704 FO18 – Avenues for prevention using the epidemiolgy of sport-related concussion from a large high school surveillence study

Background Epidemiology provides fundamental opportunities to protect student-athlete health. Objective Describe the epidemiology of sport-related concussion (SRC) across 7 years (2015/16–2021/22), and compare boys' and girls' sports SRC incidence. Design Retrospective cohort. Setting State-wide high school head injury surveillance system. Participants High school student-athletes (n=1,914,056; boys: n=1,109,497; girls: n=804,559) with SRCs reported by school-based professionals (e.g., athletic trainer, coach, athletic director). Risk Factors Study year and boys and girls in sex-comparable sports. Outcome Measurements We calculated annual clinical incidence by dividing SRC counts in each sport by the number of sport participants multiplied by 100 player-seasons and presented 95% confidence intervals (CI). We include 2019/20 and 2020/21 with caution due to the COVID-19 pandemic. Relative rate ratios (RRs) were estimated for sex-comparable sports. Results 25,001 SRCs occurred (clinical incidence: 1.31, 95%CI:1.29,1.32) with an all boys' sports rate of 0.76 (95% CI:0.75,0.78) and girls' rate of 2.06 (95%CI:2.03,2.09). Boys' sports with the highest clinical incidence included 11-player football (range:2.08, 95%CI:1.92,2.24 to 6.29, 95% CI:6.03,6.57), 8-player football (range:1.08, 95%CI:0.65,1.68 to 4.73, 95%CI:3.88,5.70), ice hockey (range:0.90, 95%CI:0.60,1.29 to 3.84, 95%CI:3.20,4.57), and wrestling (range: 0.84, 95%CI:0.60,1.29 to 3.69, 95%CI: 3.31,4.10). Girls' sports with the highest clinical incidence included basketball (range: 0.86, 95%CI:0.72,1.02 to 3.99, 95%CI:3.66,4.33), soccer (range:1.62, 95%CI:1.39,1.87 to 3.96, 95%CI:3.61,4.32), lacrosse (range:1.08, 95%CI:7.31,1.54 to 4.32, 95%CI:3.63,5.11), competitive cheer (range:0.89, 95%CI:0.65,1.18 to 3.31, 95%CI:2.86,3.80), and gymnastics (range:0.49, 95%CI:0.10,1.42 to 2.39, 95%CI:1.31,3.98). Girls consistently had higher SRC rates relative to boys for baseball/softball, basketball, and soccer (RR range:1.65, 95%CI:1.41,1.93 to 3.32, 95%CI:2.85,3.89). Girls had lower SRC in lacrosse in 2015–16 (RR:0.63, 95%CI:0.40,0.97), no difference 2016/17–2020/21, but had higher rates in 2021/22 (RR:1.69, 95%CI:1.31,2.18) relative to boys. Conclusions This data can help understand the potential impact of interventions aimed at preventing or reducing SRC. Including girls' sports within this study extends research for a largely underrepresented group.