Comparative analysis of state-level concussion legislation and review of current practices in concussion

Neurosurg Focus. 2012 Dec;33(6):E11: 1-9. doi: 10.3171/2012.9.FOCUS12280.


Object: Forty-two states and the District of Columbia have passed legislation based on the Lystedt law of Washington state, enacted in 2009 to protect young athletes who have sustained a concussion. The aim of this study was to note the several similarities and differences among the various laws.

Methods: Concussion legislation was compared for 50 states and the District of Columbia. Evaluation parameters of this study included stipulations of concussion education, criteria for removal from play, requirements for evaluation and return to play after concussion, and individuals required to assess young athletes. Other parameters that were not consistent across states were also noted.

Results: Forty-three states and the District of Columbia have passed concussion legislation, and an additional 4 states have pending legislation. All states with existing legislation support concussion education for coaches; however, only 48% require coaches to undergo formal education. Athletes must be educated on concussion in 86% of states and parents in 88.7%. Suspicion of concussion is a criterion for removal from play in 75% of states; signs and symptoms of concussion are criteria for removal from play in 16% of states. The individuals allowed to evaluate and clear an athlete for return to play differ greatly among states.

Conclusions: Injury prevention legislation holds historical precedent, and given the increasing attention to long-term sequelae of repeated head trauma and concussion, concussion legislation has been rapidly passed in 43 states and the District of Columbia. Although the exact stipulations of these laws vary among states, the overall theme is to increase recognition of concussion in young athletes and ensure that they are appropriately cleared for return to play after concussion.

Publication types

  • Comparative Study
  • Review

MeSH terms

  • Athletic Injuries / prevention & control*
  • Brain Concussion / prevention & control*
  • Humans
  • Physical Education and Training / legislation & jurisprudence*
  • School Health Services / legislation & jurisprudence*
  • State Government
  • United States