Concussion Risk Research Articles

Narrative Force: How Science and Storytelling Impact Parental Concussion Beliefs and Intentions Through Transportation and Trust.

Although news and entertainment coverage of sports concussions has increased in recent years, many parents of adolescent athletes remain indifferent to or unaware of practices that would mitigate concussion harm. This experiment with U.S. parents of 10- to 17-year-olds (N = 502) explores how narratives and expository concussion science could be used together to increase concussion risk assessments, mitigation intentions, and support for sports concussion policy. Direct and indirect relationships through narrative transportation and trust are explored.

Examining the Reliability and Validity of Coding Perceived Force Severity and Bracing in the NHL Concussion Spotter Program.

Data obtained from the National Hockey League (NHL) have shown that a risk prediction model, including both visible signs and mechanisms of injury, improves the identification of possible concussion. However, only about half of concussions diagnosed by club medical staff in the NHL exhibit visible signs. At present, the NHL concussion spotter protocol does not include central league spotters' subjective judgments of the severity of forces associated with a direct hit to the head (perceived force severity [PFS]) or whether players brace before a hit (bracing). To examine the interrater reliability, preliminary validity, and association with concussion diagnosis of central league spotter determinations of PFS and bracing. Cross-sectional study. Video footage of 1071 events after a direct or indirect blow to the head were observed from the 2020-2021 and 2021-2022 NHL seasons. These events were classified into 4 groups: concussion with visible signs; concussion without visible signs; no concussion with visible signs; and no concussion without visible signs. A total of 50 events were randomly selected from the total events in each group. Then, 2 raters (NHL central league spotters) coded PFS for each of the 200 video events as low, medium, or high. Bracing was coded as no bracing, insufficient bracing, or full bracing. Interrater reliability was fair to moderate for the categorical and continuous ratings of both PFS (κ = 0.36 and 0.45, respectively) and bracing (κ = 0.40 and 0.49, respectively). There was no significant association between concussion diagnosis and either PFS (Z = 0.00, P = .99) or bracing (Z = 0.77, P = .44). Exploratory, post hoc analyses suggested a possible relationship between bracing and reduced concussion risk among a select subsample of events with no visible signs (r = -0.29, P < .01). The interrater reliability for PFS and for bracing was fair to moderate. Neither PFS nor bracing were significantly related to concussion diagnosis, but they were significantly associated with other visible signs and mechanisms of injury.

Variability in youth coach concussion education requirements across states.

Youth sports coaches play a critical role in proper concussion recognition and management, reinforcing the need for coach concussion education. As of 2021, most states have statutory and policy measures mandating concussion education for coaches. In practice, these mandates have been enacted through state legislatures and their respective youth sport governing bodies. Prior studies have found significant variations in the contents of state-level concussion risk reduction policies and have raised questions about their specificity. To expand on previous analyses to provide an overview of youth sports coach concussion education, highlighting variations in state policies and discrepancies between state mandates and youth sport governing bodies. This report utilized qualitative content analysis to characterize and compare U.S. state and governing body concussion education requirements for youth sport coaches. State concussion statutes were identified via the National Conference of State Legislatures and Open States databases, and governing body handbooks/bylaws were obtained via their websites. Two researchers independently coded the policies, and discrepancies were resolved through consensus meetings with additional youth traumatic brain injury experts. We found significant variability in educational requirements and their implementation. A majority (68%; n = 34) of states require the completion of concussion education training for coaches. Notably, many states designate responsibility for enforcement and implementation of provisions to another party but just four state statutes delineate explicit consequences for noncompliance. Additionally, only 12 state statutes extend mandates to noninterscholastic sports, limiting their reach. In most cases, independent sanctioning authorities implement more stringent policies than the minimum acceptable standard established by state law. Our findings provide a coded data set of youth coach concussion laws and independent sanctioning authority guidelines that can be used in future research efforts. Further research investigating a relationship between the strength of coach concussion education policies and relevant youth and adolescent concussion-related metrics is required.

Association of concussion history with psychiatric symptoms, limbic system structure, and kynurenine pathway metabolites in healthy, collegiate-aged athletes

Psychiatric outcomes are commonly observed in individuals with repeated concussions, though their underlying mechanism is unknown. One potential mechanism linking concussion with psychiatric symptoms is inflammation-induced activation of the kynurenine pathway, which is thought to play a role in the pathogenesis of mood disorders. Here, we investigated the association of prior concussion with multiple psychiatric-related outcomes in otherwise healthy male and female collegiate-aged athletes (N = 212) with varying histories of concussion recruited from the community. Specially, we tested the hypotheses that concussion history is associated with worse psychiatric symptoms, limbic system structural abnormalities (hippocampal volume, white matter microstructure assessed using neurite orientation dispersion and density imaging; NODDI), and elevations in kynurenine pathway (KP) metabolites (e.g., Quinolinic acid; QuinA). Given known sex-effects on concussion risk and recovery, psychiatric outcomes, and the kynurenine pathway, the moderating effect of sex was considered for all analyses. More concussions were associated with greater depression, anxiety, and anhedonia symptoms in female athletes (ps ≤ 0.005) and greater depression symptoms in male athletes (p = 0.011). More concussions were associated with smaller bilateral hippocampal tail (ps < 0.010) and left hippocampal body (p < 0.001) volumes across male and female athletes. Prior concussion was also associated with elevations in the orientation dispersion index (ODI) and lower intracellular volume fraction in several white matter tracts including the in uncinate fasciculus, cingulum-gyrus, and forceps major and minor, with evidence of female-specific associations in select regions. Regarding serum KP metabolites, more concussions were associated with elevated QuinA in females and lower tryptophan in males (ps ≤ 0.010). Finally, serum levels of QuinA were associated with elevated ODI (male and female athletes) and worse anxiety symptoms (females only), while higher ODI in female athletes and smaller hippocampal volumes in male athletes were associated with more severe anxiety and depression symptoms (ps ≤ 0.05). These data suggest that cumulative concussion is associated with psychiatric symptoms and limbic system structure in healthy athletes, with increased susceptibility to these effects in female athletes. Moreover, the associations of outcomes with serum KP metabolites highlight the KP as one potential molecular pathway underlying these observations.

Early Childhood Concussion.

The unconsolidated motor and cognitive skills that are typical of the early childhood period place infants, toddlers, and preschoolers at risk for a variety of traumatic injuries. Such injuries may include mild traumatic brain injury or concussion. Knowledge regarding the risk, diagnosis, outcomes, and management of early childhood concussion is limited, especially compared with what is known about concussion in school-age children, adolescents, and adults. This state-of-the-art review aims to provide current knowledge on the epidemiology, physical signs, behavior, and clinical outcomes associated with early childhood concussion. Research on this condition has been challenged by the need to adapt methods to the unique physical, behavioral, and developmental characteristics of young children. We provide information on observable symptoms associated with concussion, recommended approaches to care, and suggestions for overcoming barriers to research in this area. Developmentally appropriate efforts are needed to improve our ability to identify, evaluate, and treat early childhood concussion.

How Shell Add-On Products Influence Varsity Football Helmet Performance?

PurposeThe study purpose was to investigate the laboratory-based performance of three commercially available shell add-on products under varsity-level impact conditions.MethodsPendulum impact tests were conducted at multiple locations (front, front boss, rear, side) and speeds (3.1, 4.9, 6.4 m/s) using two helmet models. Tests were performed with a single add-on configuration for baseline comparisons and a double add-on configuration to simulate collisions with both players wearing shell add-ons. A linear mixed-effect model was used to evaluate peak linear acceleration (PLA), peak rotational acceleration (PRA), and concussion risk, which was calculated from a bivariate injury risk function, based on shell add-on and test configuration.ResultsAll shell add-ons decreased peak head kinematics and injury risk compared to controls, with the Guardian NXT producing the largest reductions (PLA: 7.9%, PRA: 14.1%, Risk: 34.1%) compared to the SAFR Helmet Cover (PLA: 4.5%, PRA: 9.3%, Risk: 24.7%) and Guardian XT (PLA: 3.2%, PRA: 5.0%, Risk: 15.5%). The same trend was observed in the double add-on test configuration. However, the Guardian NXT (PLA: 17.1%; PRA: 11.5%; Risk: 62.8%) and SAFR Helmet Cover (PLA: 12.2%; PRA: 9.1%; Risk: 52.2%) produced larger reductions in peak head kinematics and injury risk than the Guardian XT (PLA: 5.7%, PRA: 2.2%, Risk: 21.8%).ConclusionIn laboratory-based assessments that simulated varsity-level impact conditions, the Guardian NXT was associated with larger reductions in PLA, PRA, and injury risk compared to the SAFR Helmet Cover and Guardian XT. Although shell add-ons can enhance head protection, helmet model selection should be prioritized.

The Effect Of Playing Surface And Temperature On Concussion Risk In High School Women's Lacrosse

The Effect Of Playing Surface And Temperature On Concussion Risk In High School Women's Lacrosse

‘Mind your head’, tackle characteristics associated with concussions in rugby league: A case-control study

ObjectivesIdentify tackle characteristics associated with concussions in male professional rugby league. DesignCase-control study. MethodsTackles resulting in 196 clinically diagnosed concussions and 6592 non-concussive tackles were analysed, from the men's rugby league Super League between 2018 and 2022. Eleven tackle characteristics were coded for each tackle, and Firth penalised logistic regression models were employed to identify influential variables through forward stepwise selection. Three multivariate models were produced; all (i.e., ball-carrier and tackler), tackler, and ball-carrier concussions. ResultsOf the 196 concussions, 70 % occurred to the tackler and 30 % to the ball-carrier. Initial impact location on the ball-carrier was identified as a predictor in all models, specifically the shorts, upper- and lower-leg (OR 9.1–12.3, compared to shoulder) for tacklers and head/neck (OR 66.1, compared to shoulder) for ball-carriers. Tackler head placement in front of the ball-carrier (OR 8.5, compared to away from the body) and a ball-carrier leading arm in any position (OR 4.8–22.1, compared to no leading arm) provided the greatest odds of a tackler concussion. For player's body position the greatest risk of concussion for all players was observed when both players were falling/diving (OR 8.8, compared to both players upright). One (OR 4.9, compared to two) and four (OR 3.7, compared to two) defender tackles provide the greatest odds for all concussions. ConclusionsConcussion prevention strategies should aim to reduce head impacts by deterring initial contact with the ball-carrier's head/neck. Tackle technique should prioritise making initial impact with the torso and avoid the head being in front of the ball-carrier and any leading arms.

Increasing neck extension strength may reduce concussion risk in adolescent athletes

Increasing neck extension strength may reduce concussion risk in adolescent athletes

Video Analysis of Concussion Among Slap Fighting Athletes.

This cross-sectional study assesses the risk of concussion among 56 slap fighting athletes via video analysis of 78 slap fighting matches.

A Machine Learning Approach to Concussion Risk Estimation Among Players Exhibiting Visible Signs in Professional Hockey.

The identification of concussion risk factors, such as visible signs and mechanisms of injury, improves concussion identification. Exploring individual risk factors, such as concussion history, may help to improve existing concussion risk models and algorithms. The primary aim of the current study was to use machine learning techniques to develop a comprehensive, prospectively coded concussion risk model in professional hockey among players exhibiting visible signs. The secondary aim was to examine whether including concussion history improves model performance. Data from the National Hockey League (NHL) spotter program, including coded visible signs and mechanisms of injury associated with possible concussive events, were extracted from the 2018-2019 to the 2021-2022 seasons. Each unique spotter event was matched with data extracted from the medical record to determine whether the event was associated with a subsequent physician diagnosed concussion. We compared the ability of three machine learning-based approaches to identify the likelihood of physician diagnosed concussion: conditional inference tree, conditional inference random forest, and logistic regression. A total of 1563 unique events with visible signs were identified by spotters (183 leading to a concussion diagnosis). A randomly selected training sample had 1250 events (146 concussions) and the remaining set-aside test sample had 313 events (37 concussions). The obtained models performed at a high level with large effects in the training [area under the receiver operating characteristic curve (AUC) = 0.79] and set-aside test data (AUC = 0.82). Concussion history was retained in the tree and logistic regression models, with each additional prior concussion associated with a 1.32 times increased odds of concussion diagnosis. We present simple tree and logistic algorithms for concussion screening and as diagnostic aids. Our results show that player concussion history can explain additional risk above and beyond that explained by visible signs and mechanisms of injury alone.

An initial assessment of an opinion leader-informed intervention to improve concussion-related outcomes among middle school parents: a randomized controlled trial

Introduction There is a need for evidence-based prevention programming that can reduce head impacts and increase reporting and disclosure of concussion. This study assessed an intervention to decrease concussion risk and improve concussion management through improving concussion-related knowledge, attitudes, intentions, and self-efficacy among parents in the middle school (MS) sport setting. Patients and methods This randomized controlled trial (NCT04841473) examined parents of MS-aged children. Participants were randomized into one of two study arms: (1) CDC, which completed an education training module that compiled concussion education from the Centers for Disease Control and Prevention (CDC); and (2) TRAIN + CDC, which completed the CDC training module and an additional TRAIN educational module that provided strategies (originating from the Popular Opinion Leader framework) on communicating such information with one’s personal peer networks and children. Validated measures of concussion-related knowledge, attitudes, intentions, and self-efficacy were collected before completing the training modules and one week following completion. Linear mixed model analyses examined differences in outcomes between study arms. Results Overall, 103 parents completed the training modules and had valid pre- and post-intervention data (TRAIN + CDC n = 49; CDC n = 54). Analyses found that the study arms did not differ in the change scores from pre- to post-intervention across concussion-related outcomes. However, scores from pre- to post-intervention improved across both study arms for knowledge metrics, such as ‘Concussions are less likely to happen when athletes play by the rules of the sport’ (p < 0.001), and self-efficacy metrics, such as feeling confident in one’s knowledge and recognition of concussion symptoms (p < 0.001 and p = 0.001, respectively). Conclusions Although study arms did not differ in change scores from pre- to post-intervention, beneficial increases were nonetheless found across both knowledge and self-efficacy. Additional research is needed to further examine the beneficial manners in which concussion education can be best delivered and the most effective.

Individual and combined effects of sport-related concussion and ACL injury on neurocognitive and neuromechanical reaction time.

Recent epidemiological data indicates a potential connection between sport-related concussion (SRC) and elevated anterior cruciate ligament (ACL) injury risk. Limited research exists quantifying cognitive and motor outcome measures between SRC and ACL injury history. To examine the individual and combined effects of a history of SRC and ACL injury and reconstruction (ACLR) on neurocognitive and neuromechanical function. Cross-sectional study. Research laboratory. 47 recreationally active college individuals with either an injury history of SRC (n=12), ACLR (n=12), combination of SRC+ACLR (n=11), or uninjured controls (n=12). Participants completed a neurological battery using the C3 Logix application and TRAZER system for neuromechanical reaction time (RT). C3 Logix sub-tests consisted of the Trail Making Test (TMT) A,B, and B -/minus A, simple and choice RT, and processing speed. TRAZER sub-tests consisted of simple, Flanker-task, and Stroop-task RT. Participants were categorized into 3 group comparisons of either: (i) SRC, ACLR, SRC+ACLR, and controls, (ii) Any or No SRC overall, (iii) Any or No ACLR overall. No differences were demonstrated between SRC, ACLR, SRC+ACLR, and controls on TMT (p=.07-.14), neurocognitive (p=.14-.93) or neuromechanical (p=.64-.99) performance. Those with Any SRC had slower TMT B-A times (p=.03), while those with Any ACLR had slower Trail A (p=.02) times when compared to those with no ACLR. No differences were noted for TRAZER simple, Flanker, or Stroop RT for Any or No SRC and ACLR groups. College students with a combined effect of SRC and ACLR did not differ from other groups on neurocognition and neuromechanical reaction time. Individuals with a history of SRC or ACLR had worse TMT, leading to inquiry about potential long-term neurological deficits, despite no differences in those with a combined history.

Assessing Kinematic Variables in Short-Track Speed Skating Helmets: A Comparative Study between Traditional Rigid Foam and Anti-Rotation Designs

Purpose: Short-track speed skating results in high-energy crashes with an elevated risk of head injury. The goal of this study was to evaluate the resulting kinematics of an anti-rotation helmet technology for speed skating. Methods: Two traditional rigid foam speed-skating helmets (BT and ST) were compared with one anti-rotation speed skating helmet (MIPS). Each helmet was impacted with a pneumatic device across three locations. The resulting linear or rotational accelerations (PLA or PRA) and rotational velocities (PRV) were measured with accelerometers placed on a Hybrid III head form. Additionally, the head impact criterion (HIC) was calculated from accelerations and the brain injury criterion (BrIC) was obtained from rotational velocities. Results: MIPS showed significantly higher values of accelerations (PLA = 111.24 ± 9.21 g and PRA = 8759.11 ± 2601.81 rad/s2) compared with the other helmets at all three impact locations (p &lt; 0.01, ES = 3.00 to 4.11). However, velocities were lowest, but not significantly different, for the MIPS helmet (25.77 ± 1.43 rad/s). Furthermore, all resulting kinematics except peak linear accelerations were significantly different across impact locations. Conclusion: Helmet designs specific to the collision characteristics of speed skating may still be lacking, but would decrease the risk of sport-related concussions.

Concussion Reduction in Division I and II Athletes: Effects of Simple Cervical Spine Exercise Regimen.

Primary preventative medicine lacks a consensus on effective concussion prevention strategies for collegiate athletes. Cervical strength has been identified as a potential factor in concussion risk reduction. This study evaluates the impact of a commercially available, portable cervical muscle stretching and strengthening device, NeckX®, on cervical strength, range of motion (ROM), and concussion incidence in collegiate athletes participating in high-concussion-risk sports. A single-arm prospective cohort study was conducted with 162 collegiate athletes from various sports. Participants underwent a 12-week neck exercise protocol using the NeckX® device. Clinical data, including neck strength and ROM, were collected at weeks 0, 6, and 12. Concussion incidence was self-reported by participants and cross-referenced with records from the athletic department. Data were analyzed for significant neck strength and ROM changes throughout the 12-week study. A two-way analysis of variance multiple comparisons with the Tukey-Kramer significant difference test was utilized, using the Holm-Sidak method, with an alpha of 0.05. All athletic teams experienced a significant increase in cervical strength during the 12-week intervention (α = 0.05, p < 0.05). Increases in cervical flexion and extension force were most consistent between teams. Cervical ROM increased significantly in male and female soccer players (α = 0.05, p < 0.05). The overall incidence of head and neck injuries, including concussions, was reduced to 6.60% during the study period, the lowest recorded value in the university's athletic department history. The use of the NeckX® device for 12 weeks was effective in enhancing pericervical muscle strength and ROM while reducing concussion incidence in collegiate athletes participating in high-concussion-risk sports. Interestingly, the positive outcomes were consistent for both males and females, indicating the universal advantages of neck training among collegiate athletes. These findings support existing research on the benefits of cervical strengthening exercises for reducing concussions in collegiate athletes and highlight the convenience and affordability of using this device.

Mitigating Traumatic Brain Injury: A Narrative Review of Supplementation and Dietary Protocols.

Traumatic brain injuries (TBIs) constitute a significant public health issue and a major source of disability and death in the United States and worldwide. TBIs are strongly associated with high morbidity and mortality rates, resulting in a host of negative health outcomes and long-term complications and placing a heavy financial burden on healthcare systems. One promising avenue for the prevention and treatment of brain injuries is the design of TBI-specific supplementation and dietary protocols centred around nutraceuticals and biochemical compounds whose mechanisms of action have been shown to interfere with, and potentially alleviate, some of the neurophysiological processes triggered by TBI. For example, evidence suggests that creatine monohydrate and omega-3 fatty acids (DHA and EPA) help decrease inflammation, reduce neural damage and maintain adequate energy supply to the brain following injury. Similarly, melatonin supplementation may improve some of the sleep disturbances often experienced post-TBI. The scope of this narrative review is to summarise the available literature on the neuroprotective effects of selected nutrients in the context of TBI-related outcomes and provide an evidence-based overview of supplementation and dietary protocols that may be considered in individuals affected by-or at high risk for-concussion and more severe head traumas. Prophylactic and/or therapeutic compounds under investigation include creatine monohydrate, omega-3 fatty acids, BCAAs, riboflavin, choline, magnesium, berry anthocyanins, Boswellia serrata, enzogenol, N-Acetylcysteine and melatonin. Results from this analysis are also placed in the context of assessing and addressing important health-related and physiological parameters in the peri-impact period such as premorbid nutrient and metabolic health status, blood glucose regulation and thermoregulation following injury, caffeine consumption and sleep behaviours. As clinical evidence in this research field is rapidly emerging, a comprehensive approach including appropriate nutritional interventions has the potential to mitigate some of the physical, neurological, and emotional damage inflicted by TBIs, promote timely and effective recovery, and inform policymakers in the development of prevention strategies.

Association of Alzheimer's disease polygenic risk score with concussion severity and recovery metrics.

Identification of genetic alleles associated with both Alzheimer's disease (AD) and concussion severity/recovery could help explain the association between concussion and elevated dementia risk. However, there has been little investigation into whether AD risk genes associate with concussion severity/recovery, and the limited findings are mixed. We used AD polygenic risk scores (PRS) and APOE genotypes to investigate any such associations in the NCAA-DoD Grand Alliance CARE Consortium (CARE) dataset. We assessed six outcomes in 931 total participants. The outcomes were two concussion recovery measures (number of days to asymptomatic status, number of days to return to play (RTP)) and four concussion severity measures (scores on SAC and BESS, SCAT symptom severity, and total number of symptoms). We calculated PRS using a published score [1] and performed multiple linear regression (MLR) to assess the relationship of PRS with the outcomes. We also used t-tests and chi-square tests to examine outcomes by APOE genotype, and MLR to analyze outcomes in European and African genetic ancestry subgroups. Higher PRS was associated with longer injury to RTP in the normal RTP (<24 days) subgroup ( p = 0.024), and one standard deviation increase in PRS resulted in a 9.89 hour increase to the RTP interval. There were no other consistently significant effects, suggesting that high AD genetic risk is not strongly associated with more severe concussions or poor recovery in young adults. Future studies should attempt to replicate these findings in larger samples with longer follow-up using PRS calculated from diverse populations.

Enhancing Protocols for Concussion Management in Professional Soccer Events.

Every year, there are an estimated 1.7 to 3.8 million sports-related traumatic brain injuries. A sports concussion results from an external force or a blow to the head or body, causing cranial encephalic trauma that can affect motor skills and brain function, producing varying symptoms related to an alteration in neurological functioning. Soccer poses a risk of concussions due to heading, where the player's head directly hits the ball to redirect or accelerate it. However, most concussions are caused by contact between players, such as head-to-head or head-to-elbow contact. This study analyzed the incidence of concussions or mild traumatic brain injuries in professional soccer during the "Copa America 2019"to understand the feasibility of soccer concussion protocols and propose evidence-based enhancements. The data were previously collectedby our first two authors, O. Pangrazioand F. Forriol, during the 46th edition of the "Copa America 2019," where the South American Football Confederation implementedthe Concussion Fast Recognition Protocolto detect traumatic brain injuries. The descriptive basic data will help to raise awareness and motivate further research in this field. We have analyzed and correlated it with global data to provide a comprehensive review and tangible evidence of the population size where soccer protocols are typically applied, thus calculating incidence rates to measure it mathematically. Our study reveals that the incidence rate of concussions during the "Copa America 2019"was 5.3 per 1,000 athlete exposures, with a total of three concussions occurring among 567 players. Despite the effectiveness of current protocols in detecting concussions rapidly and accurately, the relatively low incidence rate at this level of professional competition poses a challenge to validating these protocols. These results indicate that while the protocols in place are efficient, the testing and validation of new tools and approaches would be more beneficial at different levels of play where the incidence rates of concussions are higher. In environments with a greater frequency of concussions, the robustness and reliability of these protocols can be more thoroughly evaluated, ensuring they provide optimal protection and care for athletes. The incidence of concussions is low in professional soccer tournaments. Protocols are necessary to protect players and educate sports professionals. However, their validation is difficult given the low incidence of concussions at this level of competition. Our proposed protocol helps unify a basic approach in the field and an advanced approach in any emergency department, providing better detection of concussions and improved outcomes for players. This protocol should be validated in populations with higher incidence rates to demonstrate its effectiveness.

A - 51 Examining the Role of Cognition in Lower Extremity Musculoskeletal Injury and Concussion Risk in Elite Athletes

A - 51 Examining the Role of Cognition in Lower Extremity Musculoskeletal Injury and Concussion Risk in Elite Athletes

Poster 399: The 10-Year Decreasing Trend of Youth Soccer Concussions Presenting to U.S. Emergency Departments

Objectives: Soccer is one of the most popular youth sports with nearly 3 million annual participants in the United States alone. Importantly, concussion incidence and awareness in youth soccer has prompted implementation of various protective measures. Despite these interventions, no studies have investigated the prevalence of youth soccer concussions over time. The purpose of this study is to analyze trends and etiologies of youth soccer concussions presenting to United States emergency departments (EDs). Methods: Data from National Electronic Injury Surveillance System were analyzed for soccer players 2 to 18 years old sustaining concussions from January 2013 to December 2022. Patient data collected included age, sex, mechanism of injury, diagnosis, loss of consciousness, and disposition. Raw data were used to calculate national estimates based on assigned statistical sample weight of each hospital. Results: 182,462 youth soccer concussions were diagnosed in US EDs (52.6% male). Most common mechanism of injury was head to ball (29%). Between 2013 and 2022, concussions decreased 28%. Overall concussions decreased by 1,449 per year (95% CI: -2383 to -515, p=0.007). Not specified concussions decreased by 340 per year (95% CI: -501 to -180, p=0.001), head to body by 378 per year (95% CI: -527 to -229, p&lt;0.001), head to ground by 275 per year (95% CI: -463 to -87, p=0.01), and other mechanisms by 56 per year (95% CI: -109 to -3, p=0.04). There were no changes in head to ball or head-to-head mechanisms. Exclusion of years 2020 and 2021 due to COVID demonstrated decreases in not specified concussions by 256 per year (95% CI = -394 to -118, p=0.004), head to body by 314 per year (95% CI: -431 to -196, p=0.001), and head to ground by 182 per year (95% CI: -331 to -33, p=0.02). Conclusions: There is a decreasing trend in youth soccer concussions from 2013 to 2022. Although concussion risk is greatest from contact with the ball, there was no decrease in head to ball concussions during the study period despite implementation and utilization of protective gear. This study contributes to growing literature regarding concussions in youth soccer athletes.