Association Between Design Elements of Concussion Laws and Reporting of Sports-Related Concussions Among US High School Athletes, 2009-2017.

OBJECTIVES: Studies that evaluate the effectiveness of concussion laws often use only a single variable (ie, presence of the law), failing to account for law complexity. We examined the association between multiple design elements of state concussion laws and rates of sports-related concussion reporting among US high school athletes. METHODS: We derived 3 design elements of concussion laws from the 2009-2017 LawAtlas database: (1) strength of law, (2) number of law revisions, and (3) speed of law adoption. We examined the association between these design elements and rates of new and recurrent sports-related concussion reporting from the 2009-2010 through 2016-2017 academic years in a nationally representative sample of high school athletes participating in High School Report Information Online, an online data collection tool. RESULTS: A total of 7064 sports-related concussions (6332 [89.6%] new and 732 [10.4%] recurrent concussions) were reported during the study period, with an overall rate of 39.7 sports-related concussions per 100 000 athletic exposures (eg, game or practice). Rates of new concussion reporting were higher among high schools in states with medium- or high-strength concussion laws than in states with low-strength concussion laws and in states with at least 1 concussion law revision than in states with no concussion law revisions. Rates of recurrent concussion reporting were lower among high schools in states with ≥2 concussion law revisions than in states with <2 concussion law revisions. Early law adoption was associated with higher rates of new and recurrent concussion reporting, and late law adoption was associated with lower rates of new and recurrent concussion reporting. CONCLUSION: Our findings may help inform legislators of the public health effect of concussion laws.

Epidemiology of sports concussion in the United States.

Sports and recreation-related (SRR) activities are common in the United States. Beyond the benefits to health, SRR activities can create new friendships, give people a sense of belonging, foster teamwork and other leadership skills, and develop sportsmanship and a respect for rules that govern play. Public awareness about the risk of concussion has grown as the long-term consequences of traumatic brain injury (TBI) have become better known, and likely explains the increasing concussion incidence rates. Currently, surveillance systems capture SRR concussions among high school and college athletes participating in sanctioned sports. National estimates of SRR TBI presenting to an emergency department also exist. Persons under the age of 19 sustain a majority of SRR concussions. Concussion risk is greatest for boys in contact/collision sports like football, ice hockey, and lacrosse, and is more likely to occur in competition versus practice settings. Girls have elevated concussion rates in gender-comparable sports. Despite better data, concussions are still underreported, undermanaged, and often not properly identified. This is especially true for concussions occurring outside organized sports, in nonsport recreational activities, and for concussions either not seen or evaluated in nonemergency department settings. A new surveillance system proposed by the Centers for Disease Control and Prevention aims to fill the gap.

Injuries in girls' soccer and basketball: a comparison of high schools with and without athletic trainers.

BACKGROUND: Sports injuries impose physical and economic burdens on high school athletes, yet only 37% of high schools have access to a fulltime certified athletic trainer (AT). Although intuitively there are multiple benefits of AT coverage, research demonstrating the measurable effect of AT coverage on rates and patterns of injury is limited. Our objective was to investigate the epidemiology of girls' basketball and soccer injuries in high schools with and without an AT. METHODS: We compared data captured by two similar sports injury surveillance systems during the 2006/07-2008/09 academic years. High School Reporting Information Online (RIO) included a national sample of schools with ATs, and the Sports Injury Surveillance System (SISS) included a sample of Chicago public high schools without ATs. RESULTS: Overall injury rates were higher in schools without ATs than schools with ATs in girls' soccer (RR: 1.73, 95% CI: 1.51-2.00) and basketball (RR: 1.22, 95% CI: 1.03-1.45). Recurrent injury rates were even higher in schools without ATs compared to schools with ATs in soccer (RR: 6.00 95% CI: 4.54-7.91) and basketball (RR: 2.99, 95% CI: 2.12-4.14). Conversely, concussion rates were higher in schools with ATs than schools without ATs in soccer (RR: 8.05, 95% CI: 2.00-32.51) and basketball (RR: 4.50, 95% CI: 1.43-14.16). Other injury patterns were similar between the two samples. CONCLUSIONS: This study demonstrated the effectiveness of AT coverage of high school girls' soccer and basketball, both in reducing overall and recurrent injury rates and in identifying athletes with concussions. Future studies should evaluate the effect of ATs on other high school sports and on youth sports to determine if these findings are generalizable across sports and age groups.

Shoulder injuries among United States high school athletes during the 2005-2006 and 2006-2007 school years.

CONTEXT: The shoulder is one of the most commonly injured body sites among athletes. Little previous research describes shoulder injury patterns in high school athletes. OBJECTIVE: To describe and compare shoulder injury rates and patterns among high school athletes in 9 sports (football, soccer, basketball, baseball, and wrestling for boys and soccer, volleyball, basketball, and softball for girls). DESIGN: Prospective injury surveillance study. SETTING: Injury data were collected from 100 nationally representative US high schools via High School Reporting Information Online. PATIENTS OR OTHER PARTICIPANTS: Athletes from participating high schools injured while involved in a school-sanctioned practice or competition in 1 of the above sports during the 2005-2006 and 2006-2007 school years. MAIN OUTCOME MEASURE(S): Shoulder injury rates, diagnoses, severity, and mechanisms. RESULTS: During the 2005-2006 and 2006-2007 school years, athletes in this study sustained 805 shoulder injuries during 3 550 141 athlete-exposures (AEs), for an injury rate of 2.27 shoulder injuries per 10 000 AEs. This corresponds to an estimated 232 258 shoulder injuries occurring nationwide during this time. Shoulder injuries were more likely to occur during competition than practice (rate ratio = 3.01, 95% confidence interval = 2.62, 3.46). Shoulder injury rates per 10 000 AEs were highest in football (5.09), wrestling (4.34), and baseball (1.90). Common shoulder injury diagnoses included sprains/strains (39.6%), dislocations/separations (23.7%), contusions (11.5%), and fractures (6.6%). Although 44.8% of athletes sustaining a shoulder injury returned to play in less than 1 week, 22.9% were out of play for more than 3 weeks, and 6.2% of shoulder injuries required surgery. Common mechanisms of shoulder injury included player-to-player contact (57.6%) and contact with the playing surface (22.8%). CONCLUSIONS: High school shoulder injury rates and patterns varied by sport. Continued surveillance is warranted to understand trends and patterns over time and to develop and evaluate evidence-based preventive interventions.