• Frederick P Rivara, Melissa A Schiff, Sara P Chrisman, Shana K Chung, Richard G Ellenbogen, and Stanley A Herring.
• Frederick P. Rivara, Harborview Injury Prevention and Research Center, University of Washington, 325 Ninth Avenue, Box 359960, Seattle, WA 98104, USA. fpr@uw.edu.
• Am J Sports Med. 2014 May 1;42(5):1197-203.

BackgroundIncreasing attention has been paid to concussions and especially sports-related concussions in youth. To prevent an inappropriate return to play while symptomatic, nearly all states have now passed legislation on youth sports-related concussions.PurposeTo determine (1) the incidence of sports-related concussions in high school athletes using a unique system to collect reports on concussions, (2) the proportion of athletes with concussions who play with concussive symptoms, and (3) the effect of the type and modality of coach education on the likelihood of athletes reporting symptoms to the coach or playing with concussive symptoms.Study DesignCohort study; Level of evidence, 2.MethodsThis study was conducted with high school football and girls' soccer athletes playing in fall 2012 and their coaches and parents in 20 urban or rural high schools in Washington State. The main outcome was the incidence of concussions per 1000 athlete-exposures (AEs), the proportion of concussed athletes who played with concussive symptoms, and the association of coach concussion education with coach awareness of athletes with concussive symptoms.ResultsAmong the 778 athletes, the rate of concussions was 3.6 per 1000 AEs and was identical for the 2 sports studied. The cumulative concussion incidence over the course of the season was similar in girls' soccer (11.1%) and football (10.4%). Sixty-nine percent of concussed athletes reported playing with symptoms, and 40% reported that their coach was not aware of their concussion. Most measures of coach concussion education were not associated with coach awareness of concussions in their athletes, although the modalities of a video and quiz were associated with a lower likelihood of coach awareness.ConclusionMore objective and accurate methods are needed to identify concussions. Changes in athlete attitudes on reporting concussive symptoms will likely not be accomplished through legislation alone.

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