A PROSPECTIVE STUDY ON THE INCIDENCE, MECHANISMS AND RISK FACTORS FOR SPORT RELATED CONCUSSIONS IN HIGH SCHOOL SOCCER PLAYERS

BACKGROUND: There is a growing concern regarding the incidence of Sport Related Concussion (SRC) in high school soccer players. However, there is limited prospective data regarding the incidence, mechanism and risk factors for SRCs for this population. HYPOTHESIS / PURPOSE: To prospectively document the incidence, mechanisms and risk factors for SRCs sustained by high school soccer players. METHODS: High school soccer players from 32 high schools were invited to participate during academic years 2015/16 and 2016/17. Subjects completed a demographic form including their history of previous SRC and preseason PCSS symptom and severity scores from the SCAT3. Licensed Athletic trainers (ATs) and coaches recorded all (practice or competition) soccer exposures (SE). ATs reported the onset, mechanism, symptom resolution and days lost for each SRC sustained during the study. Descriptive statistics were calculated to describe the study population while Cox Proportional Hazards Ratios (HR: [95%], p-value) were used to compare the incidence of SRC among the baseline characteristics. RESULTS: thousand eight hundred eighty-one subjects (Female = 62.8%, Age = 15.7+1.2 yrs.) participated in 96,947 SE (34.3% competition) during the study duration. Two hundred seventy subjects (14.4%) reported one, while 60 (3.2%) reported two previous SRCs. The median (IQR) preseason PCSS symptom score was 0.0 [0,3] while the severity score was 0.0 [0,4]. Eighty (4.3%) subjects sustained a SRC (0.825/1000 SE) during the study time period and reported a median PCSS symptom score of 10.0 [5.0,15.0] and PCSS severity score of 21.0 [14.0,41.0]. Concussion-related symptoms were reported for 6.0 [4.0,10.0] days and 13.0 [9.3, 20.0] soccer days were missed. SRCs occurred most often during competition (78.8%) and as the result of contact with another player (41.3%), the ball (35.0%) or playing surface (20.0%). Females were more likely to sustain a SRC than males (HR: 3.78 [2.00-7.14], p<0.001). Compared to subjects without a previous SRC, the rate was higher for subjects with one (HR: 2.70 (1.65-4.42), p<0.001) and two (HR: 3.71 (1.68-8.19), p=0.001) previous SRCs. Subjects with a preseason PCSS symptom and PCSS severity score > 0 had a higher rate of SRC (HR: 1.71 [1.10-2.65], p=0.017) than players who did not. CONCLUSIONS: This study provides details regarding the incidence, mechanisms and risk factors for SRCs in high school soccer players. Females, players with a previous history of SRC or those reporting a preseason PCSS symptom and severity score >0 were more likely to sustain a SRC playing soccer.