Investigators from the University of Washington and Seattle Children’s Research Institute conducted a prospective cohort study to determine the incidence of concussion, duration of concussion symptoms, and time to return to sport and school after concussion in American youth football participants. All parents of 5–14-year-old participants in a city youth football league during two 10-week seasons were invited to participate in the study. Enrolled parent and youth participants completed a baseline demographic survey that also queried the child’s history of prior concussion and mental health history (history of diagnosed depression, anxiety, and ADHD).
The primary outcome was confirmed football-related concussion. Potential concussions were identified by study-employed athletic trainers who attended all games during the 2 football seasons. Enrolled athletes with potential concussions were subsequently interviewed by the research team to assess mechanism of injury, name of clinician seen, and any diagnosis of concussion. An independent study physician then reviewed potential concussions as confirmed or unconfirmed. Youth participants with a confirmed concussion (and their parent) completed weekly surveys regarding concussive symptoms, return to school, and return to sport. Symptom resolution was defined as ≤3 symptoms greater than pre-injury baseline using the Sport Concussion Assessment Tool-3.
Investigators calculated the incidence of confirmed football-related concussion by player-season. Multivariable logistic regression was used to assess the association of demographics, child history of concussion, and mental health diagnoses with the primary outcome. Kaplan-Meier curves were used to assess time to symptom resolution, return to sport, and return to school.
Of 2,466 parents with child participants in the youth football league, 863 agreed to participate. Of these, 133 were followed for 2 seasons, yielding a total of 996 player-seasons. There was a history of prior concussion in 13% and a diagnosis of depression, anxiety, or ADHD in 2%, 6%, and 11%, respectively.
There were 51 confirmed football-related concussions, yielding a per-season incidence of 5.1%. Participants with (vs without) a history of concussion had significantly increased odds of an incident concussion (odds ratio [OR], 2.2; 95% CI, 1.1–4.8), as did participants with (vs without) a history of depression (OR, 5.6; 95% CI, 1.7–18.8). Most (90%) with concussions returned to school by 9 days, to sport by 1 month, and had resolution of symptoms by 2 months.
The incidence of concussion in youth football participants was higher than previously reported.
Dr Dubik has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
There has been little research regarding concussions among elementary and middle school–aged children, so this study is most welcome. The current researchers found a higher incidence than others,1,2 but this is likely because of greater surveillance and perhaps more general awareness.
As has been noted previously,...