Girls Continue to Play Soccer Without Reporting Concussions

Pauline Anderson

January 31, 2014

Less than half of young female soccer players who sustain a concussion seek medical attention, and most continue playing while experiencing symptoms, a new study has found.

The research confirms that concussions are common among young female soccer players and that most concussions occur while playing games rather than during practices.

The results underscore the importance of further research "to develop education strategies to ensure players understand and report concussion symptoms and that parents and coaches ensure appropriate medical evaluation and clearance before returning to play," write the authors, led by John W. O'Kane, MD, University of Washington Sports Medicine Clinic, Seattle.

The prospective cohort study was published online January 20 in JAMA Pediatrics.

Concussion Incidence

The study included 351 girls aged 11 to 14 years who were playing in select and premier youth soccer clubs in the Puget Sound region of Washington State. Researchers observed 288 players for 1 season and 63 for 2 seasons.

From regular email surveys and phone interviews, the researchers determined that 59 concussions occurred: 51 incident and 8 repeat concussions. The cumulative concussion incidence was 13.0% per season, and the incidence rate was 12 per 1000 athletic exposure hours.

This rate is higher than previously reported, possibly because of differences in methods used. Other studies included only athletes seeking medical attention and may have underreported concussion rates, said the authors.

More concussions (54.3%) resulted from contact with another person than with a ball (29.8%), but heading the ball was the activity that led to the largest percentage of concussions (30.5%).

"In the collegiate and professional literature, debate exists over concussion risk from heading alone vs contact with another player or object during heading," said the authors. Other research has found that "purposeful heading" did not result in neurocognitive deficits, including among 13- to 18-year-old players, they noted.

In this study, most concussions (86.4%) occurred during a game, which is consistent with previous studies, note the authors. "This increased risk may be due to more aggressive play in games or more attempts to use the head in games when the stakes are higher," they write.

Headache (reported by 89.3% at the initial interview) was the most common symptom, followed by dizziness (67.8%), concentration problems (42.4%), and drowsiness (33.9%).

The mean length of a concussion was 9.4 days, with symptoms resolving by 3 weeks in 91.6% of players. Symptom type and number were associated with time to full recovery. Players with light sensitivity, emotional lability, noise sensitivity, memory loss, nausea, and concentration problems had a longer recovery time than players without these symptoms.

Playing With Symptoms

Expert consensus guidelines recommend that athletes with concussion symptoms stop play and be medically evaluated before getting back into the game. However, in this study, only 44.1% were examined by a qualified healthcare professional, and most players (58.6%) reported playing soccer while still symptomatic.

It's unclear how many of the participants reporting concussions symptoms might have received a different diagnosis had they been formally evaluated. Conversely, concussions may have been underreported because parents had to be aware of their daughter's symptoms to be able to report them. Another limitation was that the assessment of recovery may have been premature in some cases.

About 50,000 soccer-related concussions occur annually among US high school players, the authors note. About 3 million soccer players aged 5 to 15 years are registered with US Youth Soccer, and 48% of them are female.

The study was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health. The authors have disclosed no relevant financial relationships.

JAMA Pediatr. Published online January 20, 2014. Abstract

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