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Coach and parent concussion education programs are essential for the prevention, diagnosis, management, and return to play of youth athletes. This systematic review examined the content and efficacy (changes in knowledge, impact on concussion incidence) of concussion education programs for coaches and parents of youth and high school athletes. Six databases were searched: SPORTDiscus, Academic Search Premiere, CINAHL, PsycINFO, PubMed, and Google Scholar. Studies evaluated the use and/or efficacy of concussion education programs among coaches or parents of youth athletes. A total of 13 articles (out of 1553 articles) met selection criteria. Although different concussion education programs exist, only three have been evaluated in the literature: ACTive Athletic Concussion Training™, USA Football’s Heads Up Football, and the Center for Disease Control and Prevention’s HEADS UP. These programs are well liked among coaches and parents and the suggested practices are easily implemented by coaches. These programs increased concussion knowledge among coaches and parents and promoted behavioral changes among coaches to reduce the concussion risk in high school sports. Few studies have assessed the efficacy of concussion education programs on youth athlete health outcomes. No studies included a longitudinal follow up to determine the degree of knowledge retention following the intervention. While online educational programs are sufficient to improve coach knowledge, in-person training may be a more effective educational tool for reducing the incidence of youth sport concussion. Future studies addressing the efficacy of concussion education programs should include a longitudinal follow up to assess knowledge retention and fidelity.

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Coach and parent knowledge of concussion is essential for the prevention, appropriate diagnosis, management, and return-to-play of youth athletes. This systematic review examined concussion knowledge of coaches and parents of youth athletes including general knowledge, sign and symptom recognition, management, and return-to-play protocols. Six databases were searched for studies that evaluated baseline knowledge levels of coaches and parents of youth athletes regarding concussion. A total of 17 articles (out of 1500 articles) met selection criteria. Coaches and parents could identify common signs and symptoms of concussion (e.g. headaches, dizziness, etc.) but were less aware of emotional symptoms (e.g. sadness or mood swings). Coaches were unaware that youth athletes may require more time to recover from a concussion compared to adults. Parents lacked knowledge regarding proper concussion management and return-to-play guidelines. Physicians were the main source of information for parents, while coaches and athletic trainers were the least utilized. There were clear gaps in both coach and parent knowledge of concussion. Future education programs should provide pediatric-specific information for concussion management, recovery, and return-to-play. Additional efforts are needed to increase communication and knowledge transfer between coaches, medical staff, and parents.

ObjectivesFor young patients sustaining concussion, assessing recovery is vital in determining safe return to play. Identifying risk factors may aid clinicians in recognising patients at risk for prolonged recovery. The study objective is to identify risk factors for prolonged (>28 days) and extended (>90 days) recovery (defined as symptom duration) and analyse how these risk factors differ between the two groups.MethodsWe retrospectively analysed electronic health record data (n=4937) among patients aged 10–18 years collected at Nationwide Children’s Hospital Sports Medicine concussion clinics between 1 July 2012 and 30 June 2019. Data collected included patient demographics, comorbidities (eg, prior psychiatric diagnoses, prior concussions) and injury characteristics (eg, loss of consciousness, injury setting). We examined patient risk factors for prolonged (>28 days) and/or extended (>90 days) recovery using modified Poisson regression models.ResultsFactors associated with increased risk of prolonged recovery from concussion included prior concussions (adjusted risk ratio (ARR) 1.19, 95% CI 1.02 to 1.38) for two concussions (ARR 1.36, 95% CI 1.14 to 1.61), for >3, and higher initial symptom score (ARR 2.57, 95% CI 2.34 to 2.83) for postconcussion symptom (PCS) scores 21–60 (ARR 2.89, 95% CI 2.54 to 3.29), for PCS>60. Risk factors for extended recovery included history of concussion (ARR 1.50, 95% CI 1.09 to 2.06) for two concussions (ARR 1.75, 95% CI 1.17 to 2.62), for >3 and older age (15–18 years, ARR 1.11, 95% CI 1.05 to 1.18). Additionally, comorbid attention deficit hyperactivity disorder increased risk of prolonged recovery (ARR 1.14, 95% CI 1.01 to 1.29) while anxiety increased risk for extended recovery (ARR 1.47, 95% CI 1.10 to 1.95).ConclusionOverall, risk factors for prolonged recovery differ somewhat from risk factors for extended recovery. For patients who present to clinic with concussion, mental health is an important consideration which may impact the timeline for symptom recovery.

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