Concussion in high school sports: findings from injury surveillance

Pediatric Research

January 20, 2025

Background

We aimed to examine the epidemiology of concussions within high school (HS) boys’ and girls’ sports, and to assess the incidence of concussion within HS sports during the timespan inclusive of the COVID-19 pandemic.

Methods

We analyzed data captured within High School Reporting Information Online (HS RIO) during 2018/19-2022/23. Injury counts, rates (enumerated per 10,000 athlete-exposures (AEs)), and proportions were used to describe injury characteristics by sport, event type, injury mechanism, and injury history. Injury rate ratios (IRR) and accompanying 95% Confidence Intervals (CIs) were used to evaluate differential injury incidence across event types and sports.

Results

A total of 4663 concussions were reported during the study period (Rate = 3.50 per 10,000 AEs). Overall rates were highest in boys’ football (8.22 per 10,000 AEs) and girls’ soccer (6.11 per 10,000 AEs). Among sex-comparable sports, overall concussion rates were higher in girls’ sports as compared with boys’ sports (IRR = 2.15; 95%CI = [1.94, 2.37]). Concussion rates fluctuated across the study period and were lower during the COVID-19-impacted seasons, as compared with neighboring years.

Conclusions

Our findings underscore the necessity for continuous surveillance of concussions in HS sports and suggest that concussion incidence in girls’ sports warrants targeted attention.

Impact

Sport-related concussions are a significant concern, particularly in youth athletics, with changes to concussion management and the impact of the COVID-19 pandemic necessitating a re-evaluation of concussion incidence and management in high school sports.

In this surveillance study (2018/19-2022/23), boys’ football and girls’ soccer had the highest concussion rates, with a decrease in incidence observed during the COVID-19 pandemic as compared with surrounding years.

The incidence of concussions in girls’ sports requires increased scrutiny, especially due to an overall increase in incidence density observed after an initial decrease during the COVID-19 pandemic.

Funding

Funding for HS RIO was originally provided in part by the Centers for Disease Control and Prevention (Awards R49/CE000674-01, R49/CE001172-01, and R49/CE002106-01) and the National Center for Research Resources (Awards KL2 RR025754), for which R. Dawn Comstock, PhD, served as principal investigator (but she was not a coauthor of the study). We also acknowledge the research funding contributions of the National Federation of State High School Associations, National Operating Committee on Standards for Athletic Equipment, DonJoy Orthotics (DonJoy Performance), and EyeBlack. HS RIO is currently managed by the Datalys Center for Sports Injury Research and Prevention with support from the National Federation of State High School Associations.

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