Epidemiology of pediatric sports-related concussions presenting to the emergency room over the last decade in the United States

Background: There continues to be clinical significance of pediatric sports-related concussion (pSRC) for pediatric specialists. The overall trends of pSRC are not well understood. The aim of this study was to summarize the epidemiology of pSRC presenting to the emergency room (ER) in the United States (US) over the last decade.

Methods: The National Electronic Injury Surveillance System (NEISS) database was retrospectively interrogated to identify pediatric (≤ 18 years) presenting to ERs in the US between 2013 and 2022. Weighted estimates and 95 % confidence intervals (CI) were generated using survey data analyses, and trends evaluated using linear regression analyses.

Results: In 2022, an estimated total of 96,135 [95 % CI 71,486-120,783] cases of pSRC presented to the ER, equivalent to 132 [97-165] cases per 100,000 pediatric population. There has been a significant downtrend in pSRC presentations over the last decade (P = 0.02), with 2020 having the lowest number of cases in the 2013-2022 time period. In terms of gender, the latest proportion of presentations were 65 % [63-67 %] male and 35 % [33-37 %] female, with there being a significantly higher proportion of females and lower proportion of males over the last decade (P < 0.01). Of all causes for pSRC, the most frequent by proportion were football in 23 % [20-26 %], soccer in 9.6 % [7.7-12 %], basketball in 8.6 % [7.0-10 %], bicycle in 5.0 % [4.0-6.3 %], and baseball 4.1 % [3.3-5.0 %], with both football and basketball rates decreasing over the last decade. In 2020, there was a noticeable, non-sustained, decrease in proportion of football and basketball presentations, and an increase in proportion of bicycle presentations. Finally, there were multiples differences between sports and gender with only four in common sports causes amongst the ten most common sports (football, basketball, soccer, bicycle), although they were differently ranked by gender.

Conclusions: In the last decade, the incidence of pSRC presenting to the ER in the US has decreased. This is likely driven by decrease in proportion of football and basketball related injuries, which in turn has led to an increase in proportion of female pSRC which more commonly result from other sports. The Covid-19 pandemic in 2020 resulted in a number of trend anomalies which have since largely resolved. This data implicates that future prevention and treatment protocols should be more individualized.