Study Shows Increase in Concussions Among High School Athletes

2 Jun, 2020

By: Michael Popke

A new study released as part of the American Academy of Orthopaedic Surgeons’ (AAOS) Virtual Education Experience determined that — despite increased awareness of concussions in high school athletics and traumatic brain injury (TBI) laws —  the number of concussions athletes suffer continues to rise.

Since 2005, Wellington Hsu, professor of orthopaedics at Northwestern University’s Feinberg School of Medicine and senior author of a study titled “The Incidence of Reported Concussions Sustained by High School Athletes Continues to Increase,” has collected annual reports generated by the High School Reporting Information Online (RIO) surveillance system. Hsu and his team extracted injury data from 100 high schools across the United States for nine sports: football, soccer, basketball, wrestling and baseball for boys; soccer, basketball, volleyball and softball for girls. The data included detailed information on each player (sport, age, year in school), the athlete’s injury (diagnosis, severity and return to play), the mechanism of injury, and the situation that lead to the injury.

Approximately 300,000 adolescents suffer concussions, or mild TBIs, each year while participating in high school sports, according to Hsu. As children and adolescents have less cognitive reserve (a resistance to brain damage) than adults, a concussion may cause a greater risk for more severe symptoms, including headaches, memory loss, confusion and dizziness, as well as a prolonged recovery. 

“It’s understandable to think that with increased awareness among practitioners who diagnose concussions, the incidence would naturally rise,” Hsu said in a statement regarding analysis of injury data from 2015 to 2017. “However, because we’ve studied and reported on concussions for a number of years now, I feel that enough time has passed and I would have expected to see the numbers start to level out. What we found was that the overall average proportion of concussions reported annually in all sports increased significantly, as did the overall rate of concussions.”

Not only did girls’ soccer players continue to have a higher proportion of concussions compared to boys’ football players (29.8 percent vs. 25.2 percent, respectively), but girls’ volleyball demonstrated the largest increase in number, proportion and rate of concussions compared with all other sports in this study.

“Since volleyball is generally considered a ‘low risk’ sport for concussions, this was an unexpected discovery compared to what we saw three years ago,” Hsu said. “The jump in both girls’ soccer and volleyball is likely due to increased participation in the sports and concussion awareness.”

Another finding was that, in gender-matched sports, girls continued to experience a significantly higher concussion rate than boys. 

Hsu says he plans to continue his research and is hopeful that the collective findings will lead to stronger implementation of rule changes, protective headgear and contact avoidance.

In other concussion-related news:

• Less than half of patients with sports-related mild traumatic brain injuries (mTBI) achieve clinical recovery within two weeks, according to a study in the Clinical Journal of Sport Medicine. “This study challenges current perceptions that most people with a sports-related mTBI recover within 10 to 14 days,” writes Stephen Kara of Axis Sports Medicine in Auckland, New Zealand. The findings also question the belief that children recover more slowly after sports-related concussion, and highlight the importance of early access to care after mTBI. The average age of study participants was 20.

• World renowned neuroscientist Adrian Owen and his team at Western University have discovered that Canadian football players who suffer concussions fare poorly in tasks related to inhibition. Researchers analyzed results of 12 cognitive tests from an online survey of nearly 20,000 people in the general population to develop a baseline of data about concussions. They then used those results to successfully predict how 74 Canadian university football players would perform on the same set of tests. A significant inhibition impairment was identified in the football players. “If you have an impairment of inhibitory control, it means that you are likely to carry on doing something when perhaps you should have stopped,” Owen, professor of Cognitive Neuroscience and Imaging at Western’s Shulich School of Medicine & Dentistry, said in a statement. “For example, running an amber light when it may have been safer to stop, or on the field, it might mean a player would continue with a tackle long after they’ve heard the whistle to stop.”

• Mechanical engineers at the University of Wisconsin-Madison might have figured out a “cool” way to treat concussions. Christian Franck, an associate professor of mechanical engineering led a study that suggests cooling brain cells soon after injury can help them better repair themselves. According to, “Franck says there’s more to learn before cooling the brain could be a practical treatment for patients at a clinic. For example, it’s not as easy as simply lowering the temperature of a person’s whole body, which taxes the heart and can have a strong negative effect on the immune system. Rather, isolating cooling to the brain is crucial.”


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