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Study Finds Female Youth Soccer Players Five Times More Likely than Boys to Return to Play Same Day Following Concussion


Findings especially concerning since girls also sustain concussions at higher rates, according to abstract of new research to be presented at American Academy of Pediatrics 2017 National Conference & Exhibition.

CHICAGO – A new study found girls were significantly more likely than boys to return to play the same day following a soccer-related concussion, placing them at risk for more significant injury.

The study abstract, "Gender Differences in Same-Day Return to Play Following Concussion Among Pediatric Soccer Players," will be presented on Saturday, Sept. 16, during the American Academy of Pediatrics 2017 National Conference & Exhibition in Chicago.

The study examined young athletes, average age 14, who sustained a concussion while playing soccer and who were treated at a pediatric sports medicine clinic in Texas. Of the 87 athletes diagnosed with a soccer-related concussion, two-thirds (66.7 percent) were girls. Among them, more than half (51.7 percent) resumed playing in a game or practice the same day as their injury, compared to just 17.2 percent of boys.

"The girl soccer players were 5 times more likely than boys to return to play on the same day as their concussion," said Shane M. Miller, MD, FAAP, senior author of the abstract and a sports medicine physician at Texas Scottish Rite Hospital for Children. "This is cause for concern, especially with previous studies showing that girls suffer twice as many concussions as boys," he said.

"Consistent with our findings in other sports, young soccer players are returning to play on the same day despite recommendations from medical organizations, such as the American Academy of Pediatrics, and laws in all 50 states intended to protect their growing brains," he said. "Despite increased concerns about the risks of concussions, the culture among athletes to tough it out and play through an injury often takes priority over the importance of reporting an injury and coming out of a game or practice."

"Considering the dangers of returning to play prematurely, parents need to familiarize themselves with organizational guidelines for concussions, which should be aligned with current national recommendations, and should have a heightened awareness of signs and symptoms of concussions," said Aaron Zynda, the abstract's lead author and Texas Scottish Rite's clinical research coordinator. "Current education efforts may not be enough to help athletes, parents and coaches identify concussion symptoms, know the guidelines for immediate removal from play and understand the risks of returning to play after an injury. More research is needed on how to better spread this message intended to protect the health of young athletes and help them comply with state laws."

"Concussion recognition and identification is a team effort," Zynda said. "Athletes, parents, coaches and medical staff need to come together to prevent premature return to play."

Miller and Zynda will present the abstract, available below, between 11 a.m. and 11:15 a.m. in room S104A of McCormick Place West in Chicago. To request an interview, contact Avery Wyatt at or 214-559-8395. In addition, the authors will be available to the media during an informal Media Meet-and-Greet session Saturday, Sept. 16, from 12:15-1:15 p.m. CT in the Grant Park CD room of the Hyatt Regency McCormick Place (Press Office). 

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The American Academy of Pediatrics is an organization of 66,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit

Texas Scottish Rite Hospital for Children is one of the nation's leading pediatric centers for the treatment of orthopedic conditions, sports injuries and fractures, as well as certain related arthritic and neurological disorders and learning disorders, such as dyslexia. For more information visit

Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal. 


Abstract Title: Gender Differences in Same-Day Return to Play Following Concussion Among Pediatric Soccer Players

Introduction. Over the past several decades, soccer has been growing in popularity in the US. Since 1990, there has been a 90% increase in registered youth soccer players, reaching greater than 3 million < 19 years of age as of 2014. This increase in participation has been accompanied by an increase in concussions. The annual incidence rate of reported concussions increased 1600% from 1990 to 2014. Concussions in high school soccer players were found to be 1.5 times more common in girls than boys, as recently reported in a 2015 study. Medical guidelines and legislation established in all states call for immediate removal from play and prohibit athletes from same-day return to play if a concussion is suspected. However, there is limited literature examining whether these concussion guidelines and laws are being followed in youth soccer. Purpose. To identify gender differences and the frequency at which pediatric soccer players returned to play on the same day following concussion. Methods. A retrospective review of patients diagnosed with a concussion sustained while playing soccer was performed. All patients were seen consecutively over a two year period at a pediatric sports medicine center by a single provider. Medical records were reviewed for patient demographics, same-day return to play, soccer position, injury characteristics, symptoms, and other clinical measures. Results. Of the 87 athletes diagnosed with a soccer-related concussion, 58 (66.7%) were girls and 29 (33.3%) were boys with a mean age of 14.13 years (range 7-18). 30 of 58 girls (51.7%) returned to play the same day compared to only 5 of 29 boys (17.2%)(p=.002). Girl soccer players had a 414% greater likelihood of returning to play on the same day as their concussion than boys (OR=5.14; 95% CI, 1.72-15.3). Overall, 35 (40.2%) soccer players returned to play on the same day following a concussion. Of those, 34 (97.1%) returned to play during the same game or practice, and one returned to a different game in a tournament later that same day. Conclusions. Pediatric soccer players return to play on the same day as their concussion at a high rate despite established medical guidelines and state laws. Girl soccer players not only have a higher incidence of reported concussions, but also demonstrate a significantly higher frequency of same day return to play than boys. Further research is needed to understand contributing factors and to improve injury identification and immediate removal from play following a concussion.