When a student athlete in a Collin County suburb suffers a head injury during a Friday night football game, there is a high likelihood that a certified athletic trainer is on the sidelines. A specific protocol is then followed, ensuring that the injury is documented and reported. However, this level of care and attention is not always available in other parts of the city or in less affluent school districts, according to a recent study from UT Southwestern Medical Center.
The results of the study, published in February, analyzed more than 6,300 concussion cases reported by Texas high school students through the ConTex2 project, a statewide data-collecting program led by UT Southwestern and the Medical Advisory Committee of the University Interscholastic League (UIL).
The data shows that lower-income urban schools across the Dallas-Fort Worth area report far fewer concussions than wealthier suburbs – despite having much larger student populations.
Researchers looked at schools across Dallas, Tarrant, Collin, Denton, and Rockwall counties while tracking students not just in the main or most popular sports, but also in activities like marching band, drill team, and cheerleading. Researchers then organized schools by income level and geographic location, and the pattern was consistent across both.
“Concussions are a major issue, with an estimated 15% of school athletes experiencing a concussion at some point that disrupts daily life and academic performance,” said Dr. Mathew Stokes, the study’s senior author and Assistant Professor of Pediatrics and Neurology at UT Southwestern.
“While reporting differences are likely multifactorial, our findings suggest that differences in concussion awareness and access to resources such as medical personnel, athletic trainers, and protective equipment may contribute,” Dr. Stokes continued.
The gap in reported concussions was the smallest in football.
“While the differences were small between high socioeconomic and low socioeconomic districts in popular sports such as football, they were far more pronounced in smaller sports with fewer participants, such as wrestling, cross country, and swimming and diving, as well as activities such as drill team and band,” explained co-author Dr. Joshua Beitchman.
What makes the underreporting of concussions particularly dangerous is what comes next — or rather, what doesn’t. Concussions that go unrecognized often receive no treatment and no follow-up care.
“Children and adolescents who experience a concussion are highly vulnerable for disparate health and social outcomes when their post-concussion symptoms are unrecognized or untreated,” said Dr. Karin Reuter-Rice, an associate professor at Duke whose research specializes in adolescent traumatic brain injuries.
Research found that a common assumption – that most children recover from a concussion within a week or two – is not always accurate, and that students who don’t know they’ve experienced a concussion, or if that information hasn’t been communicated to the school, are expected to perform as usual.
A 2015 study published by the National Library of Medicine adds that high school students who had not yet recovered from a concussion reported much more negative academic effects, with those who reported worsening symptoms consistently linked to worsening school performance, regardless of how much time had passed since the injury.
“One of the best ways we can improve safety for young athletes is providing equitable access to concussion awareness and medical resources, regardless of where or what they play,” said Dr. C. Munro Cullum, Professor of Psychiatry, Neurology, and Neurological Surgery at UT Southwestern.
“Unrecognized or unreported concussions can delay treatment and increase the risk of prolonged symptoms, academic difficulties, and repeat injury,” added Dr. Cullum.
For thousands of student-athletes competing in smaller programs at lower-income schools across DFW, the question of whether anyone catches their concussion may depend less on the severity of the injury and more on where they live.
Currently, all UIL schools are encouraged to report concussion data to the ConTex2 portal, but only the state’s largest 6A schools are required to do so.
Smaller schools – often the ones with fewer resources – aren’t required to report concussions whatsoever.