title: Epidemiology of concussions among United States high school athletes in 20 sports.
abstract: BACKGROUND
  In the United States (US), an estimated 300,000 sports-related concussions occur annually. Among individuals 15 to 24 years of age, sports are second only to motor vehicle crashes as the leading cause of concussions.
  
  
  OBJECTIVE
  To investigate the epidemiology of concussions in high school athletes by comparing rates and patterns of concussion among 20 sports.
  
  
  METHODS
  Descriptive epidemiology study.
  
  
  METHODS
  Using an Internet-based data collection tool, RIO, certified athletic trainers from a large, nationally disperse sample of US high schools reported athlete exposure and injury data for 20 sports during the 2008-2010 academic years.
  
  
  RESULTS
  During the study period, 1936 concussions were reported during 7,780,064 athlete-exposures (AEs) for an overall injury rate of 2.5 per 10,000 AEs. The injury rate was higher in competition (6.4) than practice (1.1) (rate ratio [RR], 5.7; 95% confidence interval [CI], 5.2-6.3). The majority of concussions resulted from participation in football (47.1%, n = 912), followed by girls' soccer (8.2%, n = 159), boys' wrestling (5.8%, n = 112), and girls' basketball (5.5%, n = 107). Football had the highest concussion rate (6.4), followed by boys' ice hockey (5.4) and boys' lacrosse (4.0). Concussions represented a greater proportion of total injuries among boys' ice hockey (22.2%) than all other sports studied (13.0%) (injury proportion ratio [IPR], 1.7; 95% CI, 1.4-2.1; P < .01). In gender-comparable sports, girls had a higher concussion rate (1.7) than boys (1.0) (RR, 1.7; 95% CI, 1.4-2.0). The most common mechanisms of injury were player-player contact (70.3%) and player-playing surface contact (17.2%). In more than 40% of athletes in sports other than girls' swimming and girls' track, concussion symptoms resolved in 3 days or less. Athletes most commonly returned to play in 1 to 3 weeks (55.3%), with 22.8% returning in less than 1 week and 2.0% returning in less than 1 day.
  
  
  CONCLUSIONS
  Although interest in sports-related concussions is usually focused on full-contact sports like football and ice hockey, concussions occur across a wide variety of high school sports. Concussion rates vary by sport, gender, and type of exposure. An understanding of concussion rates, patterns of injury, and risk factors can drive targeted preventive measures and help reduce the risk for concussion among high school athletes in all sports.
authors.affiliation: Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA.
authors.forename: Mallika
authors.initials: M
authors.lastname: Marar
authors.forename: Natalie M
authors.initials: NM
authors.lastname: McIlvain
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Fields
authors.forename: R Dawn
authors.initials: RD
authors.lastname: Comstock
mesh_terms: D000293:Adolescent; D001265:Athletic Injuries / Q000453:epidemiology*; D001924:Brain Concussion / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D011159:Population Surveillance; D013177:Sports / Q000145:classification / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D055815:Young Adult