Lindsey Straus Lindsey Straus   IN: Identification & Diagnosis, Top Stories, Treatment & Management, What's New   Tagged: ,  
  • Lindsey Straus

    Author: Lindsey Straus is an award-winning youth sports journalist, practicing attorney, and has been Senior Editor of SmartTeams since its launch as MomsTEAM in August 2000. She can be reached at lbartonstraus@MomsTEAM.com.

  • Lindsey Straus

Four in Ten Youth and High School Athletes Continue Playing With Concussion Signs and Symptoms

Nearly four out of ten youth and high school athletes who show signs or experience symptoms of concussion nevertheless return to play on the same day,  say researchers in a presentation at the American Academy of Pediatrics National Conference and Exhibition in San Francisco. (1)

The research is said to be the largest to date looking at return to play patterns in young athletes with concussions.

Reviewing records for 185 patients between the ages of 7 and 18 treated for concussion at a Texas pediatric sports clinic  in 2014, researchers at Texas Scottish Rite Hospital for Children in Plano, Texas, found that 71 reported returning to play on the same day as their initial injury. 

Those who immediately returned to play after their injury reported less severe symptoms of dizziness and balance problems immediately after being hurt than the 62% of athletes who did not return.  

By the time they were seen in the clinic, however, they were significantly more likely to report the presence and increased severity of such concussion symptoms as nausea, dizziness, balance problems, sensitivity to light and noise, feeling “slowed down,” pressure in the head, confusion and trouble with both concentrating and falling asleep.  

No statistical differences in age, gender, presence of concussion symptoms on day of injury, sport, mechanism of injury or impact location were observed between those who returned to play on the same day and those who did not. 

The findings come despite concussion guidelines strongly recommending against same day return if an athlete shows any signs or symptoms of suspected concussion, and laws in all 50 states banning same day return in case of suspected concussion, at least at the high school level.  

They are also generally consistent with earlier studies finding that, for a variety of reasons, between 40 and 60 percent of youth and high school athletes still fail to immediately report concussion symptoms.

Recent studies have linked delayed removal from play with longer concussion recoveries.  One 2016 study found that high school athletes who continue to play with a sport-related concussion take nearly twice as long to be cleared for a full return to sports than those who are immediately removed from play and were 8 times more likely to take 21 days or longer to receive medical clearance for full sports participation after concussion. (2)  

“Our findings suggest that we still have work to do to change behaviors to protect short- and long-term brain health of youth athletes,” said Meagan Sabatino, a senior clinical research coordinator and co-author of the abstract, and highlighted the ongoing need for concussion education. “We need to emphasize the message, `when in doubt, sit them out — and keep them out — until full recovery,” said Shane M. Miller, a pediatric sports medicine specialist at the Texas hospital.

“It is deeply concerning, that despite all efforts to educate on the dangers of continuing to play with concussion symptoms, athletes continue to play through this injury. This is why it is important to identify the barriers to recognize, report, and seek medical attention after a concussion,” says Shannon Bauman, a primary care sports medicine physician with Concussion North in Barrie, Ontario, Canada.

“We need to partner with schools to ensure concussion education is part of the the curriculum and ensure this young generation is taught about concussions and the dangers of playing through this injury before an injury occurs.  We need to also educate the parents of youth — to ensure parents understand the importance of connecting with medical care after a concussion,” Bauman said. 

Clinicians and schools need to partner to provide a seamless transition from injury to care, she said, because concussions impact much more than returning to sport. “Connecting with a physician knowledgeable in concussions is essential to recovery for life, learning and sport,” said Bauman.  “I hear too often from patients and parents, “I never realized how serious a concussion could be until my (son or daughter) had one. Now I tell everyone.”

Noting that the study sample included many younger athletes, Rosemarie Moser, a concussion neuropsychologist and director of the Sports Concussion Center of New Jersey, observed that, “Reporting concussion is especially difficult for younger children under the age of 12.  Seven year-olds may not have the cognitive, abstract thinking capacity to report and describe symptoms such as feeling disoriented or mentally slow.  It is difficult for them to understand the word “concussion”, let alone know how to report it.  That makes it even more imperative for the adults on the sideline to be vigilant and responsible for the safety of these very young athletes.”

The continued under-reporting of concussion by athletes has prompted an increasing number of concussion educators to conclude that the best way to increase the rate at which athletes report concussion symptoms, either their own or their teammates, may be to reshape the culture around concussion reporting by changing individual and team reporting attitudes and norms by creating a climate in which athletes feel comfortable reporting their symptoms. by teaching that immediate reporting actually helps the team’s chances of winning, not just in that game, but by giving athletes the best chance to return as quickly as possible from concussion, the rest of the season, and by teaching that honest reporting is a valued team behavior and a hallmark of a good teammate.


  1. Research Abstract.  “Same Day Return to Play After Pediatric Athletes Sustain Concussions,”  Sabatino M, Miller SM.  Presented at American Academy of Pediatrics National Conference and Exhibition, San Francisco, CA October 22, 2016 (https://www.eurekalert.org/pub_releases/2016-10/aaop-sss101416.php) (accessed October 21, 2016).
  2. Elbin RJ, Sufrinko A, Schatz P, French J, H Luke, Burkhart S, Collins MW, Kontos AP.  Removal From Play After Concussion and Recovery Time. Pediatrics 2016;138(3):e20160910 (epublished August 29, 2016); DOI:10.1542/peds.2016-0910.

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