Ongoing Study Shows Continued Increase in Concussions Among High School Athletes

In a new study from Wellington Hsu, MD, FAAOS, the incidence of concussions in young athletes was found to be on the rise despite increased awareness of concussions in high school athletics and traumatic brain injury (TBI) laws. This analysis of injury data from 2015 to 2017 is the latest to be reported from a 13-year study evaluating trends in reported concussion proportions and rates in high school sports.

The study was scheduled for presentation at the annual meeting of the American Academy of Orthopaedic Surgeons (AAOS), canceled due to the COVID-19 pandemic, and has now been released in the AAOS Virtual Education Experience.

Since 2005, Dr. Hsu, professor of orthopaedics at Northwestern University’s Feinberg School of Medicine and senior author of the study, has collected annual reports generated by the High School Reporting Information Online (RIO) surveillance system. Dr. Hsu and his team extracted injury data from 100 high schools across the US for 9 sports:

  • Football, soccer, basketball, wrestling and baseball for boys
  • Soccer, basketball, volleyball and softball for girls

The data included detailed information on each player (sport, age, year in school), the athlete’s injury (diagnosis, severity and return to play), the mechanism of injury, and the situation that lead to the injury.

“It’s understandable to think that with increased awareness among practitioners who diagnose concussions, the incidence would naturally rise; however, because we’ve studied and reported on concussions for a number of years now, I feel that enough time has passed and I would have expected to see the numbers start to level out,” Dr. Hsu said.

“What we found was that the overall average proportion of concussions (total estimated concussions proportionate to all other injuries for a particular sport) reported annually in all sports increased significantly, as did the overall rate of concussions (the number of concussions per 10,000 athlete exposures).”

Not only did girls’ soccer players continue to have a higher proportion of concussions compared with boys’ football players (29.8% vs. 25.2%, respectively), but girls’ volleyball demonstrated the largest increase in number, proportion, and rate of concussions (+64.3%; P=0.022) compared with all other sports in this study.

“Since volleyball is generally considered a ‘low risk’ sport for concussions, this was an unexpected discovery compared to what we saw 3 years ago,” Dr. Hsu said. “The jump in both girls’ soccer and volleyball is likely due to increased participation in the sports and concussion awareness.”

The research also demonstrated:

  • Between academic years 2015 and 2017, the overall average proportion of concussions reported annually increased significantly compared with academic years 2010 to 2014 at 1.012 fold, as did the overall rate at 1.101 fold.
  • Despite a 3.2% decrease of participation in boys’ football, the proportion of concussions increased 1.045 fold and the rate increased 1.110 fold from 2010-2014 to 2015-2017.
  • Girls’ soccer saw a 4.3% increase in participation and demonstrated a significant increase in average annual proportion (1.095 fold) and rate (1.210 fold) of concussions during the academic years 2015 to 2017 compared with 2010 to 2014.
  • In gender-matched sports, girls continued to experience a significantly higher concussion rate than boys.

Dr. Hsu plans to continue his research and is hopeful that the collective findings will lead to stronger implementation of targeted preventative measures such as rule changes, protective headgear, and contact avoidance.



Schallmo MS, Weiner JA, Hsu WK. The Incidence of Reported Concussions Sustained by High School Athletes Continues to Increase, Poster P0237. AAOS Virtual Education Experience.

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