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Pediatric Research (2025)
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We aimed to examine the epidemiology of concussions within high school (HS) boys’ and girls’ sports, and to assess the incidence of concussion within HS sports during the timespan inclusive of the COVID-19 pandemic.
We analyzed data captured within High School Reporting Information Online (HS RIO) during 2018/19-2022/23. Injury counts, rates (enumerated per 10,000 athlete-exposures (AEs)), and proportions were used to describe injury characteristics by sport, event type, injury mechanism, and injury history. Injury rate ratios (IRR) and accompanying 95% Confidence Intervals (CIs) were used to evaluate differential injury incidence across event types and sports.
A total of 4663 concussions were reported during the study period (Rate = 3.50 per 10,000 AEs). Overall rates were highest in boys’ football (8.22 per 10,000 AEs) and girls’ soccer (6.11 per 10,000 AEs). Among sex-comparable sports, overall concussion rates were higher in girls’ sports as compared with boys’ sports (IRR = 2.15; 95%CI = [1.94, 2.37]). Concussion rates fluctuated across the study period and were lower during the COVID-19-impacted seasons, as compared with neighboring years.
Our findings underscore the necessity for continuous surveillance of concussions in HS sports and suggest that concussion incidence in girls’ sports warrants targeted attention.
Sport-related concussions are a significant concern, particularly in youth athletics, with changes to concussion management and the impact of the COVID-19 pandemic necessitating a re-evaluation of concussion incidence and management in high school sports.
In this surveillance study (2018/19-2022/23), boys’ football and girls’ soccer had the highest concussion rates, with a decrease in incidence observed during the COVID-19 pandemic as compared with surrounding years.
The incidence of concussions in girls’ sports requires increased scrutiny, especially due to an overall increase in incidence density observed after an initial decrease during the COVID-19 pandemic.
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The data that support the findings of this study are available from the Datalys Center for Sports Injury Research and Prevention, but restrictions apply to the availability of these data, which were used under agreement for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of the Datalys Center for Sports Injury Research and Prevention.
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We thank the many athletic trainers who have volunteered their time and effort to submit data to HS RIO. Their efforts are greatly appreciated and have had a tremendously positive effect on the safety of high school student-athletes.
Funding for HS RIO was originally provided in part by the Centers for Disease Control and Prevention (Awards R49/CE000674-01, R49/CE001172-01, and R49/CE002106-01) and the National Center for Research Resources (Awards KL2 RR025754), for which R. Dawn Comstock, PhD, served as principal investigator (but she was not a coauthor of the study). We also acknowledge the research funding contributions of the National Federation of State High School Associations, National Operating Committee on Standards for Athletic Equipment, DonJoy Orthotics (DonJoy Performance), and EyeBlack. HS RIO is currently managed by the Datalys Center for Sports Injury Research and Prevention with support from the National Federation of State High School Associations.
Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN, USA
Avinash Chandran, Adrian J. Boltz, Megan Anderson, Neel Rao & Christy L. Collins
Michigan Concussion Center, University of Michigan Ann Arbor, Ann Arbor, MI, USA
Adrian J. Boltz
Department of Epidemiology, University of Michigan Ann Arbor, Ann Arbor, MI, USA
Jillian Baker
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Avinash Chandran conceptualized and designed the study, conducted data analyses, drafted the initial manuscript, and critically reviewed and revised the manuscript. Adrian J. Boltz supported data analysis, and critically reviewed and revised the manuscript. Megan Anderson, Jillian Baker, and Neel Rao critically reviewed the manuscript for important intellectual content. Christy L. Collins designed the data collection instruments, collected data, and critically reviewed the manuscript for important intellectual content.
Correspondence to Avinash Chandran.
We disclose the content of this report represents data collection from High School Reporting Information Online (HS RIO). Separately, authors Chandran, Boltz, Rao, and Collins disclose research funding from the National Collegiate Athletic Association. Dr. Chandran also discloses research funding from the North Carolina Translational and Clinical Sciences Institute, the Atlantic Coast Conference Center for Research in Intercollegiate Athletics, as well as the Canadian Institutes of Health Research- Human Development, Child and Youth Health Institute, on unrelated projects; he also discloses receiving honoraria from the Sports Neuropsychological Society, the National Athletic Trainers’ Association, as well as the American Medical Society for Sports Medicine. The content of this report is solely the responsibility of the authors and does not necessarily represent the official views of the funding organizations.
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Chandran, A., Boltz, A.J., Baker, J. et al. Concussion in high school sports: findings from injury surveillance. Pediatr Res (2025). https://doi.org/10.1038/s41390-025-03863-y
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DOI: https://doi.org/10.1038/s41390-025-03863-y
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