Washington State's Lystedt Law in Concussion Documentation in Seattle Public High Schools

Abstract

Context: The Lystedt law requires high school athletes who have sustained a concussion to be removed from practice and play and not to be allowed to return until cleared by a medical professional. Objective: To determine the effect of the Lystedt law on injury and concussion documentation in the Seattle public high schools. Design: Cross-sectional study. Setting: Seattle public high schools. Patients or Other Participants: The numbers of students, aged 13 to 19 years in the 2008–2009, 2009–2010, and 2010–2011 school years, were 4348, 4925, and 4806, respectively. Main Outcome Measure(s): All injuries documented in SportsWare by athletic trainers in Seattle public high schools. We evaluated all injuries, including concussions recorded during the 2008–2009 school year, before the Lystedt law, and during the 2 school years after the law took effect (2009–2010 and 2010–2011). Incidence rates before and after the law were estimated and compared. Results: The concussion rate was −1.09% in 2008–2009, 2.26% in 2009–2010, and 2.26% in 2010–2011. A comparison of relative risks showed that the incidence rates of concussions were different before and 1 year after the Lystedt law (relative risk = 2.10; 95% confidence interval [CI] = 1.50, 2.93) and 2 years after the law (relative risk = 2.10; 95% CI = 1.49, 2.93). Overall, the mean number of days out of play after 2008–2009 was almost 7 days greater after the law took effect (difference = 6.9 days; 95% CI = 0.70, 13.1). For females, the mean number of days out of play after 2008–2009 was more than 17 days in 2009–2010 (difference = 17.2 days; 95% CI = 4.81, 29.5) and was more than 6 days in 2010–2011 (difference = 6.3 days; 95% CI = 1.62, 11.0). Conclusions: The number of documented concussions more than doubled after the institution of the Lystedt law, which may be attributed to heightened awareness and closer monitoring.