Epidemiology of concussion in youth participants to action sports

Purpose: Concerns related to susceptibility and concussion recovery in pediatric and adolescent population make it necessary to focus research on young athletes. The present study examines the epidemiology of concussion in action sports(AS), defined according to Immonen et al1. Methods: A systematic review and meta-analysis of medical literature were performed using the standardized guidelines proposed by Harris et al.2, the guidelines MOOSE3, and the PRISMA checklist4. A protocol addressing the PICOS criteria was preliminarily registered to the PROSPERO system5. We included studies. involving at least ten subjects, which aimed to study the incidence of injuries in youth athletes involved in AS. Meta-analysis was limited to studies reporting days of athletic exposure (DAEs) and conducted adopting the Der Simonian and Laird random-effects model. We calculated a pooled estimation of the incidence rates relative to single sports and the overall incidence of concussion across the discussed ASs. We generated a forest plot and calculated both Q and I2 statistics. The software JASP 0.13.1 (significance: p\0.05) was used. Results: The selected studies were relative to seven sports: alpine skiing (n = 10), freestyle skiing (n = 2), snowboarding (n = 12), motocross (n = 2), dinghy sailing (n = 1), sliding sports (n = 2), skating sports (n = 1). Regarding the methodological quality, we have to report that 26.3% of the studies reported the definition of concussion while 36.8% presented age and gender-specific incidence rates. The pooled incidence of concussion per 1000 DAEs (8 sports/ 13 studies) was 0.33(95% CI 0.22–0.45); Q statistic: p\0.001. The incidence of concussion (9 1000 DAE) ranged from 0.30 in skiing to 39.22 in motocross. Conclusions: The results of this study may help youth AS participants, their coaches and families to become aware of the concussion risk. They can also be used to steer future safety research and allow participants and governing bodies to develop relevant sport-specific safety policies concerning training, event organization, protective clothing, equipment, and other safety systems. Moreover, the awareness of the concussion risk in AS may improve concussion diagnosis, which is crucial because youth athlete is more susceptible to concussion and takes more time to recover. The main limitation of this study is the heterogeneity in the overall concussion estimate across the sports. It stems from differences between sports, the designs of the studies, and the different sources of data used as the denominator. References: 1. Immonen, et al. Sports Med. Open. 2017;1:18. 2. Harris, et al. Am. J. Sports Med. 2014;42:2761–2768. 3. Stroup, et al. JAMA. 2000;9:2008–2012. 4. Moher D, et al. PLoS Med. 2009;21:1000097. 5. University of York, Centre for Reviews and Dissemination PROSPERO. http://www.crd.york.ac.uk/PROSPERO