Concussion among female middle-school soccer players
O’Kane JW, Spieker A, Levy MR, Neradilek M, Polissar NL, Schiff MA. JAMA Pediatr. 2014; published online
Take Home Message: Young female soccer players (11 to 14 years) have a high rate of concussions, often continue to play with symptoms, and commonly fail to seek medical attention.
Over 1.4 million girls between 5 and 15 years of age registered to play US Youth Soccer. Youth players typically lack injury-tracking systems and are largely understudied. This is concerning since younger athletes and the female sex are risk factors for concussions. Therefore, the authors described the incidence rate, frequency, and duration of concussion symptoms in female youth soccer players. They also determined if these symptoms prompted the young athletes to stop playing or seek medical care. Three hundred and fifty-one female youth soccer players aged 11 to 14 years from 4 youth soccer clubs (33 teams from Puget Sound region of Washington State) were observed for at least 1 full season from 2008 to 2012. During preseasons, athletes answered a health history. During the season an injury surveillance system was implemented, where player’s parents received a weekly email with a link to an internet-based survey to report if his or her daughter experienced a hit to the head resulting in concussion symptoms. A trained medical personnel called players who reported a possible concussion and conducted a standardized interview within 1 week of the injury. Weekly follow-up interviews assessing length of symptom resolution and recovery time were also completed. The weekly internet survey also collected the number of athletic exposure hours in practice and the number of practices per week. Trained parent volunteers collected the number of game-minutes for each player using a timing sheet. The players included in this study experienced 59 concussions. Among the concussed players 73% had 1 concussion and 27% had 2 concussions. The symptoms lasted a mean of 9 days (median, 4 days). Over half (52%) of the players’ symptoms lasted 1-7 days. Eighty-six percent of the concussions occurred during a game involving contact with another person (54%), heading the ball (30%), and goal tending (12%). Most players (59%) continued to play with concussion symptoms. Additionally, more than half (56%) of the players reporting concussion symptoms stated that a qualified medical professional never examined them. Cumulative concussion incidence was 13% per season (1.3 per 1000 hours of athletic participation), and the rate of concussion diagnosed by qualified medical personnel was just 0.4 per 1000 hours of athletic participation.
This is the first study to look at middle school female soccer concussion rates, and the authors found that these rates are higher in middle school (1.3 concussion per 1000 athletic exposures) compared with previously reported rates in high school (0.23 to 0.85 per 1000 athletic exposures). Due to the lack of medical personnel at middle school games and practices players must actively seek medical attention. Remarkably, even after being prompted that the athlete may have sustained a concussion only 44% of the athletes sought medical attention. Additionally, over half of the athletes continued to play with concussion symptoms. Soccer is categorized as a non-contact sport, which should be especially true at the youth level; however, over half of the concussions sustained were due to a contact with another person, and 30% were from heading the ball. Due to the immature skeleton, developing brain, and other risk factors associated with youth players this study suggests that we may need rules to decrease the amount of player contact and soccer ball heading these players execute during games and practices. Though, this study had several limitations, for example, none of player’s concussions included in this study were formally evaluated, it highlights the need for concussion education at a the youth level.
Questions for Discussion: Are rule changes necessary to decrease player-to-player contact in youth soccer? Should youth soccer games have medical coverage? Should there be a heading count for youth soccer? Do youth soccer coaches in your area attend mandatory concussion training programs?
Written by: Jane McDevitt, PhD
Reviewed by: Jeffrey Driban
Typical vs Prolonged Recovery Time and Predictors Following Concussion in High School and College Athletes
O'Kane JW, Spieker A, Levy MR, Neradilek M, Polissar NL, & Schiff MA (2014). Concussion Among Female Middle-School Soccer Players. JAMA pediatrics PMID: 24446018