Jan 29, 2015
Concussion Calculations

By Dawn Comstock

Dawn Comstock, PhD, is a principle investigator at the Center for Injury Research and Policy at Columbus Children’s Research Institute, Columbus Children’s Hospital. She is also an assistant professor at The Ohio State University in the College of Medicine and the College of Public Health. Her research interests include the epidemiology of sports, recreation, and leisure activity-related injuries among children and adolescents as well as the life-long health benefits associated with an active childhood. She can be reached at [email protected].

Concussions, although often downplayed through the use of terms such as “having your bell rung,” “seeing stars,” or being “dinged,” are serious and relatively common injuries. Sustaining repeated concussions throughout an athletic career can result in lasting physical and mental impairment. In extreme situations, receiving multiple concussions in a short period of time can even lead to second impact syndrome, a serious and potentially fatal condition. In recent years, concussions have been brought to the national spotlight by former NFL stars such as Mike Webster and Larry Morris suffering from post concussion syndrome and dementia.

One recent study examined concussion incidence among high school and college athletes on a national scale. This study found U.S. high school athletes sustain an estimated 130,000 concussions every year. Not surprisingly, concussions were found to be most common in sports involving player-to-player contact, with the highest rates in football. On average, a high school football player sustains 1 concussion in every 650 games played. In college, this number increases to 1 in every 330 games.

It is important to keep in mind that concussions are not unavoidable sports-related injuries. Instead, concussion incidence can be reduced through sport-specific training, rule changes, and equipment modifications. To develop these interventions, we must know how and when concussions occur. Sports injury surveillance systems provide the data needed to calculate concussion rates, monitor patterns of concussions, and identify risk factors for concussions.

Here is what the latest research tells us:

• Concussions are more likely to occur during competition than practice. This is probably due in part to an increased amount of full contact in competition.

• Concussion rates are higher among collegiate athletes compared to high school athletes. This may be attributed to the increased size and strength of college athletes. Additionally, college athletes may be playing at a faster, more competitive level.

• In sports played by both girls and boys, such as soccer and basketball, girls have higher rates of concussions than boys. This may be due to biological differences, such as smaller head to ball ratios or weaker necks among girls.

This may also stem from cultural differences. American society has traditionally been more protective of female athletes. Thus, coaches, certified athletic trainers, and/or parents may treat head injuries in girls more seriously or may delay their return to play. Similar cultural tendencies may encourage boys to avoid reporting injuries, either because they underestimate the seriousness of the injury or because they do not want to be pulled from competition.

• These sport-specific activities are most likely to lead to a concussion:

Boys’ sports:

• Football: tackling or being tackled (67.6% of all football concussions) • Soccer: heading the ball (40.5%) • Basketball: rebounding (30.5%) and chasing loose balls (26.0%) • Wrestling: takedowns (42.6%) • Baseball: being hit by a pitch (50.6%)

Girls’ sports

• Soccer: heading the ball (36.7%) • Basketball: defending (22.2%) and ball handling/dribbling (19.0%) • Softball: catching (29.7%)

When concussions do occur, emphasis needs to be placed on timely identification and management. Although the most commonly reported concussion symptoms among high school athletes are headache (40.1 percent of all concussions), dizziness (15.3 percent), and confusion (8.6 percent), a concussion can result in a multitude of symptoms. Coaches and athletic trainers should make sure their athletes are aware of all potential concussion symptoms, and coaches should stress the importance of reporting any concussion-like symptom as soon as it occurs.

Coaches and athletic trainers should work together to ensure that appropriate return-to-play guidelines are followed in all situations. To help with preventing, identifying, and managing concussions, we recommend that all sports teams request their free copy of Heads Up: Concussion in High School Sports, which can be ordered by visiting the following Web site: http://www.cdc.gov/ncipc/tbi/Coaches_Tool_Kit.htm.


1) Gessel LM, Fields SK, Collins CL, Dick RW, Comstock RD. Concussions among US high school and college athletes. J Athl Train. (In press.)

2) Barnes BC, Cooper L, Kirkendall DT, McDermott TP, Jordan BD, Garrett WE, Jr. Concussion history in elite male and female soccer players. Am J Sports Med. 1998;26(3):433-8. 3) Lovell M CM, Maroon J, et al. Inaccuracy of symptom reporting following concussion in athletes. Med Sci Sports Exerc. 2002;34(Supplement):S298.

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