Concussion Occurrence at Various Time Points During High School Athletic Events

Covassin T, Petit KM, Savage
JL, Bretzin AC, Fox ME, Walker LF & Gould D. American Journal of Sports Medicine. doi: 10.1177/0363546518780225.
Take Home Message:
The risk for concussion is greatest during the middle of a practice or game in
high school sports.

Identifying when, where,
and why most concussions occur is important to later implement changes to
reduce the risk of concussion. One factor that has been ignored is the timing when
a concussion occurs during practices and games. Therefore, the authors aimed to
identify when during a practice or competition a concussion is likely to occur in
high school sports. They used data from the Michigan High School Athletic Association’s Head Injury Reporting System,
which collected data on 4,314 concussions from 182,719 athletes across 13
sports during the 2015-2016 academic year. A healthcare provider diagnosed each
concussion that occurred during a sanctioned practice or competition and
required an athlete to be withheld from sport. An athletic trainer, coach, or
school official reported if a concussion occurred during the beginning, middle,
or final third of practice or competition. The authors examined the occurrence
of concussion overall and for each sport separately and then checked if
concussions were more common at the beginning, middle, or end of practices and
games. The authors found that ~2.4 athletes for every 100 athletes experienced a
concussion that year. Men’s football (4.9 per 100 athletes) and women’s soccer
(3.0 per 100 athletes) had the highest rate of concussion among males and
females. An athlete was more likely to sustain a concussion during the middle
(4.9 times more) and end (3.3 times more) versus the beginning of games and
practices combined. An athlete was also 50% more likely to sustain a concussion
during the middle versus the end of a game or practice. Similar patterns were found
in practices and games when separated.

These findings are among
the first to assess when a concussion is more likely to occur during a practice
or game. The middle of games and practices demonstrated a higher risk for
concussions than the beginning or end of sporting events. This complements a
recent post on Sports Med Res that demonstrated that ankle sprains are more common in
the 2nd, 3rd, or 4th quarter of a game than
the first. These findings are important as clinicians are not always able to
attend practices and games due to time constraints and multiple sport
responsibilities –  especially at the
secondary school level. Clinicians could use these results, along with other
injury surveillance studies, to maximize where their medical care is best
suited during sport sessions for their clinical practice. The authors findings
also indicate sports such as men’s football and women’s soccer have higher
concussion incidences than others. Clinicians may not be able to attend all
practices and games, especially with numerous sport healthcare responsibilities.
By understanding where and what sports injuries are more likely to occur,
clinicians can maximize their time and provide optimal healthcare.
Questions for Discussion:
Do you use injury statistics to determine where your clinical expertise is
likely more needed at? If so, how has this helped your clinical practice? If
not, what are some barriers to incorporating this branch of evidence-based
medicine? Lastly, do these findings change the way you intend to manage your
medical coverage time?
Reviewed by: Jeffrey