title: Concussion symptoms in youth motocross riders: a prospective, observational study.
abstract: OBJECTIVE
  Action motorsports, including motocross, have been gaining popularity among children and adolescents, raising concerns for increased risk of concussions in participating youth. The authors undertook this study to test the following hypotheses: 1) that there is a high rate of concussion symptoms associated with a number of preventable or adjustable risk factors, and 2) that a high percentage of these symptoms are not be reported to adults and medical personnel.
  
  
  METHODS
  The authors identified all motocross riders under the age of 18 at a regional racetrack during the riding season between May and October 2010. The participants completed questionnaires pertaining to demographic characteristics and variables associated with motocross. The questionnaire results were compared with the incidence of self-reported concussion symptoms.
  
  
  RESULTS
  Two hundred two riders were identified who met the criteria for participation in the study, and 139 of them completed the study questionnaire. Of these 139 riders, 67 (48%) reported at least 1 concussion symptom during the season. The majority of riders (98%) reported "always" wearing a helmet, and 72% received professional help with fitting of their helmets. Proper helmet fitting was associated with a 41% decreased risk of concussion symptoms (RR 0.59, 95% CI 0.44-0.81, p < 0.01). Sixty-six riders (47%) reported having received sponsor support for motocross participation. Sponsor support conferred a relative risk for concussion symptoms of 1.48 (95% CI 1.05-2.08, p = 0.02).
  
  
  CONCLUSIONS
  Nearly half of all motocross competitors under the age of 18 reported concussion symptoms. Preventive measures are necessary to limit the negative impact from concussions. The risk of concussive injury can be decreased for pediatric motocross riders if they receive professional help with proper helmet fitting and through implementation of stricter guidelines regarding sponsorship.
authors.affiliation: Departments of 1 Orthopedic Surgery.
authors.forename: T David
authors.initials: TD
authors.lastname: Luo
authors.forename: Michelle J
authors.initials: MJ
authors.lastname: Clarke
authors.forename: Amy K
authors.initials: AK
authors.lastname: Zimmerman
authors.forename: Michael
authors.initials: M
authors.lastname: Quinn
authors.forename: David J
authors.initials: DJ
authors.lastname: Daniels
authors.forename: Amy L
authors.initials: AL
authors.lastname: McIntosh
mesh_terms: D000059:Accidents; D000293:Adolescent; D000328:Adult; D001265:Athletic Injuries / Q000150:complications; D001924:Brain Concussion / Q000175:diagnosis* / Q000209:etiology*; D002648:Child; D005260:Female; D006260:Head Protective Devices / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D009049:Motorcycles; D015541:Off-Road Motor Vehicles; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires
keywords: CBI = concussive brain injury; concussion; motocross; pediatric; return to play; symptoms; trauma