Abstract
Background:
There is much concern over the incidence of concussion in high school sports, with a growing focus on soccer, necessitating the need for legislation and formal rule changes for safety reasons.
Objective:
To note differences in concussive injury between boys and girls soccer and determine the change in reported concussion rates from 2011 vs. 2017 in order to study the impact of legislation and rule changes on the rates of concussion in high school soccer in the state of New Jersey.
Design:
Comparative Study
Methods:
Licensed athletic trainers working in the secondary school setting in the state of New Jersey voluntarily participated in an online survey on the incidence of concussion in boys and girls soccer. This de-identified data was compared with data collected from a similar survey conducted in 2011.
Results:
In 2017 there were 168 concussions occurred among 3255 male soccer athletes. Eight-five percent of concussions (145/168) occurred during games, with the remainder occurring in practice. Forty-five percent (76/168) occurred to varsity players with the majority occurring during games (84%). Fewer concussions were reported to junior varsity and freshman players.. In 2017, Incidence Rate (IR) for all male soccer athletes was calculated at 0.36 concussions per 1000 athletic exposures (AE). Injury Proportion (IP) was 5%. Clinical Incidence was 0.05 concussions per athlete. This represented a 38% increase in IR/1000 AE from 2011 to 2017, and a 39% increase in IP 2011 vs 2017
In 2017, a total of 2604 female soccer athletes, reported 195 concussions with the majority occurring during games (83%). Varsity athlete reported the higher number of concussions relative to junior varsity and freshman soccer athletes IR/1000 AE was 0.48 vs 0.43 in 2011 (12% increase), while IP was 7% vs 6% in 2011 (17% increase Females had a greater IR/1000 AE than males (.48 vs. .36). Clinical incidence was also greater for female soccer athletes than male soccer athletes (0.075 vs. 0.05).
Conclusion:
Despite legislation and rule changes, the incidence of concussion in both boys and girls high school soccer is increasing and particularly during games. Playing at the varsity level and game play has the highest association with injury and should be subject to greater scrutiny. Additionally, more concussions are occurring to female soccer athletes than male players. This information provides a snapshot of a significant problem that deserves greater attention.
Table 1.
Boys Soccer Comparison
| Boys Soccer: Overall |
2017 62 Highs Schools Reporting 3255 Athletes 168 Concussions Reported |
2011 45 Schools Reporting 1984 Athletes 72 Concussions Reported |
|---|---|---|
| Incidence Proportion: | 5%; SE(IP)= 0.0038; 95% CI: 4.3%, 5.8% |
3.6%; SE(IP)=0.0041; 95% CI:2.8%, 4.4% |
| Incidence Rate: | 0.35 concussions/1,000 AE; SE(IR)=2.75E-05; 95% CI:0.3, 0.4 | .26/1,000 AE; SE(IR)3.03E-05;95% CI:02,0.32 |
| Clinical Incidence: | .05 concussions/athlete; SE=0.0038; 95% CI: 0.04, 0.06 | .36 concussions/athlete; SE(IP); 95% CI: .03, 0.04 |
| Games: | ||
| Incidence Proportion | 4.93%; SE(IP)=0.004; 95% CI: 0.37, 0.51 | 2.9%; SE(IP)=0.004; 95%CI: 2.2%,3.7% |
| Incidence Rate | 1.722 concussions/1,000 AE; SE(IR):0.00014; 95% CI: 1.722, 1.723 | 0.975 concussions/1,000 AE; SE(IR)= 0.00013; 95% CI: 0.724, 1.23 |
| Clinical Incidence | 0.04 concussions/athlete; SE=0.004; 95% CI: 0.037, 0.051 | 0.029 concussions/athlete; SE=0.004; 95% CI: 0.029, 0.037 |
| Practices: | ||
| Incidence Proportion | 0.7%; SE(IP)=0.002; 95% CI: 0.4%, 1.1% | 0.7%; SE(IP)= 0.002; 95% CI: 0.3%,1% |
| Incidence Rate | 0.069 concussions/1,000 AE: SE(IR):1.39E-05; 95% CI:0.03, 0.08 | 0.066 concussions/1,000 AE; SE(IR)=1.82E-05; 95% CI: 0.03, 0.1 |
| Clinical Incidence | 0.007 concussions/athlete; SE=0.004, 95% CI: 0.004, 0.011 | 0.07 concussions/athlete; SE=0.002; 95% CI: 0.03, 0.01 |
Table 2.
Girls Soccer Comparison:
| Girls Soccer Overall |
2017 60 High Schools Reporting 2604 athletes 195 concussions |
2011 45 High Schools Reporting 1987 Athletes 119 Concussions |
|---|---|---|
| Incidence Proportion | 7%; SE(IP)= 0.0049; 95% CI: 6%, 8% | 6%; SE(IP)=0.005; 95% CI: 5%,7% |
| Incidence Rate | 0.48 Concussions/1,000 AE; SE(IR)=3.58E; 95% CI: 0.4, 0.6 | 0.44 concussions/1,000 AE; SE(IR)=0.006; 95% CI: 0.43, 0.45 |
| Clinical Incidence | 0.075 concussions/athlete; SE=0.0049; 95% CI: 0.07, 0.09 | 0.06 concussions/athlete; SE=0.005, 95% CI: 0.05, 0.07 |
| Games: | ||
| Incidence Proportion | 5.7%; SE(IP)=0.005; 95% CI: 4.8%, 6.6% | 5.6%; SE(IP) = 0.005; 95% CI: 4.6%, 6.6% |
| Incidence Rate | 2.24 concussions/1,000 AE; SE(IR)= 0.00018; 95% CI: 1.88, 2.60 | 1.86 concussions/1,000 AE; SE(IR) = 0.00013; 95% CI: 1.85, 1.87 |
| Clinical Incidence | 0.06 concussions/athlete; SE = 0.005; 95% CI: 0.05, 0.07 | 0.056 concussions/athlete; SE= 0.005; 95% CI: 0.046, 0.066 |
| Practices: | ||
| Incidence Proportion | 1.2%; SE(IP)= 0.002; 95% CI: 0.8%, 1.7%, | 0.6%; SE(IP)= 0.002; 95% CI: 0.2%, 0.9% |
| Incidence Rate | 0.11 concussions/1,000 AE; SE(IR)= 1.97E-05; 95% CI: 0.07, 0.15 | 0.055 concussion/1,000 AE; SE(IR) = 0.002; 95% CI: 0.05, 0.06 |
| Clinical Incidence | 0.01 concussions/athlete; SE= 0.002; 95% CI: 0.008, 0.017 | 0.06 concussions/athlete; SE= 0.002; 95% CI: 0.002, 0.009 |