Monday, June 25, 2018 CDC: Concussion Rates Among High Schoolers May be Undercounted A new report from the US Centers for Disease Control and Prevention (CDC) says that in 2017, an estimated 15% of high school students experienced 1 or more concussions, and 6% experienced 2 or more. Authors of the study say that's a number higher than some previous estimates, probably because the CDC study includes anonymous self-reports from the students themselves, many of whom may try to hide the injury from coaches and parents. The data were drawn from the most recent Youth Risk Behavior Study (YRBS), which, in addition to gathering demographic variables, asked students “During the past 12 months, how many times did you have a concussion from playing a sport or being physically active?” Students were also asked to respond to the question, “During the past 12 months, on how many sports teams did you play? (Count any teams run by your school or community groups.)” Here's what researchers found: Overall, 9.1% of high school students reported 1 concussion, 3.0% reported 2, 1.0% reported 3, and 2.0% reported 4 or more concussions related to sports or physical activity during the 12 months before the survey. Male students were more likely to report 1, 2, and 4 or more concussions than were female students. Students in grades 9, 10, and 11 were more likely to report a single concussion than were students in grade 12, and students in grade 9 were more likely to report a single concussion than were students in grade 10. Black and Hispanic students were more likely to report 4 or more concussions than were white students. Among students who played on 1, 2, and 3 or more sports teams, the prevalence of reporting having had at least 1 concussion was 16.7%, 22.9%, and 30.3%, respectively. According to the CDC, the study yielded higher prevalence rates than those from earlier studies based on emergency department reports and data from athletic trainers, which yielded rates of 622.5 per 100,000 and 1.8 per 100, respectively. Authors of the CDC report speculate that the numbers from both sources may be artificially low, as emergency department data lack information on concussions treated elsewhere, and athletic trainer data miss concussions sustained outside school sports—and neither include medically untreated concussions. The CDC report acknowledges that its higher numbers may reflect a greater awareness of concussion symptoms but says that another factor may be at play. "A study of high school athletes found that among athletes with concussions, 40% reported that their coach was unaware of their symptoms," the report states. "Students might not always recognize or remember that they have experienced a concussion, or they might not want to report having experienced a concussion. In this study, the opportunity to anonymously self-report a concussion, without negative consequences, such as a loss of playing time, might have aided in including concussions missed by other data sources." The bottom line, according to the report, is that concussions among high school students may be undercounted and that more needs to be done to educate students, parents, coaches, and school personnel to recognize and report the injury. "Coaches and parents can encourage athletes to follow the rules of play for their sport with an emphasis on player safety, which might reduce the incidence and severity of concussions," authors write. "It is important that any athlete with a suspected concussion be removed from practice and competition and not return to play without the clearance of a health care provider." Physical therapists have a critical role in concussion prevention and management. APTA offers multiple resources on concussion, which include a Traumatic Brain Injury webpage and a clinical summary on concussion available for free to members on PTNow. The association also offers a patient-focused Physical Therapist's Guide to Concussion on APTA's MoveForwardPT.com consumer website. Continuing education offerings from APTA include the prerecorded webinar "Managing Concussions With an Interprofessional Team" available through the APTA Learning Center.