Journal Article

Incidence and Risk Factors for Concussion in High School Athletes, North Carolina, 1996–1999

Mark R. Schulz, Stephen W. Marshall, Frederick O. Mueller, Jingzhen Yang, Nancy L. Weaver, William D. Kalsbeek and J. Michael Bowling

in American Journal of Epidemiology

Published on behalf of Johns Hopkins Bloomberg School of Public Health

Volume 160, issue 10, pages 937-944
Published in print November 2004 | ISSN: 0002-9262
Published online November 2004 | e-ISSN: 1476-6256 | DOI:
Incidence and Risk Factors for Concussion in High School Athletes, North Carolina, 1996–1999

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A prospective cohort study was used to quantify risk factors for sports concussions. Analysis was based on a stratified cluster sample of North Carolina high school athletes followed during 1996–1999. Clustering was by school and sport, and the sample included 15,802 athletes with 1–8 seasons of follow-up per athlete. Concussion rates were estimated for 12 sports, and risk factors were quantified using generalized Poisson regression. Concussion rates ranged from 9.36 (95% confidence interval: 1.93, 16.80) per 100,000 athlete-exposures in cheerleading to 33.09 (95% confidence interval: 24.74, 41.44) per 100,000 athlete-exposures in football, where “athlete-exposure” is one athlete participating in one practice or game. The overall rate of concussion was 17.15 (95% confidence interval: 13.30, 21.00) per 100,000 athlete-exposures. Cheerleading was the only sport for which the practice rate was greater than the game rate. Almost two thirds of cheerleading concussions involved two-level pyramids. Concussion rates were elevated for athletes with a history of concussion, and they increased with the increasing level of body contact permitted in the sport. After adjustment for sport, body mass index, and year in school, history of concussion(s) remained a moderately strong risk factor for concussion (rate ratio = 2.28, 95% confidence interval: 1.24, 4.19). The fact that concussion history is an important predictor of concussion incidence, even in this young population, underscores the importance of primary prevention efforts, timely identification, and careful clinical management of these injuries.

Keywords: athletic injuries; brain concussion; Poisson distribution; risk factors; sports; students; Abbreviations: NCHSAA, North Carolina High School Athletic Association; NCHSAIS, North Carolina High School Athletic Injury Study.

Journal Article.  5759 words.  Illustrated.

Subjects: Public Health and Epidemiology

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