Reducing traumatic
brain injuries in youth sports: Youth sports traumatic brain injury state laws,
January 2009-December 2012

H., Harvey JD. American Journal of Public Health. 2013; ahead of print.

Take Home Message: In the United States, traumatic brain
injury laws reflect a uniform, but not scientifically proven consensus about
return to play time, who makes the return to play decisions, and the best
delivery method to distribute educational information. None of the laws target
injury prevention.

Forty-four states and Washington DC
passed legislation to reduce the overall impact of traumatic brain injuries.
However, there are no studies comparing the content of the laws with the
current scientific literature regarding symptoms, treatment, and the effect the
laws have on youth traumatic brain injuries. Therefore, the purpose of this
study was to describe the current statewide youth sports traumatic brain injury
laws and their relationship to established scientific literature of youth
traumatic brain injuries. Westlaw and Lexis-Nexis databases were used to create
a 50-state dataset of youth sports traumatic brain injury laws enacted between
January 2009 and December 2012. The laws were coded to identify key variables,
which included types of sports covered, age of target population, and reporting
protocols. The laws primarily focus on secondary problems that arise following
traumatic brain injuries and are modeled on the
Lystedt framework (Washington; i.e., removal from play, evaluation by
a health professional, and distribution of concussion information). None of the
states enacted any primary prevention protocols. Forty-two laws include a mandatory
removal from play when a concussion is suspected. Most laws require a minimum
of 24 hours before return to play. Forty states and Washington DC require a
young athlete to be cleared by third party before returning to play and almost
all of these laws express that this third party must be a health professional.
Only 26 states require that the health professional be trained in traumatic
brain injury identification or management. Furthermore, 34 jurisdictions require
traumatic brain injury information to be distributed to parents and/or
guardians of student athletes. The content within the information packets are
not specified in the laws, but the CDC’s material have been specifically
mentioned in some of the laws. Out of the 45 jurisdictions that have traumatic
brain injury laws only 25 explicitly require coach education in recognizing the
symptoms of traumatic brain injuries in youth sports and the training
requirements range from annually to every several years.

across the U.S. are responding to the increased public awareness of traumatic
brain injuries in youth sports by passing laws to improve identification and management.
These laws vary little in their content across the states and none of the
states focus on prevention. Many states implemented a minimum of a 24-hour
removal period; however, 24 hours may not be enough time to safely monitor
symptoms and conduct a graduated return-to-play protocol (McCrory et al., 2013).
States seem to diverge the most regarding who is qualified to make the return
to play decision. There are 19 jurisdictions that do not require traumatic
brain injury specific training and there is no research whether or not this is appropriate
and safe for youth athletes. The educational component is one of the most
important aspects of the laws, but is lacking in its efficacy in helping
parents prevent, identify, and respond to traumatic brain injuries because the
content of the required educational information in most cases is not specified.
Lastly, because youth sports typically do not have athletic training or medical
personnel coverage during practice or games traumatic brain injury training for
coaches is vital but the training standards are lacking in the laws. Furthermore,
the laws do not try and regulate the content of sports activity like how many
impacts is safe or banning specific maneuvers. This all suggests that we need
to evaluate the existing laws to develop more comprehensive laws governing
traumatic brain injuries in youth sports. It is important that we encourage not
just evidence-based practice for traumatic brain injuries but also
evidence-based legislation. As clinicians and researchers in sports medicine,
we must work with the legislatures to improve the existing laws and when we
believe the legislation is lacking we should help fill the gaps by raising the
standards of education, awareness, and prevention in our communities.

Questions for Discussion: Do you think the current laws in
place substantially improve the recognition and management of traumatic brain
injuries in youth sports? Do you think changing the laws will help prevent
concussions? What aspects of the laws do you think are the most or least

Written by: Jane McDevitt PhD, ATC,
Reviewed by: Jeffrey Driban


Harvey HH (2013). Reducing traumatic brain injuries in youth sports: youth sports traumatic brain injury state laws, january 2009-december 2012. American Journal of Public Health, 103 (7), 1249-54 PMID: 23678903