By Lisa Rapaport
(Reuters Health) – While concussion rates remain higher among U.S. high school students playing football than among those playing other sports, a new study also suggests these brain injuries are becoming less common in football practices and repeat concussions are happening less often in all sports.
Researchers looked at injuries per athletic exposure (AE) for 20 high school sports during the 2013-2014 to 2017-2018 school years. For every athlete, one practice or competition counts as one exposure.
Overall, 9,542 concussions were reported during the study period, for an overall injury rate of 4.17 concussions per 10,000 AEs.
Football game-day concussion rates rose during the study from 33.19 to 39.07 per 10,000 AEs, researchers reported October 14 online in Pediatrics. But football practice concussions became less common, dropping from 5.47 to 4.44 per 10,000 AEs.
And across all high school sports in the study, repeat concussion rates declined from 0.47 to 0.28 per 10,000 AEs.
“The decreasing rates of recurrent concussions (over the study period) were also most notable in football,” said Avinash Chandran, a co-author of the study and a brain injury researcher at the University of North Carolina at Chapel Hill.
“This may at least be partially attributable to policies such as mandatory removal from play following concussions, and strict requirements associated with return-to-play,” Chandran said by email.
A growing awareness of concussion risks has prompted more evaluations of athletes on the sidelines as soon as a head injury is suspected, and it has also led many schools to develop protocols to ensure injured students don’t return to sports or academics too soon.
It’s not clear whether football concussions on game day might be rising because of more reporting or more injuries.
Concussion rates were higher for girls than boys, at 3.35 versus 1.51 injuries per 10,000 AEs.
In sports like soccer and basketball played by both sexes, girls also had higher rates of repeat concussions: 9.3% versus 6.4%.
Soccer had the highest concussion rate for girls, at 8.19 injuries per 10,000 AEs overall, followed by basketball, lacrosse, volleyball, and field hockey.
For boys, ice hockey had the highest concussion rates after football, at 7.69 injuries per 10,000 AEs, followed by lacrosse, wrestling, soccer, and basketball.
The study only included concussions reported by athletic trainers, so it might not reflect experiences in all youth sports programs. And data from practices and games might not accurately reflect total injuries based on the total amount of time individual athletes spent playing sports.
Athletic trainers are more common at more affluent schools, and smaller or less wealthy school districts might not have as many resources to detect concussions, said Dr. Monica Vavilala, director of the Harborview Injury Prevention and Research Center (HIPRC) at the University of Washington in Seattle.
Some things are clearly improving, Vavilala, who wasn’t involved in the study, said by email.
“First, all states have a return to play law, which at least urges schools and teams to pay attention to the issue of concussion symptoms and needed rest and evaluation for athletes,” Vavilala said. “Over time, athletic directors have become more a part of the conversation to engender a culture where students come forth with symptoms and students are tested for concussion at the sidelines.
In football, where concussions are most common, attention is being paid to helmet quality and the game is generally safer than before, but not all athletes have access to the same quality of helmets, Vavilala added.
“Pressure to win at all costs still encroaches on the idea that safe play trumps winning,” Vavilala said. “Hence, athletes may not come forth when they have a concussion and may return to play when not fully better.”