Concussion Rates in U.S. Middle School Athletes, 2015-2016 School Year

Concussion incidence estimates in middle school sports settings are limited. This study examines concussion incidence in nine U.S. middle schools during the 2015-2016 school year.

Concussion data originated from nine public middle schools in Prince William County, Virginia, during the 2015-2016 school year. Certified athletic trainers collected concussion and athlete exposure (AE) data in school-sanctioned games and practices in boys' baseball, basketball, football, soccer, track, and wrestling; and girls' basketball, cheerleading, soccer, softball, track, and volleyball. Athletic trainers also acquired data on non-school sanctioned sport concussions. In 2017, concussion rates were calculated per 1,000 AEs. Injury rate ratios with 95% CIs compared rates between games and practices and by sex.

Overall, 73 concussions were reported, of which 21.9% were from non-school sanctioned sport settings. The 57 remaining game and practice concussions were reported during 76,384 AEs, for a concussion rate of 0.75/1,000 AEs. Football had the highest concussion rate (2.61/1,000 AEs). Concussion rates were higher in games versus practices (injury rate ratio=1.83, 95% CI=1.06, 3.15), and in girls versus boys in sex-comparable sports, i.e., baseball/softball, basketball, soccer, and track (injury rate ratio=3.73, 95% CI=1.24, 11.23).

Current findings parallel those found in high school and college sports settings in that higher concussion rates were reported in girls and competitions. However, concussion rates exceeded those recently reported in high school and youth league settings, highlighting the need for continued research in the middle school sports setting. Given that one in five concussions were from non-school sanctioned sport settings, prevention efforts in middle school sports settings should consider sport and non-sport at-risk exposure.