Mechanisms of Concussions Among High-School Athletes in School-Sponsored Sports: Implications for Safety

Helen J Kemprecos; Annabelle Shaffer; Zelda Moran; Aaron T Anderson; Kelly Harrington; Adam Tarr; John Flannell; Graham Huesmann; Tracey M Wszalek; Jerrad Zimmerman; Paul M Arnold

doi:10.1227/neu.0000000000003887

Mechanisms of Concussions Among High-School Athletes in School-Sponsored Sports: Implications for Safety

Neurosurgery. 2025 Dec 19. doi: 10.1227/neu.0000000000003887. Online ahead of print.

Authors

Helen J Kemprecos¹, Annabelle Shaffer^{1

2}, Zelda Moran¹, Aaron T Anderson^{1

3

4}, Kelly Harrington⁵, Adam Tarr⁵, John Flannell⁵, Graham Huesmann^{1

3

4}, Tracey M Wszalek³, Jerrad Zimmerman⁵, Paul M Arnold^{1

3

6

7}

Affiliations

¹ Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, Illinois, USA.
² Current affiliation: Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.
³ Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, Illinois, USA.
⁴ Department of Neurology, Carle Foundation Hospital, Urbana, Illinois, USA.
⁵ Department of Orthopedics and Sports Medicine, Carle Foundation Hospital, Urbana, Illinois, USA.
⁶ Department of Neurosurgery, Carle Foundation Hospital, Urbana, Illinois, USA.
⁷ Current affiliation: Department of Neurosurgery, Loyola University Medical Center, Maywood, Illinois, USA.

PMID: 41416784
DOI: 10.1227/neu.0000000000003887

Abstract

Background and objective: Over 1 million sport-related concussions (SRCs) occur among US children annually. Enhancing sport safety requires a detailed understanding of SRC mechanisms. However, limited data characterize the specific actions causing SRCs in high-school athletes. The objective was to classify SRC mechanisms using a standardized hierarchical scheme and evaluate associations between mechanism categories and symptom profiles, overall and by sport and sex.

Methods: This retrospective study analyzed Sport Concussion Assessment Tool (SCAT), evaluations and athletic-trainer documentation from high-school athletes (age 14-19 years) across 19 schools (2009-2023). SRCs were coded as hit-to-head and tackle/collision (present/absent) and, when applicable, by hit-to-head subtype, head contact location, and contact context (opponent/teammate; practice vs competition). Analyses included descriptive statistics, χ2/Fisher tests, and odds ratios (95% CIs) with Bonferroni adjustment. Symptom burden and individual symptom endorsement were compared by sex and mechanism (hit-to-head vs no hit-to-head). Logistic regressions with cluster-robust SEs, adjusted for sex and sport, assessed associations between mechanisms (and subtypes) and symptoms.

Results: A total of 455 SRCs (401 athletes) were analyzed; 111 (24.4%) occurred in females. Overall, 73.6% involved a hit-to-head and 65.9% a tackle/collision, with co-occurrence in 56.0%. SRCs most frequently occurred in football (53.8%), soccer (21.1%), and basketball (8.4%). Mechanisms were sport-specific: tackling in football (38.9%), heading in soccer (54.2%), rebounding or loose-ball play in basketball (41.7%), takedowns in wrestling (83.3%), spiking in volleyball (66.7%), and stunting in cheerleading (90.5%). After adjustment for sex, sport, and tackle/collision, headache and "don't feel right" remained significantly associated with a hit-to-head mechanism. Tackle/collision was independently associated with greater odds of dizziness (adjusted odds ratios 2.07), feeling slowed (1.92), and headache (2.82).

Conclusion: High-school SRCs most often result from head-to-ground impacts, player collisions, or sport-specific actions such as tackling or heading. Characterizing these mechanisms can guide targeted, sport-specific prevention strategies.

Keywords: Adolescents; Athletes; Brain concussions; Concussion mechanisms.