Incidence and risk factors of sport-related concussion in amateur handball players: findings from the PRECCOCE study.

INTRODUCTION

Sport related concussion (SRC) is a major concern in contact sports. Handball, a high-contact sport played by nearly 30 million people worldwide, remains underrepresented in SRC research.

OBJECTIVE

Primary objective was to estimate the incidence and identify risk factors for SRC in non-professional handball. Secondary objectives were to determine the proportion of players at high risk of SRC who sought medical evaluation and to assess medical rest rates.

DESIGN

A prospective survey was conducted over two seasons (2023-2025) among adult players of the French Handball Federation (FFHB) who received a "white card" (WC) for suspected SRC (FFHB protocol).

METHODS

Inclusion criteria were age ≥18 and non-professional status; incomplete or late responses (>7 days) were excluded. Players were classified as having high, intermediate or low SRC risk based on questionnaire responses, including immediate neurological signs and symptom score. Incidence was expressed per 1,000 match-hours, and multivariable logistic regression explored factors associated with high SRC risk.

RESULTS

A total of 2,618 responses were analysed, including 1,239 high-risk players. Estimated overall incidence was 0.885 per 1,000 match-hours (95% CI: 0.836-0.937), higher in women (1.287) than men (0.645). Risk decreased with age; male sex was protective (OR = 0.56); higher risk was observed in wingers (OR = 1.45) and after falls with head impact (OR = 1.98).

CONCLUSION

This first nationwide study in amateur handball highlights higher SRC risk among women, younger players, wingers, and during falls with head impact, while low consultation rates underscore the need for improved awareness and prevention.