Compliance with return to play guidelines following concussion in US high school athletes, 2005-2008

Brain Inj. 2009 Oct;23(11):888-98. doi: 10.1080/02699050903283171.


Primary objective: To determine whether US concussed high school athletes complied with recommended return-to-play guidelines during the 2005-2008 school years.

Research design: Prospective cohort study in 100 nationally-representative US high schools.

Methods and procedures: Certified athletic trainers submitted injury reports for concussed athletes in five boys' (football, soccer, basketball, wrestling, baseball) and four girls' (soccer, basketball, volleyball, softball) sports via High School RIO (Reporting Information Online). Concussions were retrospectively graded and it was determined whether athletes followed American Academy of Neurology (AAN) or Prague return-to-play guidelines.

Main outcomes and results: There were 1308 concussions reported during 5 627 921 athlete-exposures (23.2 concussions per 100 000 athlete-exposures), reflecting an estimated 395 274 concussions sustained nationally. At least 40.5% and 15.0% of concussed athletes returned to play prematurely under AAN and Prague return-to-play guidelines, respectively. In football, 15.8% of athletes sustaining a concussion that resulted in loss-of-consciousness returned to play in <1 day. Males (12.6%) were more likely than females (5.9%) to return 1-2 days after sustaining an initial grade II concussion.

Conclusions: Too many adolescent athletes are failing to comply with recommended return-to-play guidelines. Sports medicine professionals, parents, coaches and sports administrators must work together to ensure athletes follow recommended guidelines.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Athletes / psychology
  • Athletes / statistics & numerical data*
  • Brain Concussion / classification
  • Brain Concussion / epidemiology*
  • Female
  • Guideline Adherence*
  • Guidelines as Topic
  • Humans
  • Male
  • Patient Compliance
  • Prospective Studies
  • Risk Assessment
  • Schools
  • Sports
  • Students / psychology
  • Students / statistics & numerical data*
  • Time Factors
  • United States / epidemiology