Mechanisms of Concussions Among High School Athletes in School-Sponsored Sports: Implications for Safety.

BACKGROUND AND

OBJECTIVE

Over 1 million sport-related concussions (SRCs) occur among US children annually. Enhancing sport safety requires a detailed understanding of SRC mechanisms. However, limited data characterize the specific actions causing SRCs in high-school athletes. The objective was to classify SRC mechanisms using a standardized hierarchical scheme and evaluate associations between mechanism categories and symptom profiles, overall and by sport and sex.

METHODS

This retrospective study analyzed Sport Concussion Assessment Tool (SCAT), evaluations and athletic-trainer documentation from high-school athletes (age 14-19 years) across 19 schools (2009-2023). SRCs were coded as hit-to-head and tackle/collision (present/absent) and, when applicable, by hit-to-head subtype, head contact location, and contact context (opponent/teammate; practice vs competition). Analyses included descriptive statistics, χ 2 /Fisher tests, and odds ratios (95% CIs) with Bonferroni adjustment. Symptom burden and individual symptom endorsement were compared by sex and mechanism (hit-to-head vs no hit-to-head). Logistic regressions with cluster-robust SEs, adjusted for sex and sport, assessed associations between mechanisms (and subtypes) and symptoms.

RESULTS

A total of 455 SRCs (401 athletes) were analyzed; 111 (24.4%) occurred in females. Overall, 73.6% involved a hit-to-head and 65.9% a tackle/collision, with co-occurrence in 56.0%. SRCs most frequently occurred in football (53.8%), soccer (21.1%), and basketball (8.4%). Mechanisms were sport-specific: tackling in football (38.9%), heading in soccer (54.2%), rebounding or loose-ball play in basketball (41.7%), takedowns in wrestling (83.3%), spiking in volleyball (66.7%), and stunting in cheerleading (90.5%). After adjustment for sex, sport, and tackle/collision, headache and "don't feel right" remained significantly associated with a hit-to-head mechanism. Tackle/collision was independently associated with greater odds of dizziness (adjusted odds ratios 2.07), feeling slowed (1.92), and headache (2.82).

CONCLUSION

High-school SRCs most often result from head-to-ground impacts, player collisions, or sport-specific actions such as tackling or heading. Characterizing these mechanisms can guide targeted, sport-specific prevention strategies.