Trends in Emergency Department Visits for Contact Sports-Related Traumatic Brain Injuries Among Children — United States, 2001–2018

Waltzman D, Womack LS, Thomas KE, Sarmiento K. MMWR Morb Mortal Wkly Rep. 2020 July 10. DOI:

Full Text Freely Available

Take-Home Message

Child emergency room visits due to contact sports-related traumatic brain injuries doubled from 2001 to 2012. They then decreased by 32% from 2012 to 2018, primarily due to a decrease in football-related TBIs during this period.


Children visit the emergency room for sport and recreation-related traumatic brain injuries (TBIs) > 250,000 times per year in the United States. Children who play contact sports at the time of injury make up almost half of these emergency room visits. Sports programs have implemented age and contact restrictions due to growing concerns regarding the long-term effects of TBIs on the brain. It is unclear if these policies may have changed emergency department-related TBI incidence. Hence, the CDC analyzed children’s (≤ 17 years old) emergency room visits from 2001-2018 with the National Electronic Injury Surveillance System–All Injury Program, which includes a nationally representative sample of hospitals. The authors defined a sports- and recreation-related TBI as an injury related to either organized or unorganized sport or recreational-related activities, which they divided into 4 categories: contact sport, limited-contact sport, noncontact sport, or recreation.

The authors found that almost 3.9 million children visited the emergency room for a sports- and recreation-related TBI. Children’s rate of emergency room visits doubled from 2001 to 2012, regardless of a child’s age. This increase was heavily driven by the rate of emergency room visits due to contact sport-related TBIs, which almost tripled. Males visited the emergency room 3 times more often in 2012 than in 2001. Similarly, females visited the emergency room 3.5 times more often in 2014 than in 2001. Fortunately, children’s emergency room visits declined by 27% from 2012 to 2018. The decrease in children’s visits for TBI was driven by a 32% decrease in contact sports-related TBI visits, especially in football, which decreased 39% from 2013 to 2018.


The authors found that across most groups, children increasingly visited the emergency room for sports and recreation-related TBIs from 2001 to 2012 and then less often from 2013 to 2018. Interestingly, female children experienced a decreased rate in emergency room visits 2 years later than male children. This delay may be due to several factors, such as a greater focus early on for concussion policies in football. For example, leading organizations released guidelines in 2012 to decrease the frequency of tackling during practice and to improve tackling technique. Also, fewer children have been participating in football since 2010. Clinician awareness, improved concussion recognition, and increased reporting may have contributed to the initial increases in sports and recreation-related TBIs emergency room visits. The authors acknowledge several limitations that must be considered, such as children that suffer TBIs who do not go to the emergency room and the inability to determine the causes of the observed trends. Children may be increasingly visiting clinicians outside of the hospital, such as UrgentCare sites or athletic trainers. Despite this, continued research into the prevention and treatment of TBIs can help further improve children’s health and prevent the possible long-term harm of TBIs. These data offer support for low-risk, high-benefit policies like limiting contact whenever possible, promoting healthy techniques, and educating players about TBI symptoms and outcomes.

Questions for Discussion

What caused the observed increase and later decrease in emergency room visits related to SRR-TBIs? What can clinicians do to further decrease TBI rates in children?

Written by: Ryan Paul
Reviewed by: Jeffrey Driban

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