The Epidemiology of Concussions in Ivy League and Big Ten Sports

"The Ivy League Big Ten Epidemiology of Concussion Study is a prospective, multisite surveillance initiative launched in the 2013–2014 athletic season to systematically detect, characterize, and follow sport-related concussion (SRC) cases among university student-athletes. Conducted across institutions in the Ivy League and Big Ten, the study accrues data on SRC and non-SRC events and their outcomes, generating a robust database for descriptive epidemiology and longitudinal study of concussion in collegiate sports. Over five athletic seasons (2013-2014 through 2017-2018), the surveillance system enrolled 1,922 SRC cases (649 women, 1,004 men) drawn from 27 sports, including varsity programs and club rugby. American football accounted for the largest share of identified concussions (n = 495; 25.8%), followed by women's rugby (n = 199; 6.2%), men's ice hockey (n = 106; 5.5%), men's lacrosse (n = 105; 5.5%), women's soccer (n = 103; 5.4%), wrestling (n = 93; 4.8%), men's soccer (n = 89; 4.6%), and women's ice hockey (n = 78; 4.1%).

The surveillance findings highlight sport- and context-specific variations in concussion rates. Women's lacrosse had the highest overall concussion rate at 1.35 concussions per 1,000 athletic exposures (AEs), with football close behind at 1.26 per 1,000 AEs. Concussion incidence was generally higher during competition than practice; the highest competition-specific rates were observed in wrestling (4.06 per 1,000 AEs) and football (3.68 per 1,000 AEs). These patterns underscore the importance of distinguishing competition versus practice exposures in risk assessment and prevention planning.

Clinical features and short-term outcomes are also described from this large cohort. The median number of concussion symptoms reported was seven, and athletes presenting with seven or more symptoms experienced a longer time to symptom resolution compared with those reporting fewer than seven symptoms (P < .001). Time to symptom resolution did not differ across the four sports with comparable rules by sex and did not differ significantly between women and men; median days to symptom resolution were reported as eight days for women and nine days for men. Likewise, days to return to academics, exertion activities, and full competition did not differ significantly between sexes in this cohort.

This report documents the study's methods and provides first epidemiologic findings from a continuing surveillance platform now extending into its sixth year. As a collaborative, multisite effort, the project demonstrates the feasibility and value of coordinated concussion surveillance across collegiate athletic programs and produces a large, diverse case series for future hypothesis-driven analyses. The dataset offers opportunities to refine understanding of concussion incidence by sport and exposure type, examine mechanisms and activity contexts associated with injury, and evaluate clinical trajectories including symptom burden and return-to-activity timelines. These initial descriptive findings form a foundation for ongoing work that will leverage the surveillance infrastructure to inform prevention, management, and policy efforts aimed at reducing concussion risk and improving outcomes for university student-athletes.