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Effect of Multiple Concussions in High School

January 24, 2017

Short Attention Span Summary

They do well
Even high school athletes with multiple concussions did not have long-term cognitive problems, according to this large cross sectional study.  This can be used to reassure an injured athlete but not to embolden them to take risks and sustain more injuries.

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Multiple concussions in high school caused increased symptoms but did not lead to a measurable difference in cognitive outcome.


Am J Sports Med. 2016 Dec;44(12):3243-3251. Epub 2016 Jul 29.

Multiple Past Concussions in High School Football Players: Are There Differences in Cognitive Functioning and Symptom Reporting?

Brooks BL1,2,3, Mannix R4, Maxwell B5, Zafonte R6,7, Berkner PD8, Iverson GL7,9,10,11.

Author information:

1Neurosciences Program (Brain Injury and Rehabilitation), Alberta Children’s Hospital, Calgary, Alberta, Canada brian.brooks@albertahealthservices.ca.

2Departments of Paediatrics, Clinical Neurosciences, and Psychology, University of Calgary, Calgary, Alberta, Canada.

3Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.

4Division of Emergency Medicine, Brain Injury Center, Boston Children’s Hospital, Boston, Massachusetts, USA.

5Department of Computer Science, Colby College, Waterville, Maine, USA.

6Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA.

7Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, Massachusetts, USA.

8Health Services and Department of Biology, Colby College, Waterville, Maine, USA.

9Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA.

10Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA.

11Sport Concussion Program, Massachusetts General Hospital for Children, Boston, Massachusetts, USA.



There is increasing concern about the possible long-term effects of multiple concussions, particularly on the developing adolescent brain. Whether the effect of multiple concussions is detectable in high school football players has not been well studied, although the public health implications are great in this population.


To determine if there are measureable differences in cognitive functioning or symptom reporting in high school football players with a history of multiple concussions.


Cross-sectional study; Level of evidence, 3.


Participants included 5232 male adolescent football players (mean [±SD] age, 15.5 ± 1.2 years) who completed baseline testing between 2009 and 2014. On the basis of injury history, athletes were grouped into 0 (n = 4183), 1 (n = 733), 2 (n = 216), 3 (n = 67), or ≥4 (n = 33) prior concussions. Cognitive functioning was measured by the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) battery, and symptom ratings were obtained from the Post-Concussion Symptom Scale.


There were no statistically significant differences between groups (based on the number of reported concussions) regarding cognitive functioning. Athletes with ≥3 prior concussions reported more symptoms than did athletes with 0 or 1 prior injury. In multivariate analyses, concussion history was independently related to symptom reporting but less so than developmental problems (eg, attention or learning problems) or other health problems (eg, past treatment for psychiatric problems, headaches, or migraines).


In the largest study to date, high school football players with multiple past concussions performed the same on cognitive testing as those with no prior concussions. Concussion history was one of several factors that were independently related to symptom reporting.

© 2016 The Author(s).

PMID: 27474382 [PubMed – in process]

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