Sport Specialization and Exposure in a Tertiary Concussion Program

Background/Purpose: Sport specialization is an important area of focus within pediatric sports medicine with studies relating specialization to the rising incidence of sport-related injuries. The relationship between sport specialization and concussion remains unexplored. The objective of this study was to assess the prevalence of sport specialization and its relationship to concussion in athletes seen in a tertiary concussion program. Methods: Athletes completed a sport specialization questionnaire as part of a comprehensive intake questionnaire and were classified into low, moderate, or high specialization groups using a previously published 3-point scale. Categories were derived from their responses to 3 binary questions: 1) Have you quit other sports to focus on 1 sport? 2) Do you train >8 months out of the year in 1 sport? 3) Do you consider your primary sport more important than other sports? Results: Of the 1,098 athletes, ages 8-19 years, who completed the questionnaire, 572 (52%) were female, 718 (65.5%) had a sports-related concussion (SRC) and 439 (40%) had a prior history of concussion. The cohort was categorized into low (n=568, 51.7%), moderate (n=339, 30.9%), or high (n=191, 17.4%) sport specialization groups. Athletes reported their primary sport was more important than other sports (702, 64%) and training >8 months out of the year in 1 sport (594, 54%) more commonly than quitting other sports to focus on 1 sport (270, 25%). Sport specialization differed by primary sport (Figure 1), but did not significantly differ when primary sport was grouped by level of contact (p=0.47). Sport specialization did not significantly differ by sex, race, or ethnicity, but significantly differed by insurance (p=0.014) and age (p=0.0001), with greater specialization among those with private insurance and adolescents, respectively. Moderately or highly specialized athletes were significantly more likely than less specialized athletes to present with a SRC compared to a non-SRC (p<0.0001) and to report prior history of concussion (p=0.005). After controlling for demographic and sport participation factors, only endorsement of training more than 8 months out of the year in one sport was significantly associated with SRC (p=0.001) and prior concussion (p=0.007). Conclusion: Sport specialization is prevalent among youth athletes with concussion. Training >8 months out of the year in a single sport is associated with SRC and prior history of concussion. Further research is warranted to evaluate how exposure among specialized athletes relates to concussion.