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Meta-Analysis
. 2021 Jun;55(12):663-669.
doi: 10.1136/bjsports-2020-102967. Epub 2020 Oct 19.

What is the risk of recurrent concussion in children and adolescents aged 5-18 years? A systematic review and meta-analysis

Jacqueline van Ierssel  1 , Martin Osmond  2   3   4 , Jemila Hamid  2   5 , Margaret Sampson  2 , Roger Zemek  2   3   4
Affiliations
Meta-Analysis

What is the risk of recurrent concussion in children and adolescents aged 5-18 years? A systematic review and meta-analysis

Jacqueline van Ierssel et al. Br J Sports Med. 2021 Jun.

Abstract

Objective: We aimed to examine the risk of concussion in children with a previous history of concussion.

Design: Systematic review and meta-analysis. The primary outcome was number of children with and without a previous lifetime history of concussion who sustained a diagnosed concussion within each study period. Risk of bias was assessed using the Newcastle-Ottawa Scale. A random effects model was used to estimate a pooled risk ratio (RR) with corresponding 95% CIs; results were summarised in forest plots.

Data sources: Four electronic databases (MEDLINE, Embase, CINAHL, SPORTDiscus) and selected reference lists were searched (PROSPERO registration No CRD42019135462).

Eligibility criteria: Original English language peer-reviewed publications that compared concussion risk in children aged 5-18 years with and without a previous concussion history in which risk estimates were reported or able to be calculated.

Results: Of 732 identified studies, 7 studies representing 23 411 children (risk of bias range, 7-9; maximum possible score=9) were included for meta-analysis. Pooled risk of sustaining a concussion was more than three times greater in children with a previous concussion compared with those with no previous concussion (RR=3.64; 95% CI: 2.68 to 4.96; p<0.0001; I 2=90.55%). Unreported sex-stratified data precluded direct comparison of concussion risk in male versus female athletes.

Conclusion: Previously concussed children have four times the risk of sustaining a concussion compared with those with no previous concussion history. This should be a consideration for clinicians in return to sport decision-making. Future studies examining subsequent recurrent concussion in youth sports must consider sex differences.

Keywords: children; concussion; recurrent; risk factor; sporting injuries.

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Conflict of interest statement

Competing interests: Jvl reported receiving speaking honoraria and travel expenses for presentations at scientific meetings; and is founder and an instructor for R2P Concussion Management. RZ reported being a coapplicant on a competitively funded grant administered by the National Football League through the independent scientific advisory board to fund a prospective concussion study with the goal of preventing concussions; he does not personally receive any funding for this work; his institution receives the operating funds to conduct the research; he has received honoraria from Parachute Canada (a Canadian non-profit for injury prevention) for his role on the Concussion Expert Advisory board.

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