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Background: Current research on concussion incidence in youth athletes (age Hypothesis: Concussion injuries commonly occur in high school sports programs. The likelihood of concussion among student-athletes (aged 13-18 years) depends on the sport they are participating in as well as the sex of the athlete. Study Design: Descriptive epidemiology study. Level of Evidence: Level 4. Methods: A retrospective analysis of all Hawaii high school athletes aged 13 to 18 years participating in 14 sports from 2011 through 2017 was performed as part of a statewide standardized concussion assessment and management program. Results: A total of 5993 concussions were identified among 92,966 athletes. The overall concussion rate was 0.96 (95% CI, 0.94-0.99). Girls’ judo had the highest concussion rate (1.92; 95% CI, 1.68-2.17) followed by football (1.60; 95% CI, 1.53-1.66). The concussion rate for boys (1.0; 95% CI, 0.97-1.03) was higher than that for girls (0.91; 95% CI, 0.87-0.95); however, in 4 of the 5 sports in which both girls and boys participated, girls had a higher rate of concussion injury. Conclusion: The likelihood of concussion among student-athletes aged 13 to 18 years may be higher than previously thought and varies depending on sport and sex. Clinical Relevance: Epidemiologic data on concussion injury in children and adolescents are useful in accurately determining the relative risks of high school sports participation and may be valuable in determining the appropriate allocation of health care and scholastic resources for student-athletes, as well as the impact of rule and training modifications designed to improve participant safety.

Background: The long-term effect of sport-related concussion on mood in adolescent athletes is largely unknown. Hypothesis: Longitudinal measures of depression will worsen acutely after sport-related concussion and improve with concussion symptom resolution. Study Design: Prospective cohort study. Level of Evidence: Level 3. Methods: A population-based sample of 2160 high school athletes from 31 urban, suburban, and rural high schools completed preseason baseline concussion symptom evaluation and Patient Health Questionnaire–9 (PHQ-9) assessments over 2 years. Athletic trainers recorded onset of sport-related concussion, and concussed athletes completed the PHQ-9 assessment within 24 to 72 hours, 7 days, date of return to sport, 3 months, 6 months, and 12 months after sport-related concussion. Scores at each time point were compared to baseline with mixed-effects models and repeated-measures analysis of variance. Sex-based differences were assessed using mixed-effect models. Results: Of the 2160 athletes enrolled in the study, 125 (5.8%; 80 males, 45 females) sustained a sport-related concussion. PHQ-9 scores worsened from baseline at 24 to 72 hours (+1.05; 95% CI, 0.26-1.84; P = 0.003) and 7 days (+0.91; 95% CI, 0.23-1.60; P = 0.006). However, PHQ-9 scores improved from baseline to date of return to sport (−1.38; 95% CI, −2.20 to −0.55; P < 0.001), 3 months (−1.08; 95% CI, −1.88 to −0.28; P = 0.003), 6 months (−1.19; 95% CI, −2.04 to −0.34; P = 0.001), and 12 months after sport-related concussion (−0.76; 95% CI, −1.43 to −0.08; P = 0.028). Female athletes reported more severe concussion symptoms 24 to 72 hours after sport-related concussion compared with male athletes (female, 20.5 [interquartile range (IQR), 10.0-36.2]; male, 9.0 [IQR, 4.0-19.5]; P = 0.003). Neither PHQ-9 scores nor change in PHQ-9 scores differed between male and female athletes at any time point. Conclusion: Sport-related concussion did not worsen longitudinal measures of depressed mood in this cohort of high school athletes. Clinical Relevance: Emotional symptoms are common after sport-related concussion, but typically resolve by return to sport.