Research Reports - The rise of concussions in the adolescent population

Orthop J Sports Med. 2016 Aug 16;4(8):2325967116662458. doi:
10.1177/2325967116662458. eCollection 2016.

Zhang AL(1), Sing DC(1), Rugg CM(1), Feeley BT(1), Senter C(2).

BACKGROUND: Concussion injuries have been highlighted to the American public
through media and research. While recent studies have shown increased traumatic
brain injuries (TBIs) diagnosed in emergency departments across the United
States, no studies have evaluated trends in concussion diagnoses across the
general US population in various age groups.
PURPOSE: To evaluate the current incidence and trends in concussions diagnosed
across varying age groups and health care settings in a large cross-sectional
STUDY DESIGN: Descriptive epidemiological study.
METHODS: Administrative health records of 8,828,248 members of a large
private-payer insurance group in the United States were queried. Patients
diagnosed with concussion from years 2007 through 2014 were stratified by year of
diagnosis, age group, sex, classification of concussion, and health care setting
of diagnosis (eg, emergency department vs physician's office). Chi-square testing
was used for statistical analysis.
RESULTS: From a cohort of 8,828,248 patients, 43,884 patients were diagnosed with
a concussion. Of these patients, 55% were male and over 32% were in the
adolescent age group (10-19 years old). The highest incidence of concussion was
seen in patients aged 15 to 19 years (16.5/1000 patients), followed by those aged
10 to 14 years (10.5/1000 patients), 20 to 24 years (5.2/1000 patients), and 5 to
9 years (3.5/1000 patients). Overall, there was a 60% increase in concussion
incidence from 2007 to 2014. The largest increases were in the 10- to 14-year
(143%) and 15- to 19-year (87%) age groups. Based on International Classification
of Disease-9th Revision classification, 29% of concussions were associated with
some form of loss of consciousness. Finally, 56% of concussions were diagnosed in
the emergency department and 29% in a physician's office, with the remainder in
urgent care clinics or inpatient settings.
CONCLUSION: The incidence of concussion diagnosed in the general US population is
increasing, driven largely by a substantial rise in the adolescent age group. The
youth population should be prioritized for ongoing work in concussion education,
diagnosis, treatment, and prevention.
CLINICAL RELEVANCE: The rise of concussions in the adolescent age group across
the general population is concerning, and clinical efforts to prevent these
injuries are needed. 

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