August 2021


New research presented at the National Athletic Trainers’ Associations’ 2021 NATA Virtual Clinical Symposia & AT Expo, held virtually this year due to COVID-19, found that middle school sports have an overall higher rate of concussion than reported in high school and collegiate settings. The research also concluded that middle school athletes playing football had the greatest overall concussion rate, girls suffered concussions twice as much as boys participating in sex-comparable sports, and overall concussion rate was higher in competition than practice. Sports with the highest concussion rates were football, girls’ soccer, and wrestling.

“The higher rates of concussion observed in middle school may in part be due to the unique and highly variable neuro-biopsychosocial characteristics of these rapidly developing children,” said Shane V. Caswell, PhD, ATC, research author and lead of the Advancing Healthcare Initiatives for Underserved Student (ACHIEVES project). “Additionally, other distinct differences associated with the middle school sport setting itself, such as, the large variations in player size and skill, coaching, or the shorter sports seasons providing less time to skill acquisition may also contribute the higher rates of concussion”

Athletic trainers recorded injury and athlete exposure (AE) data from public middle schools in Virginia (COVID disruptions were noted). Concussion rates were calculated for 12 school-sponsored sports (baseball, football, wrestling, boys’ and girls’ basketball, cheerleading, boys’ and girls’ soccer, softball, boys’ and girls’ track, and volleyball). Sex-comparisons were conducted for sports played by boys and girls (eg, soccer, track and field, basketball and softball/baseball).

The researchers found that the overall concussion rate for school-sponsored sport participation was 0.60/1000 AE (95% CI, 0.56-0.64). The concussion rate for football was 1.36/1000 AE (95% CI, 1.05-1.67); for girls’ soccer the rate was 1.26/1000 AE, (95% CI, 0.77-1.75); and for wrestling the rate was 1.12/1000AE (95% CI, 0.78-1.46).

The researchers concluded that the findings reinforce the value and importance of on-site, appropriate medical care within middle school sport settings.

This research was conducted as part of the Advancing Healthcare Initiatives for Underserved Students (ACHIEVES) project at George Mason University. Led by Caswell, this innovative project works to address healthcare disparities by providing Virginia Commonwealth Board of Medicine Licensed Athletic Trainers (ATs) to increase accessibility to healthcare for a diverse population of more than 21,000 students in 16 middle school communities.

Source: Hacherl SL, Kelshaw PM, Erdman NK, et al. Concussion Rates in U.S. Middle School Athletes From the 2015-2016 to 2019-2020 School Years.  J Athlet Train. 2021;56(6):S-21.

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