TRENDS IN US HIGH SCHOOL AND CLUB CHEER PRACTICE CONCUSSION REPORTING FROM 2012-2017

BACKGROUND: Sport-related concussion (SRC) is one of the leading injuries among the 3.24 to 4.03 million athletes participating in cheerleading from 2012-2017. The purpose of this study was to provide a descriptive epidemiology of SRC in the school and club cheerleading practice setting from the 2012 to 2017 calendar years. METHODS: Female cheerleading athletes, ages 12 to 18 participating in school or club cheer from 2012 to 2017 were included in the current study. Injury and exposure data from school and club cheerleading practices from the Rank One Health Injury Surveillance Database (ROH ISD) were analyzed. SRC counts, percentages, rates per 10,000 athletic exposures (AEs), rate ratios (RRs), and injury proportion ratios (IPRs) were reported with 95% confidence intervals (CIs). Any RR or IPR with a 95% CI not containing 1.0 were considered statistically significant. RESULTS: From 2012-2017, 951 SRCs were recorded from a sample of 51,812 females participating in school cheerleading and 12,643 females participating in club cheerleading. Cheerleading SRCs accounted for 0.40% of all injuries in sports from 2012-2017. The total SRC rate in school cheerleading was 6.02/10,000 AEs (95% CI = 5.87, 6.17). The total SRC rate in club cheerleading was 11.98/10,000 AEs (95% CI = 11.74, 12.22). The SRC rate was higher in club practices than in school practices (RR = 1.99; 95% CI = 1.89, 2.09). More SRCs occurred at school cheerleading practices (65.62%) than club practices (34.48%). The proportion of SRCs from falls onto hardwood surfaces was higher in club cheerleading practices than school cheerleading practices (IPR = 1.69; 95% CI = 1.61, 1.77) while the proportion of falls onto padded surfaces was higher in school cheerleading practices than club cheerleading practices (IPR = 2.26; 95% CI = 2.18, 2.34). CONCLUSIONS: The findings from this study provide the largest SRC incidence rates for school and club cheerleading practices to date and reveal evidence of differences in the club and school practice settings. Club cheerleading practice SRCs occurred at a higher rate than school cheerleading practice SRCs and appear to be significantly reduced by practicing on padded surfaces. These findings should be considered when educating cheerleading coaches, parents, and athletes regrading concussion injury risks as well as identifying potential areas of injury prevention. Further research is warranted to identify potential causes for injury trends observed in the current study.