At AAP 2017

CHICAGO (FRONTLINE MEDICAL NEWS) Soccer-playing girls were five times more likely to return to play on the day of a concussion as their male peers, according to a study presented at the annual meeting of the American Academy of Pediatrics.

Records from 87 soccer players aged 7-18 years (median, 14 years) were examined in a retrospective review of patients seen over a 2-year period by a single physician at a pediatric sports medicine center. Of these, two thirds (n = 58) were girls.

Thirty of the 58 girls (51.7%) reported that they returned to play on the day of their concussion, compared to 5 of 29 boys (17.2%; P = .002). This difference in reporting yielded an odds ratio of 5.14 (95% confidence interval, 1.72-15.3) for girls returning to same-day play, compared with boys who sustained a concussion.

The soccer players included children participating in recreational, club, and school-sponsored soccer, said senior author Shane M. Miller, MD, in an interview. All patients were assessed according to a standardized concussion protocol that involved a neurologic exam and validated concussion evaluation testing, including the ImPACT and the Sports Concussion Assessment Tool (SCAT) tests.

As soccer has grown in popularity as a youth sport, so has the number of reported concussions. “The incidence of reported concussions has increased 1,600% from 1990 to 2014,” wrote Dr. Miller and his coauthors in the abstract accompanying the presentation. Dr. Miller said that girls are 1.5 times more likely than boys to sustain a concussion while playing soccer.

While seeing the patients who were the subject of the study, Dr. Miller realized that most of the soccer players had not come out of play for evaluation after the head impact. Rather, they had continued to play, only later reporting concussion symptoms to coaches, trainers, or parents.

“The athletes may have chosen not to say anything because they didn’t want to come out of the game,” said Dr. Miller, a sports medicine physician at Texas Scottish Rite Hospital for Children, Dallas.

“I was surprised by the significant degree of difference” between male and female soccer players, said Dr. Miller. The study was not designed to get at the reason for the discrepancy, so Dr. Miller could not say with certainty whether awareness of concussion symptoms is significantly lower for female athletes, or whether the athletic culture more strongly encourages minimization of symptoms for girls than boys. In any case, he said, there is room for education of players, coaches, and families to raise awareness of the importance to recognize and report concussion, and then remove the affected athlete from play,

Dr. Miller said that future research directions include collaboration with other facilities to conduct prospective research using a concussion registry. This will allow more robust statistical analysis, and help ascertain the degree of regional variation in pediatric sports concussion management.

“Current education efforts may not be enough to help athletes, parents, and coaches identify concussion symptoms, know the guidelines for immediate removal from play, and understand the risks of returning to play after an injury. More research is needed on how to better spread this message intended to protect the health of young athletes…” Aaron Zynda, the study’s first author and clinical research coordinator at Texas Scottish Rite, said in a press release accompanying the abstract. “Concussion recognition and identification is a team effort,” he said.

Neither Mr. Zynda nor Dr. Miller had any relevant conflicts of interest.