Sport Specialization and Exposure in a Tertiary Concussion Program

BACKGROUND: Sport specialization is an important area of focus within pediatric sports medicine with studies relating specialization to the rising incidence of sport-related injuries. The relationship between sport specialization and concussion remains unexplored. HYPOTHESIS/PURPOSE: The objective of this study was to assess the prevalence of sport specialization and its relationship to concussion in athletes seen in a tertiary concussion program. METHODS: Athletes completed a sport specialization questionnaire as part of a comprehensive intake questionnaire and were classified into low, moderate, or high specialization groups using a previously published 3-point scale. Categories were derived from their responses to 3 binary questions: 1) Have you quit other sports to focus on 1 sport? 2) Do you train >8 months out of the year in 1 sport? 3) Do you consider your primary sport more important than other sports? RESULTS: Of the 1,098 athletes, ages 8-19 years, who completed the questionnaire, 572 (52%) were female, 718 (65.5%) had a sports-related concussion (SRC) and 439 (40%) had a prior history of concussion. The cohort was categorized into low (n=568, 51.7%), moderate (n=339, 30.9%), or high (n=191, 17.4%) sport specialization groups. Athletes reported their primary sport was more important than other sports (702, 64%) and training >8 months out of the year in 1 sport (594, 54%) more commonly than quitting other sports to focus on 1 sport (270, 25%). Sport specialization differed by primary sport (Figure 1), but did not significantly differ when primary sport was grouped by level of contact (p=0.47). Sport specialization did not significantly differ by sex, race, or ethnicity, but significantly differed by insurance (p=0.014) and age (p=0.0001), with greater specialization among those with private insurance and adolescents, respectively. Moderately or highly specialized athletes were significantly more likely than less specialized athletes to present with a SRC compared to a non-SRC (p<0.0001) and to report prior history of concussion (p=0.005). After controlling for demographic and sport participation factors, only endorsement of training more than 8 months out of the year in one sport was significantly associated with SRC (p=0.001) and prior concussion (p=0.007). CONCLUSION: Sport specialization is prevalent among youth athletes with concussion. Training >8 months out of the year in a single sport is associated with SRC and prior history of concussion. Further research is warranted to evaluate how exposure among specialized athletes relates to concussion.