Background: Sports-related concussion (SRC) injury rates, and identifying those athletes at the highest risk, have been a primary research focus. However, no studies have evaluated at which time point during an athletic event athletes are most susceptible to SRCs. Purpose: To determine the clinical incidence of SRCs during the start, middle, and end of practice and competition among high school male and female athletes in the state of Michigan. Study Design: Descriptive epidemiological study. Methods: There were 110,774 male and 71,945 female student-athletes in grades 9 through 12 (mean time in high school, 2.32 ± 1.1 years) who participated in sponsored athletic activities (13 sports) during the 2015-2016 academic year. An SRC was diagnosed and managed by a medical professional (ie, MD, DO, PA, NP). SRC injuries were reported by certified athletic trainers, athletic administrators, and coaches using the Michigan High School Athletic Association Head Injury Reporting System. Time of SRC was defined as the beginning, middle, or end of practice/competition. Clinical incidence was calculated by dividing the number of SRCs in a time point (eg, beginning) by the total number of participants in a sport per 100 student-athletes (95% CI). Risk ratios were calculated by dividing one time point by another time point. Results: There were 4314 SRCs reported, with the highest in football, women’s basketball, and women’s soccer. The total clinical incidence for all sports was 2.36 (95% CI, 2.29-2.43) per 100 student-athletes. The most common time for SRCs was the middle, followed by the end of all events. Athletes had a 4.90 (95% CI, 4.44-5.41) and 1.50 (95% CI, 1.40-1.60) times greater risk during the middle of all events when compared with the beginning and end, respectively. There was a 3.28 (95% CI, 2.96-3.63) times greater risk at the end of all events when compared with the beginning. Conclusion: Athletes were at the greatest risk for SRCs at the middle of practice and competition when compared with the beginning and end. Clinical Relevance: The current study suggests that medical attention is particularly important during the middle of all athletic events. Intervention measures to limit SRCs may be most beneficial during the middle of athletic events.
