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The Risk of Subsequent Concussion or Reconcussion Among Youth Participating in Sports

Publication Date

4-30-2015

Keywords

sports-related concussion, reconcussion

Abstract

Background/Aims: In 2012, an amendment to the California Education Code (CA-AB 25) was enacted requiring school-based athletic programs to remove youth from the sport played when a concussion occurred, and to provide more rigorous evaluation and treatment. Youth were required to obtain written clearance from their health care provider before returning to play.

Methods: A retrospective cohort study was conducted of Kaiser Permanente Northern California (KPNC) members age 10–17 years with sports-related concussions from 2009–2010 and 2012–2013. Our aims were to calculate subsequent concussion (reconcussion) rates and compare risks for reconcussion before and after enactment of CA-AB 25. Data obtained determined type of sport, level of contact (noncontact, limited contact, contact and collision), presenting symptoms, and evidence of prior and reconcussion to the index concussion. Chi-square tests and logistic regression analysis were performed to assess the association of index concussion demographic (age, gender, race/ethnicity, median family income) and clinical characteristics with reconcussion.

Results: Preliminary results (N=1,002) of KPNC youth age 10–17 in 2009–2010 showed concussion diagnoses were highest among boys playing football (31.6% [223/706]) soccer (8.8% [62/706] and baseball (8.64% [61/706]). Concussion diagnoses were highest among girls playing soccer (27.7% [82/296]), softball (10.47% [31/296]) and basketball (10.14% [30/296]). Reconcussions occurred in 7.4% within 18 months. Reconcussions among those with concussions prior to index compared with those without were higher (11.6% [22/189] vs. 6.5% [52/795], P=0.02). Those playing contact/collision sports were more likely to have reconcussions compared with limited/noncontact sports (9.4% [53/561] vs. 5.0% [21/417], P=0.01). Of reconcussed subjects, those who played contact/collision sports were more likely to be reconcussed due to sports participation compared with those who played limited/noncontact sports (81.1% [43/53] vs. 52.74% [11/21], P=0.02). In multivariable analyses, age 14–17 compared to age 10–13 (odds ratio [OR]: 2.59, 95% confidence interval [CI]: 1.36–4.97), and blurred vision/light sensitivity (OR: 2.10, 95% CI: 1.16–3.78) and dizziness or lightheadedness (OR: 1.75, 95% CI: 1.02–2.98) vs. absence of these symptoms were significantly associated with reconcussion.

Discussion: Preliminary findings show risk of reconcussion in athletic youth is a serious public health problem. Final results on 2,065 subjects will show comparisons in reconcussion rates and risk factors associated with reconcussions before and after enactment of CA-AB 25.

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Submitted

April 7th, 2015

Accepted

April 28th, 2015