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Epidemiology, trends, assessment and management of sport-related concussion in United States high schools

Guerriero, Réjean M.a,b; Proctor, Mark R.a,e; Mannix, Rebekaha,d; Meehan, William P. IIIa,c,d,f

doi: 10.1097/MOP.0b013e3283595175
NEUROLOGY: Edited by Scott L. Pomeroy and Robert C. Tasker

Purpose of review Sport-related concussion affects athletes at every level of participation. The short and long-term effects of concussions that occur during childhood and adolescence are not fully understood. The purpose of this review is to describe the current burden of disease, current practice patterns and current recommendations for the assessment and management of sport-related concussions sustained by United States high school athletes.

Recent findings Millions of high school students participate in organized sports in the United States. Current estimates suggest that, across all sports, approximately 2.5 concussions occur for every 10 000 athletic exposures, in which an athletic exposure is defined as one athlete participating in one game or practice. At schools that employ at least one athletic trainer, most high school athletes who sustain sport-related concussions will be cared for by athletic trainers and primary care physicians. Approximately 40% will undergo computerized neurocognitive assessment.

Summary The number of high school athletes being diagnosed with sport-related concussions is rising. American football has the highest number of concussions in high school with girls’ soccer having the second highest total number. Fortunately, coaches are becoming increasingly aware of these injuries and return-to-play guidelines are being implemented.

aBrain Injury Center

bDepartment of Neurology

cSports Concussion Clinic, Division of Sports Medicine

dDivision of Emergency Medicine

eDepartment of Neurosurgery

fThe Micheli Center for Sports Injury Prevention, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA

Correspondence to William P. Meehan III, MD, Director Micheli Center for Sports Injury Prevention, 319 Longwood Avenue, Floor 6, Boston, MA 02115, USA. Tel: +1 617 919 7044; e-mail:

© 2012 Lippincott Williams & Wilkins, Inc.