Compliance with return to play guidelines following concussion in US high school athletes, 2005–2008

Abstract

Primary objective: To determine whether US concussed high school athletes complied with recommended return-to-play guidelines during the 2005–2008 school years.

Research design: Prospective cohort study in 100 nationally-representative US high schools.

Methods and procedures: Certified athletic trainers submitted injury reports for concussed athletes in five boys’ (football, soccer, basketball, wrestling, baseball) and four girls’ (soccer, basketball, volleyball, softball) sports via High School RIO™ (Reporting Information Online). Concussions were retrospectively graded and it was determined whether athletes followed American Academy of Neurology (AAN) or Prague return-to-play guidelines.

Main outcomes and results: There were 1308 concussions reported during 5 627 921 athlete-exposures (23.2 concussions per 100 000 athlete-exposures), reflecting an estimated 395 274 concussions sustained nationally. At least 40.5% and 15.0% of concussed athletes returned to play prematurely under AAN and Prague return-to-play guidelines, respectively. In football, 15.8% of athletes sustaining a concussion that resulted in loss-of-consciousness returned to play in <1 day. Males (12.6%) were more likely than females (5.9%) to return 1–2 days after sustaining an initial grade II concussion.

Conclusions: Too many adolescent athletes are failing to comply with recommended return-to-play guidelines. Sports medicine professionals, parents, coaches and sports administrators must work together to ensure athletes follow recommended guidelines.

• concussion
• traumatic brain injury
• sports
• recovery
• time loss