Concussion rate doubled in decade
- There are between an estimated 1.6 and 3.8 million sports-related concussions in the United States every year,1, 2 leading The Centers for Disease Control (C.D.C.) to conclude that sports concussions in the United States have reached an "epidemic level."
- A 2011 study8 of U.S. high schools with at least one athletic trainer on staff found that concussions accounted for nearly 15% of all sports-related injuries reported to ATs and which resulted in a loss of at least one day of play.
- According to the C.D.C., during the period 2001-2009 children and youth ages 5-18 years increased 62% to a total of 2.6 million sports-related emergency department (ED) visits annually, of which 6.5% (173,285) involved a traumatic brain injury, including concussion. The rate of TBI visits increased 57%, likely due to increased awareness of the importance of early diagnosis of TBI.
- For young people ages 15 to 24 years, sports are the second leading cause of traumatic brain injury behind only motor vehicle crashes.
Concussion rates are increasing in high school sports.
The current rates per 100,000 athletic exposures (an AE is one athlete participating in one organized high school athletic practice or competition, regardless of the amount of time played), according to the two most recent studies1,8 are as follows:
- Football: Between 601 and 76.88
- Girl's soccer: Between 338 and 351
- Boys' lacrosse: Between 301 and 46.68
- Girls' lacrosse: Between 201 and 318
- Boys' soccer: Between 171 and 19.28
- Boys' wrestling: Between 171 and 23.98
- Girls' basketball: Between 161 and 18.68
- Softball: Between 111 and 16.38
- Boys' basketball: Between 111 and 21.28
- Girls' field hockey: Between 101 and 24.98
- Cheerleading: 11.58
- Girls' volleyball: Between 51 and 8.68
- Boys' baseball:Between 4.68 and 61
Football players most at risk
- At least one player sustains a mild concussion in nearly every American football game.
- There are approximately 67,000 diagnosed concussions in high school football every year.9
- According to research by The New York Times, at least 50 youth football players (high school or younger) from 20 different states have died or sustained serious head injuries on the field since 1997.
- Anecdotal evidence from athletic trainers suggests that only about 5% of high school players suffer a concussion each season, but formal studies surveying players suggest the number is much higher, with close to 50% saying they have experienced concussion symptoms and fully one-third reporting two or more concussions in a single season.
- One study estimates that the likelihood of an athlete in a contact sport experiencing a concussion is as high as 20% per season.
- According to the National Center for Catastrophic Sport Injury Research, there were 5 catastrophic spinal cord injuries in high school football in 2010. 67.8% of all catastrophic injuries in football since 1977 are from tackling.
- According to a study reported in the July 2007 issue of The American Journal of Sports Medicine:
- Football players suffer the most brain injuries of any sport;
- An unacceptably high percentage (39%) of high school and collegiate football players suffering catastrophic head injuries (death, nonfatal but causing permanent neurologic functional disability, and serious injury but leaving no permanent functional disability) during the period 1989 to 2002 were still playing with neurologic symptoms at the time of the catastrophic event.
Girls more prone to concussion?
- While a study published in the Winter 2007-2008 Journal of Athletic Training3 suggested that girls were much more susceptible to concussions in sports like soccer and basketball than boys, recent studies suggest that, while the concussion rate for girls in soccer is higher (33.0 per 100,000 AEs versus 19.2 per 100,000 AES in the 2009-2010 school year),8 the the concussion rate for basketball is actually higher for boys (21.2) than girls (18.6).
- Whether female high school athletes are more likely than male athletes for have symptoms that persist longer than 7 days is also unclear. While a 2011 study8 found such a gender gap, a 2010 study5, reported no gender difference in the time symptoms took to clear or in the time athletes took to return to play.
The reason for the higher concussion rate for girls are unknown, although some have theorized that female athletes have weaker neck muscles and a small head mass than male athletes5 or that male athletes are more reluctant to report concussions for fear of being removed from competition, which may result in the well-documented underestimation of the incidence of concussion among boys.6
Multiple concussions
- 16.8% of high school athletes suffering a concussion had previously suffered a sport-related concussion, either that season or in a previous season (two studies released in 2011, the first4 covering the 11-year period from 1997 to 2008 at high schools in one large suburban school district, each with an athletic trainer, and the second8 covering the 2009-2010 school year for a representative sample of U.S. high schools with athletic trainers, both found that only 11% of concussions in the high school sports studied were repeat concussions;
- More than 20% of concussions in boys' and girls' soccer and basketball were repeat concussions.
- Once an athlete has suffered an initial concussion, his or her chances of a second one are 3 to 6 times greater than an athlete who has never sustained a concussion.
- Slightly more than a third of high school players in one recent survey who reported two or more concussions within the same school year.8
- High school athletes who suffer 3 or more concussions are at increased risk of experiencing loss of consciousness (8-fold greater risk), anterograde/post-traumatic amnesia/PTA (reduced ability to form new memories after a brain injury) (5.5-fold greater risk), and confusion (5.1-fold greater risk) after a subsequent concussion.
- Children who are seen in a hospital emergency room for a head injury, concussion, skull fracture or intracranial injury) are more than twice as likely to sustain a subsequent head injury of similar type within 12 months as are children seeking care for an injury not related to the head, regardless of their age.
Recovery time varies
- A 2007 study found that:
- post-concussion symptoms resolved in 3 days or less in more than 50% of the high school athletes in sports other than girls' basketball and softball;
- The same study found that more than 50% of athletes returned to play in 9 days or less;
- From 30 to 80 percent of those athletes who have sustained concussions still had post-concussion signs and symptoms (e.g. are symptomatic) three months after being injured; about one in seven were still symptomatic after one year.
- A 2010 study of high school athletes in a large, suburban publich school system,7 found, however, that, for most, concussion symptoms clear within a week.
- 27.0% had symptoms resolve in less than 24 hours;
- 36.2% between 1 and 3 days;
- 20.2% between 4 and 6 days;
- 15.1% had symptoms lasting more than a week but less than a month; and
- 1.5% were still experiencing symptoms more than a month after injury.
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Those results were confirmed in a 2011 study8 of U.S. high schools with athletic trainers for the 2009-2010 school year:
- 23.5% had symptoms resolve or clear in less than 24 hours;
- 33.8% between 1 and 3 days;
- 20.6% between 4 and 6 days;
- 19.6 between 1 week and 1 month; and
- 2.8% more than a month.
1. Halstead M, Walter K. Clinical Report - Sport-Related Concussion in Children and Adolescents, Pediatrics 2010; 126(3): 597-615 at n. 22, 23 (citing studies);
2. Lincoln A, Caswell S, Almquist J, Dunn R, Norris J, Hinton R. Trends in Concussion Incidence in High School Sports: A Prospective 11-Year Study. Am. J Sports Med. 30(10) (2011), accessed January 31, 2011 @ http://ajs.sagepub.com/content/early/2011/01/29/0363546510392326.full.pdf+html
3. Gessel LM. Fields SK. Collins CL. Dick RW. Comstock RD. "Concussions among United States high school and collegiate athletes" J. Athl Train. 2007; 42(4): 495-503.
4. Lincoln A, Caswell S, Almquist J, Dunn R, Norris J, Hinton R. "Trends in Concussion Incidence in High School Sports: A Prospective 11-Year Study" Am. J. Sports Med. 2011; 30 (10), accessed January 31, 2011 @ http://ajs.sagepub.com/content/early/2011/01/29/0363546510392326.full.pdf+html.
5. Halstead M, Walter K. Clinical Report - Sport-Related Concussion in Children and Adolescents. Pediatrics 2010; 126(3): 597-615 at n. 31, 32 (citing studies)
6. Id. at 599 nn. 24, 33.
7. Meehan W, d'Hemecourt P, Comstock D, High School Concussions in the 2008-2009 Academic Year: Mechanism, Symptoms, and Management. Am. J. Sports. Med. 2010; 38(12): 2405-2409 (accessed December 2, 2010 at http://ajs.sagepub.com/content/38/12/2405.abstract?etoc).
8. Meehan WP, d'Hemecourt P, Collins C, Comstock RD, Assessment and Management of Sport-Related Concussions in United States High Schools. Am. J. Sports Med. 2011;20(10)(published online on October 3, 2011 ahead of print) as dol:10.1177/0363546511423503 (accessed October 3, 2011).
9. Broglio SP, Sosnoff JJ, Shin S, He X, Alcaraz C and Zimmerman J. Head Impacts during high school football: a biomechanical assessment. J. Athl Train. 2009;44:342-349.
Revised November 5, 2011
