Abstract
BackgroundTraumatic brain injury legislation varies across states. A comprehensive nationwide evaluation of state traumatic brain injury laws is vital given growing populations of high school athletes. This study evaluates the effectiveness of traumatic brain injury laws by examining longitudinal trends in incident and recurrent concussion rates and determines if state level variations in legislation’s language affected the observed trends.MethodsIn this retrospective ecological study of a large national sample of US high schools from 2005/06 through 2017/18, piecewise regression models along with a profile likelihood approach were utilized to examine longitudinal trends in incident and recurrent concussion rates.ResultsOverall incident concussion rates increased by an additional 1.85%/standardized month (STDM) (95% confidence interval (CI): 1.14, 2.56%) prior to law passage and decreased by an additional 1.08%/ STDM (95%CI: − 1.43, − 0.72%) after law passage. Similar trends were observed for overall recurrent concussion rates. Among states that specified the category of healthcare provider for return to play clearance, post-law recurrent concussion rates decreased on average by an additional 1.59%/STDM (95%CI: − 3.42, 0.22%) compared to states that did not specify the category of healthcare provider.ConclusionsThe passage of state level traumatic brain injury laws was associated with an increase in overall incident and recurrent concussion rates prior to law passage and a decrease in rates after law passage. Although not statistically significant, states with traumatic brain injury laws specifying the category of healthcare provider for return to play clearance had a greater rate of decline in post-law recurrent concussion rates compared to states not specifying the category of healthcare provider. The findings suggest that state traumatic brain injury laws may benefit from specifying the category of healthcare provider allowed to provide return to play clearance, if they do not already include such language.
Highlights
Traumatic brain injury legislation varies across states
The rate of decline during the post-law period for recurrent concussion rates was 1.59%/standardized month (STDM) (95%confidence interval (CI): − 3.42, 0.22%) greater among states that specified the category of healthcare provider compared to states that did not specify the category of healthcare provider for return to play (RTP) clearance
Among states that specified the category of healthcare provider for RTP clearance, the post-law rate of decline in recurrent concussion rates was more than four times the rate compared to states that did not specify the category of healthcare provider for RTP clearance
Summary
A comprehensive nationwide evaluation of state traumatic brain injury laws is vital given growing populations of high school athletes. This study evaluates the effectiveness of traumatic brain injury laws by examining longitudinal trends in incident and recurrent concussion rates and determines if state level variations in legislation’s language affected the observed trends. In the United States (US), approximately 8 million high school athletes participate in over 60 different school sanctioned sports annually (The National Federation of State High School Associations 2018). Participation in high school sports has increased steadily over time (The National Federation of State High School Associations 2018). Sports related injuries, including concussions, may increase. A study of 25 US high schools over an 11-year period showed concussion rates increased 15.5% annually (Lincoln et al 2011). Symptoms associated with recurrent concussions, including the possibility of second impact syndrome (Cantu 1998), may be more severe and require a longer recovery time than those associated with incident concussions (Collins et al 2002; Guskiewicz et al 2003)
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