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Shedding Light on Concussion Trends in Youth Sports

June 7, 2012

In his most recent study working with scholastic athletes, Shane Caswell found that concussions are actually increasing across several girls' and boys' sports.

(This story originally appeared in Mason Research on March 13, 2012, and was written by Catherine Probst Ferraro.)

Although football season has come to a close, reports of players sustaining major concussions were all too common this year. As a result, the NFL and other sports leagues—from professional to youth levels—are increasingly concerned about making the sport safer for its players.

Keeping players safe is what Shane Caswell, associate professor of athletic training and director of the Sports Medicine Assessment, Research and Testing (SMART) Laboratory [2] in Mason's College of Education and Human Development, hopes to accomplish in his research. It focuses on the prevention of traumatic brain injury in sport.

In his most recent study working with scholastic athletes, Caswell, a licensed athletic trainer, found that concussions are actually increasing across several girls' and boys' sports. He hopes that understanding the risks and trends of concussion among girls' and boys' sports may contribute to better detection, treatment, and prevention of concussion.

For this study, Caswell and his colleague, Andrew Lincoln of MedStar Health Research Institute, partnered with Jon Almquist, a certified athletic trainer for Fairfax County Public Schools in Virginia. The researchers examined the concussion trends of more than 150,000 student athletes for 11 consecutive years, beginning in 1997 and ending in 2008.

According to Caswell, this is the first study of its kind to look at high school sports over a significant period of time to determine whether or not concussions are increasing.

The study followed student athletes from six boys' sports—football, lacrosse, wrestling, soccer, basketball, and baseball—and six girls' sports—field hockey, lacrosse, soccer, basketball, cheerleading, and softball.

The researchers began by gathering data on sport-related injuries from 25 high schools. As required by the school district, a certified athletic trainer is on site at all games and practices and records any instances of injuries and illnesses into an electronic medical record-keeping program. The data showed that 2,651 concussions were reported throughout study period.

For the purpose of this study, the researchers defined a concussion as an event occurring during official games or practices which was diagnosed as a concussion by a certified athletic trainer.

After analyzing the data, the researchers found that, not surprisingly, boys' sports accounted for three quarters (75 percent) of all concussions, with football accounting for more than half (53 percent) of these concussions. For boys' sports, the top three were football, followed by boys' lacrosse, with 244 concussions, and wrestling, with 123 concussions.

In contrast, girls' soccer reported the most concussions for girls' sports (195) and was third in overall concussions. Cheerleading (131 concussions) and basketball (120 concussions) followed girls' soccer.

When analyzing the rate of concussion, the researchers found that boys had an overall concussion rate (.34) that was more than twice what it was for girls (.13). The boys' and girls' sports that reported the most concussions—football and girls' soccer—also accounted for the highest concussion rates (.60 and .35, respectively).

Interestingly, in similar girls' and boys' sports (baseball/softball, basketball, and soccer), the concussion rate for girls was roughly twice what was reported for boys. This finding has been reported in collegiate athletes, but according to Caswell, this is the first study to demonstrate the same phenomenon at the high school level.

Caswell suggests several possible reasons for this finding. The first is that girls have less muscle mass to absorb hard impacts, thus greater forces are transferred to the brain. A second possibility is that girls might be culturally more willing to report injuries and seek care. Finally, some research suggests hormonal differences might play a role.

Overall, the results of the study show an increase in concussion rate of more than 16.5 percent annually among all 12 sports. Caswell notes that a substantial increase in concussion rate began in 2005 when the hours for athletic trainer coverage were increased at all of the high schools. With more access to trained professionals, the likelihood that concussions were reported, recognized, and treated may have increased, he says.

In addition, Caswell and his colleagues say that the extensive media coverage of concussion risk in professional sports may also have contributed to this increase. Organizations such as the National Collegiate Athletic Association and the National Federation of State High School Associations are also creating greater awareness of concussion among players, coaches, parents, and clinicians.

"At the completion of the study, we were not surprised to find that the collision sports of football and boys' lacrosse contributed to the high number of total concussions," says Caswell.

"Despite these findings, we observed increasing concussion rates in every sport, which leads us to suggest that although the highest percentage of concussions occur in high-impact sports, efforts to detect, treat, and prevent concussion should not be limited to those sports."

This study was published in the American Journal of Sport Medicine and is available on the website.

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