Increase in Diagnosed Concussions Following Mandated Concussion Policy

Study shows there is still room for improvement in documenting suspected concussions.

A study examining the effect of Ontario’s Policy/Program Memorandum #158 (PPM #158) – a policy requiring each publicly funded school board in the province to create and implement a concussion policy – has found that there has been a 30% increase in diagnosed concussions in school children after policy was implemented.[1]

Comparing Trends

The study, published in the November 2018 issue of BMC Public Health, examined 21,094 head injuries in youth aged 4-18 between 2009-2016 from five hospitals across Ontario. The purpose being to compare trends of the 8,935 diagnosed and 12,159 suspected concussions in youth before and after PPM #158 was established in March 2014.

In the 5 years prior to PPM #158, the average number of diagnosed concussions in school children was 89 concussions/month. That number increased to 117 diagnosed concussions/month after the policy was established. Similarly, there was an “almost twofold” increase in the number of diagnosed concussions where the concussion-inducing incident happened at school. Before March 2014, school-incurred concussions accounted for 28% of all diagnosed concussions. This rate increased to almost 50% in 2016. The most common places of injury at school were the playground (24%), gymnasium (22%), or sports field (20%).

The Gender Equation

Finally, there was also an increase of diagnosed concussions in females, growing from 38% in 2013 to 46% in 2016 after PPM #158. This increase in the number of confirmed concussions in women is important.[2] Some studies have suggested that female head injuries are more often overlooked despite the fact that women may receive more concussions – with longer recoveries – than their male counterparts.[3],[4],[5],[6],[7]

Is the policy truly effective?

It is important to note that the total number of identified head injuries (comprising of both suspected and diagnosed concussions) did not increase after the policy. Given the trends of under-reporting for concussion, this circumstance raises questions as to whether PPM # 158 was indeed effective at increasing concussion awareness and reporting at schools. In fact, the increase in only diagnosed concussions may suggest that there was an improvement in emergency department doctors’ knowledge and confidence in diagnosing concussion – an increase that would be unrelated to the policy.

More Research and More Policies

The study concludes that “ongoing research into the effectiveness of PPM 158 in terms of prevention of concussions and student, teacher, and parental awareness is required.” This call for research should also extend to examining the effectiveness of the Ontario government’s latest concussion safety bill: Bill 193, Rowan’s Law (Concussion Safety), 2018. Further research will help support the direction of changes made to concussion policy and legislation in Ontario as well as push other provinces to develop and implement effective concussion policy and legislation.

You can read the full study here:

About The Author

Rebecca Babcock is a recent graduate of the University of Otago in New Zealand, completing a Master’s in Bioethics and Health Law. Her thesis examined the ethical and legal issues surrounding concussion management. She currently spends her time working for the Concussion Legacy Foundation – Canada as a programming coordinator and at Sunnybrook Hospital investigating concussion prevention, management, and education services. Her dream is to be a clinical ethicist at a hospital which she is starting to fulfill by volunteering as a bioethics assistant at Humber River Hospital in Toronto.



[1] Ministry of Education of Ontario. Policy/Program memorandum no. 158. 2014. Accessed 9 Feb 2017.

[2] Zhang AL, et al. The rise of concussions in the adolescent population. Orthopaedic journal of sports medicine. 2016;4(8):2325967116662458.

[3] Snyder M. Girls Suffer Sports Concussions at a Higher Rate than Boys. Why Is That Overlooked? The Washington Post. 2015. 14 Feb 2017.

[4] Abrahams S, et al. Risk factors for sports concussion: an evidence-based systematic review. Br J Sports Med. 2014;48(2):91–7.

[5] Schallmo MS, Joseph AW, Wellington KH. Sport and sex-specific reporting trends in the epidemiology of concussions sustained by high school athletes. JBJS. 2017;99(15):1314–20.

[6]Resch JE, et al. Sport concussion and the female athlete. Clin Sports Med. 2017;36(4):717–39.

[7] Covassin T, Moran R, Elbin RJ. Sex differences in reported concussion injury rates and time loss from participation: an update of the National Collegiate Athletic Association Injury Surveillance Program from 2004–2005 through 2008–2009. J Athl Train. 2016;51(3):189–94.

Rugby Ontario teams up with HeadCheck Health to improve concussion care for provincial athletes

TORONTO – Rugby Ontario is proud to announce a new partnership with HeadCheck Health Inc. (‘HeadCheck’) to implement innovative concussion testing software for Rugby Ontario’s Sevens and XVs Representative Teams.

HeadCheck provides sports organizations with concussion testing software to enhance the implementation and management of their concussion policy. A mobile testing app includes the policy’s concussion tests and leads to faster and more data-driven assessments. An enhanced web dashboard allows for easier and more thorough management of the concussion data collected. In addition to the software, the company provides custom reporting to help organizations continuously improve their policies and procedures.

"The safety and maintenance of our athletes is our number one concern,” explained Paul Connelly, High Performance Manager of Rugby Ontario. “To be able to have our trained SportSide Athletic Therapists assess our athletes immediately, while having access to the most updated personal data is an invaluable tool."

“We are pleased to partner with a great organization in Rugby Ontario to implement our technology and help raise the standard of concussion care for all athletes,” said Harrison Brown, Co-Founder and CEO of HeadCheck Health.

The partnership will equip Rugby Ontario team therapists with HeadCheck on their mobile devices to perform concussion testing on all athletes participating in provincial activities. In addition to supplying Rugby Ontario with the HeadCheck technology, the company will also provide full training, onboarding, and data management support to the organization. The implementation of HeadCheck will allow Rugby Ontario officials to easily monitor the effectiveness of their concussion policy.

About HeadCheck Health, Inc.
HeadCheck provides sports teams, leagues and organizations with a comprehensive concussion testing and management solution. This includes mobile technology to run concussion assessments, an enhanced web management dashboard, and custom reporting. The platform includes today’s gold standard concussion tests and is flexible enough to incorporate the tests specified by any organization’s concussion policy. The technology provides comparable data to help medical professionals make appropriate concussion management decisions. All data is securely stored for convenient 24/7 access and can follow the athlete to all future sports and teams. For more information on HeadCheck Health please visit

About Rugby Ontario
Rugby Ontario is the provincial sports governing body responsible for the organization of rugby in Ontario. Our mission is to lead the sport of rugby in Ontario into a new era of growth through increased participation, community involvement, sound administration and successful player development. Our vision is to establish a stronger identity for rugby in Ontario by promoting the sport’s core values and by fostering a culture of inclusiveness and excellence on and off the field of play. Rugby Ontario is a proud member of Rugby Canada and is extremely proud to be part of the pathway to representing Canada on the international stage. For more information on Rugby Ontario please visit

Ontario passes Rowan's Law to improve concussion safety

On March 6, 2018, Rowan's Law (Concussion Safety), 2018, was passed as new legislation to establish mandatory requirements for amateur sport organizations in Ontario. The aim of the new legislation is to improve concussion safety and protect amateur athletes both on the field and at school.

The mandatory requirements are meant to ensure:

  • Annual review of concussion awareness resources by athletes, coaches, and parents/
    guardians of athletes;
  • Establishment of removal-from-sport and return-to-sport protocols, so that athletes are
    immediately removed from sport if they are suspected of having sustained a concussion; and
  • Establishment of concussion codes of conduct that will set out rules of behavior to minimize
    concussions while playing sport.

In addition to the mandatory requirements, the last Wednesday of every September will be declared "Rowan's Law Day" in honour of Rowan Stringer, the rugby player who tragically passed away in 2013 at just 17 after suffering two concussions in one week.

At HeadCheck, we're very pleased to see any legislation passed that aims to improve the concussion safety of amateur athletes. We work extensively with organizations to ensure their removal-from-sport and return-to-sport protocols are being followed. Please contact us if you have any questions about how we can help.