Concussion among female
middle-school soccer players

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.

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.

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

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?

by: Jane McDevitt, PhD
by: Jeffrey Driban


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