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Between 2009 and 2014, all 50 states and the District of Columbia enacted one or more traumatic brain injury (TBI) laws, more commonly known as concussion laws. These laws often include mandates to remove athletes from play following an actual or suspected concussion, a medical clearance before they can return to play, and annual education of coaches, parents, and athletes regarding concussion signs or symptoms. Now a new study using data collected in a national sports injury surveillance system by researchers at the Colorado School of Public Health at the University of Colorado Anschutz Medical Campus, has found that state-level TBI laws are, in fact, beneficial in reducing the rates of new and recurrent concussions among U.S. high school athletes. 

The study led by Dr. Ginger Yang at the Center for Injury Research and Policy at Nationwide Children’s Hospital with researchers from the Colorado School of Public Health and Temple University, is published in the November 2017 edition of the American Journal of Public Health. The study found that rates of new and recurrent concussions initially increase after a law goes into effect due to mandated reporting, but this is also likely due to greater awareness of the signs and symptoms of concussion itself. The authors also indicated that approximately 2 ½ years after a TBI law is in place, the data indicated that rates of recurrent concussions resulted in a significant decline. 

“These concussion laws follow in a long-line of successful legislation efforts in public health injury prevention,” said Dawn Comstock, PhD, principal investigator of High School RIO (Reporting Information Online), the national surveillance database that tracks high school sport injuries at the Colorado School of Public Health. “These laws in particular were passed quickly and are truly effective as found in the data and this study. What is even more interesting is even though there isn’t an enforcement of these laws—people wouldn’t be ticketed like they might be with speeding or not using their seatbelt, these laws did make a difference. It is a great example of how legislative efforts can actually drive public health and injury prevention.”

This study looked at TBIs in high school athletes who competed in at least one of nine sports between 2005 and 2016. The high school sports included boys football, boys wrestling, girls volleyball, boys and girls soccer, boys and girls basketball, boys baseball, and girls softball. Over 11 years, there were an estimated 2.7 million reported concussions in high school athletes engaged in these sports, which translates to an average of 671 concussions per day, or about one concussion in a high school athlete every two minutes. Of the reported concussions, approximately 89 percent were new while 11 percent were recurrent (a repeat concussion in an athlete that has already had at least one other concussion). 

The data also showed that concussions were more frequent among male athletes, particularly in football, and during competitions. Football had the highest average annual concussion rate, followed by girls’ soccer and boys’ wrestling. Overall, males have a higher average annual concussion rate than females, but when comparing the rates in gender comparable/available sports (basketball, soccer, baseball/softball), females had almost double the annual rate of concussions as males.

This study was funded by a grant from the Robert Wood Johnson Foundation’s Public Health Law Research program. State-level concussion law data was obtained from LawAtlas. Concussion data was collected from High School RIO (Reporting Information Online), a prospective, longitudinal internet-based surveillance system housed in the Program for Injury Prevention, Education and Research at the Colorado School of Public Health that collects sport-related injuries and exposures among athletes from athletic trainers at a nationally representative sample of U.S. high schools.