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Despite Youth-Concussion Law, Many Athletes Play With Concussion Symptoms

Despite the presence of a youth-concussion law, a majority of Washington state high school football and girls' soccer players reported playing with concussion symptoms during the 2012 fall season, according to a paper published online today in The American Journal of Sports Medicine.

Last week, I wrote about a new paper from the AJSM that sought to evaluate the effectiveness of Washington state's youth-concussion law, specifically in regard to its concussion-education requirements. The new paper published today by the same authors took the next logical step: determining whether concussion education is keeping student-athletes safer.

For this new paper, the authors surveyed 490 public high school football players and 288 girls' soccer players in Washington state—the first state to implement youth-concussion legislation (the Zackery Lystedt Law)—from 2012 to 2013. The student-athletes called into a voice-response system on a weekly basis to report the number of games and practices in which they participated and whether they had suffered any hits to the head or body that triggered any concussion symptoms.

In total, two-thirds of the 778 student-athletes reported having experienced concussive symptoms prior to the start of the study (333 football players and 178 girls' soccer players). Of those who did so, 72 football players (23.5 percent) and 28 girls' soccer players (17.1 percent) reported having five or more prior concussions.

Over the course of the study, the 778 student-athletes reported 23,212 athletic exposures (every instance of one student-athlete participating in one practice or game). During the football and girls' soccer season, 122 of them reported 147 concussions, 100 of which were new for that season. The authors only had athletic-exposure data for 83 of those 100 new concussions, and thus determined that the incidence of concussions was 3.6 per 1,000 athletic exposures, both among football and girls' soccer players. Alarmingly, 69 percent of student-athletes reported playing with concussion symptoms, which ranged from headaches, dizziness, and fatigue to confusion, light sensitivity, and irritability.

Both football and girls' soccer players were far more likely to sustain a concussion during a game than a practice. Football had a 6.3-fold greater rate of concussions in games compared to practices, while girls' soccer had a 12.4-fold greater rate. Previous research has also found student-athletes to be significantly more likely to sustain a concussion during a game than a practice.

Forty of the 100 athletes with new concussions reported that their coaches were unaware of their symptoms, despite having to sign a form at the beginning of the season requiring athletes to disclose concussion symptoms to their coaches. All 40 of those coaches did undergo some form of concussion education.

"Six years after the passage of the nation's first concussion law, educating coaches about concussions does not appear to be strongly associated with the coaches' awareness of concussions," said Dr. Frederick Rivera, the studies' principal investigator and the professor and vice chair of the department of pediatrics at the University of Washington, in a statement. "Too many athletes are still playing with concussion symptoms."

Based on their findings, the authors concluded that "attitudes of athletes regarding the reporting of concussive symptoms are a major barrier to the proper care of players with concussions." They asserted that legislation alone likely would not be able to change athletes' attitudes about reporting concussion symptoms.

Since nearly all states' youth-concussion laws require student-athletes who present concussion symptoms to be immediately removed from play, some youths may be hesitant to report such symptoms, especially during the postseason.

According to a study presented at the annual meeting of the Pediatric Academic Societies last May, more than 91 percent of 120 high school football players surveyed felt it was OK for someone to stay in a game after suffering a concussion. Fifty-three percent replied that they would "always or sometimes continue to play with a headache sustained from an injury," and nearly three-quarters said they would play through any injury to win a game. Just over half the football players would "sometimes" or immediately report concussion symptoms to their coaches.

Until scientists develop more effective concussion-diagnosing tools, it's up to players to be honest about their concussion symptoms. Parents, referees, and coaches can only do so much if players themselves aren't fully forthcoming.

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