Concussions in High School Athletes Where Are We Now?
R. Dawn Comstock, PhD Center for Injury Research and Policy, Nationwide Children’s Hospital The Ohio State University, College of Medicine, Department of Pediatrics and College of Public Health, Division of Epidemiology
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HS RIO
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HS RIO Methodology: Original Prospective injury surveillance study Based on proven systems
NCAA ISS (definition of injury and exposure, survey questions) CPSC NEISS (nationally representative sampling scheme)
Weekly data capture 05/06-09/10 academic years Representative sample of 100 US high schools Geography (4 US census regions) Size (=Ñ 1,000 vs >1,000 students)
9 sports
Boys’ (football, soccer, basketball, wrestling, baseball) Girls’ (volleyball, soccer, basketball, softball) 3
HS RIO Methodology: Expansion 2008/09 expansion included an additional 9 sports
Boys’ lacrosse, ice hockey, swimming & diving, track & field Girls’ lacrosse, field hockey, gymnastics , swimming & diving, track & field
2009/10 expansion included an additional 2 sports Boys’ volleyball Cheerleading
Same methodology for data reporting Convenience sample of US high schools 4
Data Collection NATA affiliated ATCs Weekly exposure reports Injury incidence Athlete exposure
Injury report forms
Injured athlete (age, height, weight, etc.) Injury (body site, diagnosis, severity, etc.) Injury event (mechanism, activity, risk factors) 5
Study Definitions Injury = an injury that
occurred as a result of an organized high school athletic practice or competition required medical attention (ATC, physician, etc) resulted in restriction of the athlete’s participation for =u 1 days beyond the day of injury 2007/08 expanded to include all concussions, fractures, and dental
Athletic exposure (AE) = 1 athlete participating in 1 practice or competition 6
Original 9 Sports 05/06-09/10 Captured 21,863 injuries 11,429 competition 10,434 practice
9,503,641 athlete exposures (AE) 2,581,681 athlete competitions 6,921,960 athlete practices
Overall 2.30 injuries per 1,000 athlete exposures 4.43 injuries per 1,000 athlete competitions 1.51 injuries per 1,000 athlete practices
Injury rate significantly higher in competition IRR=2.94, 95% CI 2.86-3.02
An estimated 6,955,868 injuries occurred nationally
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Expanded 11 Sports 08/09-09/10 Captured 2,922 injuries 1,279 competition 1,643 practice
2,410,638 athlete-exposures (AE) 537,797 athlete-competitions 1,872,841 athlete practices
Overall 1.21 injuries per 1,000 athlete exposures 2.38 injuries per 1,000 athlete competitions 0.89 injuries per 1,000 athlete practices
Injury rate significantly higher in competition IRR=2.71, 95% CI 2.52-2.92
No national estimates calculated
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Body Sites Injured, Original 9 Sport Sample 2005-09 Sport
Most Frequently Injured Body Sites (% of all injuries)
Football
Knee (15)
Ankle (14)
Shoulder (12)
Head/face (12)
B Soccer
Ankle (21)
Knee (14)
Upper leg (13)
Head/face (13)
G Soccer
Ankle (23)
Knee (20)
Head/face (15)
Upper leg (12)
G Volleyball
Ankle (41)
Knee (11)
Hand/wrist (11)
Shoulder (8)
B Basketball
Ankle (35)
Knee (12)
Head/face (12)
Hand/wrist (10)
G Basketball
Ankle (32)
Knee (18)
Head/face (14)
Hand/wrist (9)
Wrestling
Shoulder (18)
Knee (15)
Head/face (13)
Arm/elbow (11)
Baseball
Shoulder (17)
Hand/wrist (14)
Head/face (13)
Ankle (12)
Softball
Head/face (17)
Ankle (16)
Hand/wrist (16)
Knee (12) 9
Body Sites Injured, Expanded 9 Sport Sample 2008-09 Sport
Most Frequently Injured Body Sites (% of all injuries)
G Field Hockey
Head/face (25) Upper leg (16)
Ankle (14)
Knee (9)
G Gymnastics
Ankle (23)
Arm/elbow (14)
Hand/wrist (9)
B Ice Hockey
Head/face (29) Hand/wrist (12)
Shoulder (11)
Knee (10)
B Lacrosse
Head/face (19) Trunk (14)
Ankle (12)
Knee (11)
G Lacrosse
Head/face (26) Ankle (18)
Upper leg (15)
Knee (13)
B Swim/Diving
Shoulder (39)
Trunk (17)
Knee (13)
Head/face (13)
G Swim/Diving
Shoulder (55)
Head/face (9)
Trunk (9)
Upper leg (7)
B Track/Field
Upper leg (49)
Lower leg (13)
Knee (13)
Ankle (8)
G Track/Field
Upper leg (35)
Lower leg (22)
Knee (13)
Ankle (9)
Knee (21)
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Concussion Rates and Distributions 11
Concussion Rates, Original 9 Sports 05/06-09/10 Rates per 10,000 Athletic Exposures # of Concussions
National Estimates
Practice
Competition
Overall
Football
1392
357,114
2.5
19.9
5.4
B Soccer
182
89,237
0.5
5.5
2.0
G Soccer
243
132,062
0.6
8.6
3.0
G Volleyball
54
17,326
0.5
1.1
0.7
B Basketball
111
27,404
0.5
2.3
1.0
G Basketball
184
47,439
0.7
5.2
2.0
Wrestling
152
33,979
1.1
3.7
1.8
Baseball
32
9,569
0.1
0.8
0.4
Softball
66
23,692
0.7
1.5
1.0
Sport
Includes concussions resulting in
