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.
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