Recent analysis of more than 6,000 sports-related concussion cases in Texas could provide insight into how and why concussions go underreported in some school districts.
Researchers at UT Southwestern Medical Center reviewed data from a statewide database to see how factors like location and socioeconomic status affect the rate of reported concussions. In general, lower-income districts located in urban areas were associated with fewer reported concussions.
"I was pleasantly surprised by the fact that overall, those bigger sports do seem to be consistently reporting and identifying concussion," said Dr. Mathew Stokes, an assistant professor of pediatrics and neurology at UT Southwestern. "Our worry going into the study was that we were going to find differences in even things like football, soccer, and these bigger sports, which would really indicate that we're not identifying things."
Stokes said there's been a lot of emphasis on identifying concussions in more "high risk" and certain "high impact" sports. For example, USA Football, the governing body for football in the U.S., offered training to its coaches to help address concussion rates in the sport.
While the overall rate of concussions in sports like wrestling, track and band is lower than in football and soccer, concussion rates seem to vary much more between school districts, the study found.
"In the smaller sports ... there was a difference in reporting by area," Stokes said, "with a lower reporting rate in some of the areas with a little bit of a lower socioeconomic background," Stokes said.
Roy Rudewick, the director of Sports Medicine at UT Arlington, said identifying concussions can be unpredictable.
"There's a lot of information that you're relying on what the athlete is reporting to you and that information being accurate and that can be very challenging," Rudewick said. "It's impossible to tell whether somebody has a headache right now. There are certainly ways to check vertigo, vision, that kind of stuff, but the headache and just how they're generally feeling is very subjective."
At UTA, Rudewick said all student athletes are educated in concussions. The university also uses software that collects information to help the athletic team determine an athlete's baseline – which can then be used to determine how severe a concussion is and the best course of action for treatment.
Rudewick said schools should have protocols in places to ensure students are thoroughly evaluated for possible concussions. He said there are some sideline testing tools that don't cost anything.
"But having people train to know how to use those different sideline testing devices is paramount to [the] health and safety of student athletes," Rudewick said.
In the study, researchers wrote concussion rate trends in low-income districts likely have several contributing factors but may be affected by less access to athletic trainers – which could mean more underreporting and underdiagnosis.
"Limited resources may prompt schools to prioritize athletic trainer attendance at football games and other high-impact sports, while smaller sports might not receive the same attention," researchers wrote in the analysis.
In the Dallas-Fort Worth area, Stokes said analysis showed concussion rates were lower in school districts like Duncanville and Mesquite compared to school districts like Frisco and Plano.
"When you overlay kind of socioeconomic level and things like that, that's where that correlation comes," Stokes said. "And it is just a correlation. It's not a causation at this point."
Stokes said that's his team is already looking into what studies need to come next to help address underreporting and resource allocation.
Despite how challenging concussion research can be, Stokes said it's an important area to research because undiagnosed concussions can lead to worse health and academic outcomes for student athletes.
"There's lots of things we still don't know about concussions," he said. "But one of the things that we definitely know is that the sooner a concussion is diagnosed and a child is pulled from play and allowed to recover, the better that they do, the faster they get better, the less likely they are to have prolonged or lingering symptoms after the concussion."
Abigail Ruhman is KERA's health reporter. Got a tip? Email Abigail at aruhman@kera.org.
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