoor track and field, and outdoor track and field).

Figure 4.

Return-to-play time after concussions sustained by high school athletes, National Athletic Treatment, Injury and Outcomes Network (NATION), 2011–2012 through 2013–2014 academic years. Overall total includes sports in which both sexes participated (ie, baseball or softball, basketball, crew, cross-country, golf, lacrosse, soccer, swimming and diving, tennis, indoor track and field, and outdoor track and field).