Equitable Concussion Monitoring: Exploring a Generalizable Model in New York State High Schools

Sarah Frances, BS
James M. Noble, MD, MS

Concussion remains a serious public health problem in the United States, particularly in adolescents participating in contact sports. Except in limited circumstances, there are no requirements for systematically reporting sport-related concussion (SRC) in high schools reflected by limited infrastructure and support for reporting. Given these limitations, major gaps exist in understanding adolescent SRC epidemiology. Regional and even nationwide monitoring programs are of increasing interest, however the financial and practical implications of such programs are not well understood.

Local, regional, and state-wide high school SRC monitoring programs and nationwide research were identified to determine cost and other practical aspects, and potential barriers to implementation. Resources included 1) State Education department websites, 2) Compiled lists of state-level laws and implemented programs as available through the Centers for Disease Control and Prevention as well as the Brain Injury Association of New York State, and 3) other programs brought to our attention through professional networks. Costs were determined through 1) the above resources, 2) projections of athlete volume drawn from The National Federation of State High School Associations (NFHS), and 3) publicly available program- and state-level fiscal end-of-year documents detailing program expenses. Cost estimates included physicians, data managers, systems fees, and educational resources with varying athletic trainer support across models, ranging from none (presumed already in place) to new/dedicated lines. Means for fiscal support and flow of funds for support were also explored. We then created models for state- and athlete-level costs of implementing a program in New York State with 356,803 high school athletes.

Publicly available data were reviewed and semi-structured interviews were conducted with program coordinators at regional (a rural New York high school district), state (Hawaii Concussion Awareness Management Program (HCAMP) and North Texas Concussion Registry (ConTex) programs) and national (High School Reporting Information Online (RIO)) levels. Overall, there was variability in available infrastructure which ranged from a volunteer-based local enterprise to a state-funded mandatory program. Some programs were supported by state law enhanced by traffic violation surcharges, while others were supported through philanthropic or volunteer efforts. State-level cost estimates ranged from $7.9M to $33.1M, with per-athlete costs of $22.24 (ConTex) to $92.78 (Hawaii). Logistical challenges, including medical personnel and data infrastructure, appeared manageable at scale in each model.

High school SRC monitoring programs are generally financially feasible and often cheaper than routine costs associated with sports participation, such as uniforms and standard equipment. These models provide guidance for possible implementation of state- and federal-programs. Large, inclusive programs are necessary to identify critically understudied aspects of SRC including health disparities as relates to SRC detection, reporting, and recovery in diverse populations.

1. Attendees will be able to recognize the current public health burden of sport-related concussions and their unclear epidemiology within American high schools, with a focus on New York State.
2. Attendees will be able to analyze the current concussion monitoring programs in place in the United States and acknowledge the barriers to implementing similar models.
3. Attendees will be able to draw conclusions from the findings to a wider model for national and global concussion monitoring interventions to address potential unmet health disparities.