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.
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. 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.,,,,
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: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-6232-9
 Ministry of Education of Ontario. Policy/Program memorandum no. 158. 2014. http://www.edu.gov.on.ca/extra/eng/ppm/158.pdf. Accessed 9 Feb 2017.
 Zhang AL, et al. The rise of concussions in the adolescent population. Orthopaedic journal of sports medicine. 2016;4(8):2325967116662458.
 Snyder M. Girls Suffer Sports Concussions at a Higher Rate than Boys. Why Is That Overlooked? The Washington Post. 2015. https://www.washingtonpost.com/posteverything/wp/2015/02/10/our-effort-to-reduce-concussions-inyouth-sports-overlooks-the-biggest-victims-girls/?utm_term=.29b684e6a9a9.Accessed 14 Feb 2017.
 Abrahams S, et al. Risk factors for sports concussion: an evidence-based systematic review. Br J Sports Med. 2014;48(2):91–7.
 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.
Resch JE, et al. Sport concussion and the female athlete. Clin Sports Med. 2017;36(4):717–39.
 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.
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