Evaluating the Association between Concussion Policies, Equity, and Sport-Related Concussion in Children and Youth: a Population-Based Study (2014-2024)

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Abstract Background/aims Sport-related concussions (SRCs) are becoming a global public health concern as new research and policies emerge. In the Province of Ontario, a 2014 Policy/Program Memorandum (PPM 158) required all school boards to establish a policy that promoted concussion education, awareness, and tracking. This was followed by Rowan’s Law in 2018 which emphasized sports-related treatments and tracking of concussions. The objective of this study was to examine the association between these concussion policies and emergency department (ED) visits for SRCs in children and youth (5-19) in Ontario by material deprivation from 2014-2024. Methods This population-based study used routinely collected administrative data from ICES in Ontario, Canada, specifically the National Ambulatory Care Reporting System (NACRS). All ED visits for children and adolescents ages 5-19 with ICD-10 (International Classification of Disease version 10) S060 identifying concussion were included with a corresponding ICD-10 mechanism of injury code related to sports. The number of SRCs and the percent of SRCs within total concussions were analyzed. An interrupted time series analysis was conducted to examine changes in ED visits for SRC from 2014-2018 (the years following the release of PPM 158 up until the release of Rowan’s Law), from 2020-2021 (the years during the COVID-19 pandemic), and in 2019, 2022, 2023, and 2024 (the years following Rowan’s Law). Results The number of ED visits initially increased after the introduction of Policy/Program Memorandum No. 158 but started to decline after 2018 when Rowan’s Law was introduced. The numbers have remained lower post-COVID-19 pandemic suggesting that this law may have a positive impact. By material deprivation quintile, the highest income quintile saw significantly lower counts of ED (β = −628.7 (p = 0.001)) following concussion laws compared to before. Conclusions Rowan’s Law appears to have a positive lasting impact on Ontario youths by reducing ED visits for SRCs. Educational resources related to awareness and identification of concussions should continue to be available to children and youth, coaches, and parents. What is known on this subject Sport-related concussions among youths are associated with serious long-term burdens, with social disparities impacting their access to much-needed care. In Ontario, Canada, a concussion-related policy (PPM 158) and a law (Rowan’s Law) that were adopted in 2014 and 2018, respectively, have yet to be analyzed in terms of its impact. What this study adds This study contributes to a greater understanding of the association between Rowan’s Law and children and youth seeking care for sports-related concussions in emergency departments. Further, it provides insight into differences in emergency department visits by material deprivation quintiles. How might this affect policy, practice and research The results of this study may encourage other jurisdictions to enact similar legislation, and can inform school boards and sporting organizations to have an equity-driven lens when delivering concussion education to students, parents, and coaches.

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