July 20, 2016
2 min read

Study cites differences in concussion outcomes for football players by level of competition

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Investigators of this study found youth athletes, high school athletes and collegiate athletes who played football had different concussion-related outcomes which may be due to factors such as biologic differences or variations in policies.

“Overall, having athletic trainers on-site at any level of play is important to detect, diagnose and manage concussion,” Zachary Y. Kerr, PhD, MPH, told Healio.com/Orthopedics. “All colleges should have an athletic trainer on-site during football games and practices. However, a number of high schools do not have access to a full-time athletic trainer, and many youth football leagues do not have any access. An investment in an athletic trainer at these games and [at] practices is an investment in the health and safety of our adolescent and children athletes.”

Zachary Y. Kerr



He added, “More related to the study itself, our study is the first to examine concussion-related symptomatology and return-to-play time in youth, high school and collegiate athletes, finding differences among the groups.  Nevertheless, we advocate further research. We particularly hope such future research will specifically examine the many level-specific organizational, social environmental and policy-related factors that may drive such variations in outcomes.”

Kerr and colleagues collected data on 1,429 sport-related concussions in youth, high school and collegiate football teams from the following three surveillance programs: the Youth Football Safety Study; the National Athletic Treatment, Injury and Outcomes Network; and the National Collegiate Athletic Association Injury Surveillance Program. Athletic trainers attended every practice and game for the 2012 to 2014 seasons.

Investigators determined the mean number of symptoms, symptom prevalence and proportion of patients with long return-to-play time due to concussions. Differences between the competition levels and mean number of symptoms reported were determined with generalized linear models. Investigators also used logistic regression models to estimate the chance of return to play at less than 24 hours and after at least 30 hours.

Findings showed youth, high school and collegiate football players reported a mean of 5.84 symptoms. Investigators noted all competition levels had a 15.3% return to play within at least 30 days of the concussion. At less than 24 hours, 3.1% of athletes returned to play. High school athletes reported a higher number of concussion symptoms compared with youth athletes.

According to researchers, both youth and high school athletes had greater odds of return to play at least 30 days after concussion compared with collegiate athletes. Youth athletes had greater odds of return to play less than 24 hours after concussion compared with high school athletes.

“The finding related to return to play under 24 hours being the highest in the youth level is surprising, but may be the result of young football players struggling to identify concussion symptoms and express how they feel to onsite athletic trainers,” Kerr said.  “Thus, it is imperative to educate not only the young football players about concussions, but also all adults present as well, including parents, coaches, medical staff, and officials on recognition and management of concussions.   Still, we should also highlight that appropriate medical care includes managing and returning concussions at the appropriate time.  With over 40% of concussions being returned to play in 2 weeks or longer, we believe that athletic trainers are ensuring that concussed players go through an appropriate return-to-play timeline. by Monica Jaramillo



Kerr ZY, et al. JAMA Pediatr. 2016;doi:10.1001/jamapediatrics.2016.0073.

Disclosure: Kerr reports no relevant financial disclosures