Concussion Symptom Characteristics and Resolution in 20 United States High School Sports, 2013/14-2017/18 Academic Years

BACKGROUND: High school (HS) sport-related concussions (SRCs) remain a public health concern in the United States. OBJECTIVE: To describe patterns in symptom prevalence, symptom resolution time (SRT), and return-to-play time (RTP) for SRCs sustained in 20 HS sports during the 2013/14-2017/18 academic years. METHODS: A convenience sample of athletic trainers reported concussion information to the HS RIO (TM) surveillance system. Symptom prevalence, average number of symptoms, and SRT and RTP distributions were examined and compared by event type (practice, competition), injury mechanism (person contact, nonperson contact), sex, and contact level (collision, high contact, and low contact) with chi-square tests and Wilcoxon rank-sum tests. RESULTS: Among all SRCs (n = 9542), headache (94.5%), dizziness (73.8%), and difficulty concentrating (56.0%) were commonly reported symptoms. On average, 4.7 +/- 2.4 symptoms were reported per SRC. Overall, 51.3% had symptoms resolve in <:7 d, yet only 7.9% had RTP < 7 d. Differential prevalence of amnesia was seen between practice and competition-related SRCs (8.8% vs 13.0%; P < .001); nonperson-contact and person-contact SRCs (9.3% vs 12.7%; P < .001); and female and male SRCs in low-contact sports (5.8% vs 17.5%; P < .001). Differential prevalence of loss of consciousness was seen between practice and game-related SRCs (1.3% vs 3.2%; P <.001); and female and male SRCs in high contact sports (1.2% vs 4.0%; P < .001). Differential longer SRT ( >21 d) was seen between new and recurrent SRCs (9.4% vs 15.9%; P < .001). CONCLUSION: Headache was the most commonly reported symptom. Notable group differences in the prevalence of amnesia, loss of consciousness, and SRT may be associated with more severe SRCs, warranting further attention.