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Data-Driven Risk Classification of Concussion Rates: A Systematic Review and Meta-Analysis

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Abstract

Background

Concussion is a growing public health concern and generating concussion prevention programs depends on identifying high-risk sports and characteristics. Identifying the roles of sport, sex, and participation level (e.g., high school versus collegiate athletics) in concussion risk would facilitate more informed decision-making regarding sports participation and generate better targeted prevention strategies.

Objectives

The current study’s objectives were to: (1) determine the magnitude and hierarchy of sports-related concussion (SRC) risk across an array of events and (2) evaluate the modifying roles of sex, participation level, and session type on SRC rates.

Methods

A literature search was conducted on PubMed, searching concussion studies published between 2001 and December 2019. Inclusion criteria for studies required: (1) concussion occurred during sport, (2) that the SRC was clinically diagnosed, and (3) athlete exposures and concussions could be extracted or estimated. A study was excluded if it: (1) was not an original research article, (2) was not written in English language, (3) was an animal study, (4) did not have enough data to calculate SRC rates, (5) included professional or youth sample, and/or (6) contained data collected prior to 2001. The meta-analysis and meta-regression analyses were fit using a random effects model.

Results

Search results returned 2695 unique research articles, with 83 studies included in analyses. Sport, sex, participation level, and session type all significantly influenced SRC rates. Overall, rugby had the highest concussion rate and was classified as the highest risk sport (28.25 concussions per 10,000 athlete exposures). Overall, females had a higher concussion rate than males. Only lacrosse demonstrated a higher concussion rate for males compared to females. Collegiate athletes had higher concussion rates than high school athletes. Games were associated with 2.01 more concussions per 10,000 AEs than practices.

Conclusions

This meta-analysis demonstrated rugby has the highest concussion risk, followed by American Football, ice hockey, and wrestling. Concussion risk was influenced by sport, sex, participation, and session. Identifying the factors and environments that influence concussion risk can facilitate risk reduction and prevention strategies.

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Authors and Affiliations

  1. University of Kentucky, Sanders-Brown Center on Aging, Lexington, KY, USA

    Kathryn L. Van Pelt

  2. Department of Veterans Affairs, Bethesda, MD, USA

    Tim Puetz

  3. University of Michigan, Ann Arbor, MI, USA

    Jennylee Swallow

  4. University of Calgary, Hotchkiss Brain Institute, Calgary, AB, Canada

    Andrew P. Lapointe

  5. Neurotrauma Research Laboratory, University of Michigan, Michigan Concussion Center, Ann Arbor, MI, USA

    Steven P. Broglio

Authors
  1. Kathryn L. Van Pelt
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  2. Tim Puetz
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  5. Steven P. Broglio
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Corresponding author

Correspondence to Kathryn L. Van Pelt.

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No sources of funding were used to assist in the preparation of this article.

Conflict of interest

Kathryn Van Pelt, Tim Puetz, Jennylee Swallow, Andrew Lapointe and Steven Broglio declare that they have no conflicts of interest relevant to the content of this review.

Standards of reporting

PRISMA checklist was used and is included in supplementary file.

Code availability

Analysis code is available upon request.

Data availability

All data generated or analyzed during this study are included in supplementary files.

Author contributions

Conceptualization: KLVP; Methodology: KLVP, TP, SB; Literature Search: KLVP, JS, APL; Data Analysis: KLVP, TP; Writing—review and editing: KLVP, TP, JS, APL, SB; Supervision: TP, SB.

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Van Pelt, K.L., Puetz, T., Swallow, J. et al. Data-Driven Risk Classification of Concussion Rates: A Systematic Review and Meta-Analysis. Sports Med 51, 1227–1244 (2021). https://doi.org/10.1007/s40279-021-01428-7

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