Abstract
BackgroundConcussion is a preventable injury that can have long-term health consequences for children and youth. In Ontario, the Policy/Program Memorandum # 158 (PPM) was introduced by the Ministry of Education of Ontario in March 2014. The PPM’s main purpose is to require each school board in the province to create and implement a concussion policy. The purpose of this paper is to examine trends in school-based concussions prior to and subsequent to the introduction of the PPM.MethodsThis report examined emergency department (ED) visits in 5 Ontario hospitals that are part of the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), and compared trends over time in diagnosed concussions, and suspected concussions identified as “other head injury” in children and youth aged 4–18.ResultsFrom 2009 to 2016 study years, there were 21,094 suspected concussions, including 8934 diagnosed concussions in youth aged 4–18. The average number of diagnosed concussions in the 5 years before the PPM was 89 concussions/month, compared to approximately 117 concussions per month after; a 30% increase in the monthly rate of concussions presenting to the ED. The total number of concussion or head injury-related ED visits remained relatively unchanged but the proportion of diagnosed concussions rose from 31% in 2009 to 53% in 2016. The proportion of diagnosed concussions in females also increased from 38% in 2013 to 46% in 2016. The percent of all diagnosed concussions occurring at schools increased throughout the study reaching almost 50% in 2016 with most injuries taking place at the playground (24%), gymnasium (22%) or sports field (20%).ConclusionsThe introduction of the PPM may have contributed to a general increase in concussion awareness and an improvement in concussion identification at the school level in children and youth aged 4–18.
Highlights
Concussion is a preventable injury that can have long-term health consequences for children and youth
There were 164,766 emergency department (ED) injury-related visits recorded in Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) during this time period, with diagnosed concussions accounting for 5.4% of injury-related visits and minor closed head injuries accounting for 7.4%
The actual number of emergency department visits for suspected concussions started to decrease in January–February 2014, just before the Policy/Program Memorandum # 158 (PPM) was introduced (March 2014) but the number of diagnosed concussions remained similar (Fig. 1)
Summary
Concussion is a preventable injury that can have long-term health consequences for children and youth. The PPM’s main purpose is to require each school board in the province to create and implement a concussion policy. According to recent research from the Canadian Institute for Health Information (CIHI) almost 95% of all emergency department (ED) visits for sport-related brain injuries in 2014– 2015 were concussion-related [3]. Data from the US shows that sports-related concussions affect as many as 0.5–1.1 million Americans each year between the ages of 5–19, with the majority of them going to the ED [4]. Data from the provinces of Ontario and Alberta show that about 14,300 of ED visits in 2014–2015 were sports-related concussions [5]. The same data suggest that about a quarter of all brain-injuries seen in Alberta/ Ontario EDs are sports-related [5]. Complications of concussions can include post-concussion syndrome (PCS), epilepsy, recurrent headaches, second impact syndrome, depression, mild cognitive impairment and chronic traumatic encephalopathy (CTE) [4, 6, 7]
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