Concussions in Soccer: An Epidemiological Analysis in the Pediatric Population

Background: As the popularity of youth soccer has increased in the United States, more attention has been focused on the effect of concussion injuries, with recent debate on whether heading should be disallowed. There is little evidence examining the epidemiology of these injuries. Purpose/Hypothesis: The purpose of this study was to examine the prevalence and incidence of youth soccer-related concussions. We hypothesized that concussion rates will correlate with increased participation in youth soccer. Study Design: Descriptive epidemiology study. Methods: The National Electronic Injury Surveillance System was used to collect data on concussion injuries that occurred during soccer in pediatric patients from 2008 through 2016. Soccer-related concussion injuries were identified using specific codes and were analyzed for variation in disposition. The types of contact were categorized into player-to-player, head-to-ball, player-to-post, and player-to-ground contacts. Contact types related to hospitalization were subanalyzed. Results: A weighted total of 3285 concussion injuries were identified during the study period, with an average of 386 concussions each year. The average age was 13.5 years, and there were no differences seen in incidence between the sexes. The overall incidence of concussion injuries increased (r= 0.789), while hospitalizations decreased (r= -0.574). The most common cause of concussion was found to be player-to-player contact, followed by head-to-ground contact and then head-to-ball contact. Subanalysis showed that 13% of hospitalizations were due to head-to-ball contact, compared with 39% and 44% due to player-to-player contact and head-to-ground contact, respectively. The relative risk of hospitalization from a concussion due to head-to-ball contact was 7.06 compared with 22.60 due to head-to-ground contact. Conclusion: The incidence of concussion in youth soccer has been increasing over the past decade as predicted, given the growing participation rates in both male and female soccer players. The most common cause of concussion was player-to-player contact, and the majority of concussions resulting in hospitalization occurred because of head-to-ground contact.