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Original Investigation |

Concussion Among Female Middle-School Soccer Players

John W. O’Kane, MD1; Amy Spieker, MPH2,3; Marni R. Levy, BS2,3; Moni Neradilek, MS4; Nayak L. Polissar, PhD4; Melissa A. Schiff, MD, MPH2,3
[+] Author Affiliations
1University of Washington Sports Medicine Clinic, Seattle
2Harborview Injury Prevention and Research Center, Seattle, Washington
3University of Washington, School of Public Health, Department of Epidemiology, Seattle
4The Mountain-Whisper-Light Statistics, Seattle, Washington
JAMA Pediatr. 2014;168(3):258-264. doi:10.1001/jamapediatrics.2013.4518.
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Importance  Despite recent increased awareness about sports concussions, little research has evaluated concussions among middle-school athletes.

Objectives  To evaluate the frequency and duration of concussions in female youth soccer players and to determine if concussions result in stopping play and seeking medical care.

Design, Setting, and Participants  Prospective cohort study from March 2008 through May 2012 among 4 soccer clubs from the Puget Sound region of Washington State, involving 351 elite female soccer players, aged 11 to 14 years, from 33 randomly selected youth soccer teams. Of the players contacted, 83.1% participated and 92.4% completed the study.

Main Outcomes and Measures  Concussion cumulative incidence, incidence rate, and description of the number, type, and duration of symptoms. We inquired weekly about concussion symptoms and, if present, the symptom type and duration, the event resulting in symptom onset, and whether the player sought medical attention or played while symptomatic.

Results  Among the 351 soccer players, there were 59 concussions with 43 742 athletic exposure hours. Cumulative concussion incidence was 13.0% per season, and the incidence rate was 1.2 per 1000 athletic exposure hours (95% CI, 0.9-1.6). Symptoms lasted a median of 4.0 days (mean, 9.4 days). Heading the ball accounted for 30.5% of concussions. Players with the following symptoms had a longer recover time than players without these symptoms: light sensitivity (16.0 vs 3.0 days, P = .001), emotional lability (15.0 vs 3.5 days, P = .002), noise sensitivity (12.0 vs 3.0 days, P = .004), memory loss (9.0 vs 4.0 days, P = .04), nausea (9.0 vs 3.0 days, P = .02), and concentration problems (7.0 vs 2.0 days, P = .02). Most players (58.6%) continued to play with symptoms, with almost half (44.1%) seeking medical attention.

Conclusions and Relevance  Concussion rates in young female soccer players are greater than those reported in older age groups, and most of those concussed report playing with symptoms. Heading the ball is a frequent precipitating event. Awareness of recommendations to not play and seek medical attention is lacking for this age group.

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