tion data for 15 sports showed that the overall reported concussion rate doubled from 1.7 to 3.4 concussions per 1,000 athletic exposures1 between the 1988-1989 and 2003-2004 academic years (Hootman et al., 2007). Among youth ages 19 and under, the reported number of individuals treated for concussions and other nonfatal, sports- and recreation-related TBIs increased from 150,000 to 250,000 between 2001 and 2009. The rate of emergency department visits for such injuries increased 57 percent over the same time period (Gilchrist et al., 2011).

The incidence of reported concussions varies substantially by sport (see Table S-1). Available data show that among male athletes in the United States at the high school and collegiate levels, football, ice hockey, lacrosse, wrestling, and soccer consistently are associated with the highest rates of reported concussions (Datalys Center, 2013a,b; Gessel et al., 2007; Hootman et al., 2007; Lincoln et al., 2011; Marar et al., 2012). For female athletes, the high school and college sports associated with the highest rates of reported concussions are soccer, lacrosse, and basketball (Datalys Center, 2013a,b; Gessel et al., 2007; Hootman et al., 2007; Lincoln et al., 2011; Marar et al., 2012). Women’s ice hockey has one of the highest rates of reported concussions at the collegiate level (Agel and Harvey, 2010; Datalys Center, 2013b; Hootman et al., 2007), but data on the incidence of concussions for female ice hockey players at the high school level are currently unavailable. A major limitation to existing data on sports-related concussions in youth is a lack of research on the incidence of such injuries in nonacademic settings, such as in intramural and club sports, and for athletes younger than high school age.

Part of the committee’s charge was to examine sports-related concussions among military dependents as well as concussions in military personnel ages 18 to 21 that result from sports and physical training at military service academies or during recruit training. There is no evidence about whether the risks for concussion are different for these youth than for youth in general, although there is no reason to think that they would be (Goldman, 2013; Tsao, 2013). The committee also found that among military personnel, mild traumatic brain injuries (mTBIs)—of which concussions are one category—represent the majority (about 85 percent in 2012) of all TBIs and that most mTBIs (about 80 percent in 2012) do not occur in the deployed setting. These TBIs are instead most commonly caused by motor vehicle crashes (privately owned and military vehicles), falls, sports and recreation activities, and military training (DVBIC, 2013). However, it is unknown what proportion of these injuries are concussions and, among those, what proportions occur during sports and recreation activities or

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1Athletic exposures are the number of practices and competitions in which an individual actively participates (i.e., in which he or she is exposed to the possibility of athletic injury).



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