Head injuries in youth

An analysis of medical literature dating back to the 1980s singles out rugby, hockey and football as the highest-risk sports for concussion.

January 2016 


Each year more than 1,000 children and adolescents are seen with concussions at the Alberta Children’s Hospital emergency department.

Research from the Cumming School of Medicine has determined which sports pose the highest concussion risk to these youth. The systematic review, published in the British Journal of Sports Medicine, analyzed medical literature dating back to the 1980s.

The study looked at 12 sports, including rugby, lacrosse, soccer, hockey, football, wrestling, basketball, softball, baseball, cheerleading, volleyball and field hockey. Researchers were able to determine overall average concussion risk for youth to be 0.2 concussions per 1,000 athlete exposures (AE) — any single practice or game.

The three sports with the overall highest risks were rugby (four concussions per 1,000 AE), hockey (one concussion per 1,000 AE), and football (0.5 per 1,000 AE). The remaining nine sports had relatively low concussion risks.

Concussion risk in quantifiable terms

Health services researcher and the study’s senior author, Paul Ronksley, PhD, an assistant professor in the Department of Community Health Sciences and member of the O’Brien Institute for Public Health, says that concussion rates have been historically difficult to quantify so the study is advantageous in that it provides statistics that weren’t previously available.

“It has always been assumed that higher contact sports will come with a greater concussion risk for youth athletes, but this paper goes beyond that and actually quantifies this risk,” he says. “Before you could only really say, ‘I think certain sports are risky but I don’t know how risky.’ ”

Team sports provide a number of advantages to youth, such as physical and social development, so Ronksley is quick to caution that these findings should not be used to deter parents from enrolling their children in sports, but to inform their decision in doing so.

“This information could help parents decide what sports are appropriate for their children, depending on their age, health and physical abilities,” he says.

“Combined with further education about the signs of concussion, appropriate treatments, and return-to-sport protocols for concussion, this may help reduce the risk of both initial and repeat concussions for young athletes.”

Youth concussion risk under-studied  

“There needs to be better reporting for concussions in kids.”

While researchers reviewed nearly 700 studies for eligibility, only 23 qualified for inclusion in their systematic review and 13 qualified to be a part of the meta-analysis, highlighting cause to another issue: youth concussion risk is under-studied.

“There needs to be better reporting for concussions in kids,” he says. “Stronger reporting habits and more sport-specific studies will improve our knowledge of the differential risk that appears to exist across different youth sports and will help increase concussion awareness for both parents, coaches, training/medical staff and athletes.” 

Recovery period for children greater than adults

Dr. Brent Hagel, study co-author and a member of the university’s Alberta Children’s Hospital Research Institute for Child and Maternal Health (ACHRI) and Sport Injury Prevention Research Centre, says the recovery period for children following a concussion is greater than that of adults.

“Children require a longer period of rest before they are able to return to pre-injury function,” he says. “This has implications for both school work and return-to-sport.”

A recent review by Dr. Karen Barlow, paediatric neurologist and ACHRI member, found 14 to 29 per cent of children with mild traumatic brain injuries still have symptoms at three months post-injury; however, most make a good recovery.

Hagel, who is also an associate professor in the departments of paediatrics and community health sciences, says parents, coaches, trainers, referees and other stakeholders should educate themselves about prevention, recognition and management of concussion-related participation in sport. Adhering to, and enforcement of the rules of play, especially around those related to no-head contact, are essential considerations.

Hagel also advises the proper use of appropriate sport specific protective equipment, including helmets.

“Certified helmets that fit correctly should be viewed as essential equipment in a variety of sports to reduce the risk of head injury.”

Further information on concussion education and awareness resources are available through the Paediatric Traumatic Brain Injury Research Program at the Alberta Children’s Hospital and the national injury prevention organization, Parachute.

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