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Concussion education for youth athletes using Pre-Game Safety Huddles: a cluster-randomised controlled trial
  1. Emily Kroshus1,2,
  2. Sara P D Chrisman1,2,
  3. Ann Glang3,
  4. Tamerah Hunt4,
  5. Rachel Hays2,
  6. Sarah Lowry2,
  7. Alexis Peterson5,
  8. Kimberly Garrett2,
  9. Dane Ramshaw3,
  10. Kiana Hafferty2,
  11. Erin Kinney6,
  12. Maria Manzueta2,
  13. Mary Kathleen Steiner2,
  14. Beth J Bollinger2,
  15. George Chiampas7,
  16. Frederick P Rivara1,2
  1. 1Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
  2. 2Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
  3. 3Center of Brain Injury, Research and Training, University of Oregon, Eugene, Oregon, USA
  4. 4Department of Health Sciences and Kinesiology, Georgia Southern University, Statesboro, Georgia, USA
  5. 5National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  6. 6Oregon Health & Science University School of Medicine, Portland, Oregon, USA
  7. 7United States Soccer Federation, Chicago, Illinois, USA
  1. Correspondence to Dr Emily Kroshus, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA; ekroshus{at}


Objectives Determine whether Pre-Game Safety Huddles, a novel and low-resource approach to concussion education, increase the expected likelihood of concussion reporting for youth athletes.

Methods A cluster-randomised trial compared Safety Huddles to usual care. Safety Huddles bring together athletes and coaches from both teams before the start of each game for coaches to briefly affirm the importance of speaking up if a concussion is suspected. Participants were athletes from 22 competitive community-based American football and girls and boys soccer teams (ages 9–14), and randomisation into intervention or control occurred at the level of the bracket (group of teams that compete against each other during the regular season). The primary outcome was expected likelihood of reporting concussion symptoms to the coach, measured via validated athlete survey at the beginning and end of the season.

Results Of 343 eligible participants, 339 (99%) completed baseline surveys and 303 (88%) completed surveys at season end. The mean (SD) age was 11.4 (1.1) years, 26% were female soccer athletes, 27% were male soccer athletes and 47% were football athletes. In adjusted analyses accounting for baseline values and clustering by sport and team via random effects, expected likelihood of concussion reporting at the end of the season was significantly higher in the intervention group compared to controls (mean difference=0.49, 95% CI 0.11 to 0.88; Cohen’s d=0.35).

Conclusions and relevance Pre-Game Safety Huddles increased the expected likelihood of athletes reporting concussion symptoms. While further study is warranted, sport organisations should consider this approach a promising low-resource option for improving concussion safety in their setting.

Trial registration number NCT04099329.

  • Concussion
  • Behavior Change
  • Health Education
  • Recreation / Sports
  • Randomized Trial

Data availability statement

Data are available upon reasonable request. Deidentified data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request. Deidentified data are available upon reasonable request.

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  • Twitter @spdchrismanmd

  • Contributors EK and SPDC conceived and designed the study and act as study guarantors. Material preparation was performed by EK, SPDC, AG, TH, RH, AP, KG, DR, GC and FPR, and data collection was performed by RH, KG, KH, EK, MM, MKS and BJB. Analyses were designed and conducted by SL. The first draft of the manuscript was written by EK, and all other authors reviewed and revised all versions of the manuscript. All authors read and approved the final manuscript.

  • Funding This study was supported by the CDC of the US Department of Health and Human Services (HHS) through cooperative funding agreement (U01CE002880).

  • Disclaimer The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, CDC/HHS or the US Government.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.