Cumulative effects of concussion in high school athletes

Neurosurgery. 2002 Nov;51(5):1175-9; discussion 1180-1. doi: 10.1097/00006123-200211000-00011.


Objective: A common assumption in sports medicine is that a history of concussion is predictive of a lower threshold for, as well as a worse outcome after, subsequent concussive injury. The current study was conducted to investigate the relationship between concussion history in high school athletes and the on-field presentation of symptoms after subsequent concussion.

Methods: One hundred seventy-three athletes who experienced sports-related concussion composed the initial study group. Binary groups were subsequently created on the basis of concussion history. Sixty athletes with no concussion history were compared with 28 athletes with a history of three or more concussions. The groups were compared in terms of the on-field presentation of symptoms after an in-study concussion. Dependent variables included the postinjury presence of loss of consciousness, anterograde amnesia, retrograde amnesia, and confusion.

Results: Athletes with three or more prior concussions were more likely to experience on-field positive loss of consciousness (chi(2) = 8.0, P = 0.005), anterograde amnesia (chi(2) = 5.5, P = 0.019), and confusion (chi(2) = 5.1, P = 0.024) after a subsequent cerebral concussion. An odds ratio revealed that athletes with a history of three concussions were 9.3 times more likely than athletes with no history of concussion to demonstrate three to four abnormal on-field markers of concussion severity.

Conclusion: This study is the first to suggest a cumulative effect of concussion in high school athletes. A more severe on-field presentation of concussion markers is evidenced in high school athletes with a pronounced history of concussion. This study's findings highlight the need for more long-term outcome studies in high school athletes who sustain sports-related concussions.

MeSH terms

  • Adolescent
  • Amnesia / etiology
  • Athletic Injuries / physiopathology*
  • Brain Concussion / complications
  • Brain Concussion / physiopathology*
  • Brain Concussion / psychology
  • Confusion / etiology
  • Disease Susceptibility
  • Female
  • Humans
  • Male
  • Recurrence
  • Schools*
  • Trauma Severity Indices
  • Unconsciousness / etiology