Perspective

Girl soccer players are five-times more likely to return to play after concussion

CHICAGO — Although concussion guidelines recommend not returning to play the same day an injury is sustained, girl soccer players were 514% more likely to return to the field that same day than boys, according to research presented at the American Academy of Pediatrics 2017 National Conference & Exhibition.

“The girl soccer players were five-times more likely than boys to return to play on the same day as their concussion,” Shane M. Miller, MD, FAAP, a pediatric sports medicine specialist at the Texas Scottish Rite Hospital for Children, said in a press release. “This is cause for concern, especially with previous studies showing that girls suffer twice as many concussions as boys.”

To understand the differences in the rates at which girls and boys return to play after a concussion, as well as the frequency with which this happens, the researchers conducted a retrospective review that included athletes aged 7 to 18 years who sustained a concussion playing soccer and were treated during a period of 2 years at a pediatric sports medicine clinic. Patient demographics, same-day return to play information, soccer position, injury characteristics, symptoms and other measures were assessed.

Shane M. Miller, MD, FAAP
Shane M. Miller

Return to play among girls

Of those studied (n = 87), 66.7% were girls and 33.3% were boys. The average age of the soccer players was 14.13 years. Girls were more likely to be back to play after concussions, with 51.7% of girls returning the same day compared with boys (17.2%), making girls 514% more likely to return to play (OR = 5.14).

When all players were included, 40.2% returned to play on the same day, with 97.1% returning to the same practice or game, and one returned to a game later in the same day.

“Considering the dangers of returning to play prematurely, parents need to familiarize themselves with organizational guidelines for concussions, which should be aligned with current national recommendations, and should have a heightened awareness of signs and symptoms of concussions,” Aaron Zynda, clinical research coordinator at the Texas Scottish Rite Hospital for Children, said in the press release.

Education, opportunities for change

“Current education efforts may not be enough to help athletes, parents and coaches identify concussion symptoms, know the guidelines for immediate removal from play and understand the risks of returning to play after an injury,” Zynda said. “More research is needed on how to better spread this message intended to protect the health of young athletes and help them comply with state laws.”

Miller told Orthopedics Today, “Girl soccer players were five-times more likely than boys to continue playing on the same day after sustaining a concussion, despite medical guidelines recommending immediate removal from play and not returning to play on the same day. This alarming difference suggests there may be opportunities to improve efforts to increase injury reporting and removal from play, particularly among girl soccer players. Also concerning was the finding that 40% of the athletes returned to play after their injury, regardless of gender. With this information, practitioners are better equipped to educate patients, as well as parents, about the importance of recognizing a possible concussion and removing a young athlete from play.” – by Katherine Bortz and Susan M. Rapp

Disclosures: Miller and Zynda report no relevant financial disclosures.

CHICAGO — Although concussion guidelines recommend not returning to play the same day an injury is sustained, girl soccer players were 514% more likely to return to the field that same day than boys, according to research presented at the American Academy of Pediatrics 2017 National Conference & Exhibition.

“The girl soccer players were five-times more likely than boys to return to play on the same day as their concussion,” Shane M. Miller, MD, FAAP, a pediatric sports medicine specialist at the Texas Scottish Rite Hospital for Children, said in a press release. “This is cause for concern, especially with previous studies showing that girls suffer twice as many concussions as boys.”

To understand the differences in the rates at which girls and boys return to play after a concussion, as well as the frequency with which this happens, the researchers conducted a retrospective review that included athletes aged 7 to 18 years who sustained a concussion playing soccer and were treated during a period of 2 years at a pediatric sports medicine clinic. Patient demographics, same-day return to play information, soccer position, injury characteristics, symptoms and other measures were assessed.

Shane M. Miller, MD, FAAP
Shane M. Miller

Return to play among girls

Of those studied (n = 87), 66.7% were girls and 33.3% were boys. The average age of the soccer players was 14.13 years. Girls were more likely to be back to play after concussions, with 51.7% of girls returning the same day compared with boys (17.2%), making girls 514% more likely to return to play (OR = 5.14).

When all players were included, 40.2% returned to play on the same day, with 97.1% returning to the same practice or game, and one returned to a game later in the same day.

“Considering the dangers of returning to play prematurely, parents need to familiarize themselves with organizational guidelines for concussions, which should be aligned with current national recommendations, and should have a heightened awareness of signs and symptoms of concussions,” Aaron Zynda, clinical research coordinator at the Texas Scottish Rite Hospital for Children, said in the press release.

Education, opportunities for change

“Current education efforts may not be enough to help athletes, parents and coaches identify concussion symptoms, know the guidelines for immediate removal from play and understand the risks of returning to play after an injury,” Zynda said. “More research is needed on how to better spread this message intended to protect the health of young athletes and help them comply with state laws.”

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Miller told Orthopedics Today, “Girl soccer players were five-times more likely than boys to continue playing on the same day after sustaining a concussion, despite medical guidelines recommending immediate removal from play and not returning to play on the same day. This alarming difference suggests there may be opportunities to improve efforts to increase injury reporting and removal from play, particularly among girl soccer players. Also concerning was the finding that 40% of the athletes returned to play after their injury, regardless of gender. With this information, practitioners are better equipped to educate patients, as well as parents, about the importance of recognizing a possible concussion and removing a young athlete from play.” – by Katherine Bortz and Susan M. Rapp

Disclosures: Miller and Zynda report no relevant financial disclosures.

    Perspective
    Anthony P. Kontos, PhD

    Anthony P. Kontos

    The current findings are striking, with more than half of girl soccer players reporting they continued to play following a diagnosed concussion compared to 17% for the boys. The fact that any of these players let alone 40% of the total sample continued to play on the same day as their concussion is alarming, as this is contraindicated for athletes at all levels. It is therefore surprising that such high numbers of players and, in particular girls, reported continuing to play on the same day as their concussion.

    I wonder if some of the players in the study may have misunderstood the question about playing after their injury, leading to an inflation in reporting. Regardless, this highlights the need for education about the consequences of continuing to play following a concussion including potential catastrophic injury (from second impact syndrome) and, as we reported in 2016, doubling the length of recovery and experiencing greater symptoms and impairment. The findings highlight the importance of having trained athletic trainers and physicians on the sideline to identify potentially concussed players for evaluation and ensure players do not continue to play following a concussion. Similarly, coaches, parents and athletes must be aware of the consequences of continuing to play and the importance of recognizing the signs and symptoms of this injury.

    There were some limitations to the study as presented. We do not know much about the sample, including the skill/competition level, who diagnosed the concussion or how long the athletes continued to play. Importantly, the self-reported data regarding return to play may not be accurate in relation to when the concussion occurred or was diagnosed. Although these findings suggest that girl soccer players may be more likely than boys to continue to play following a concussion, the boys who were underrepresented (only one-third of the sample) in the current study may not have been as accurate or honest in reporting.

    This study needs to be replicated in a large sample with more male players and incorporate additional measures to better determine the consequences of continuing to play. We simply do not know the validity of the self-reporting, diagnoses and consequences for continuing to play from the study or if the current sample is representative of soccer players in general. The findings highlight the importance of early identification of concussion and the need for better medical coverage during soccer games and practice at youth, non-scholastic levels.

    • Anthony P. Kontos, PhD
    • Research director, UPMC Sports Medicine Concussion Program
      Pittsburgh

    Disclosures: Kontos reports no relevant financial disclosures.