MLHU - Health Status Resource



Key Findings: 

Rates of concussion more than tripled between 2005 and 2017 and most greatly affect those under age 19.

The emergency department visit rate for concussions in Middlesex-London more than tripled from 100.2 per 100,000 in 2005 to 363.9 per 100,000 in 2017. Increases have been more dramatic in recent years, with a slight reduction between 2016 and 2017 (Figure 4.5.1).

The rate has been significantly higher in Middlesex London than both the Peer Group and the province for the entire period, but the gap between Middlesex-London and its geographic comparators grew in recent years (Figure 4.5.1).

The age specific rates of concussion-related ED visits were highest in the 10-14 and 15-19 age groups, more than double all other age groups (Figure 4.5.2).

Ages 5-9 experienced the next highest rate of ED visits for concussions (Figure 4.5.2).

The rate of concussions seen in the emergency department for people living in rural areas (582.8 per 100,000) was significantly higher than urban populations (346.9 per 100,000) in 2017 (Figure 4.5.3).

However, there was no difference seen between the sexes (not shown).


Increases in concussion injuries seen in the emergency department over time may be due to an increase in concussion awareness, meaning more cases are seen not because of more concussions occurring but because of better recognition of concussion symptoms. The Ontario government passed Rowan’s Law on March 7, 2018 to help improve concussion safety for amateur athletes on playing fields and at schools; dedicated to the memory of Rowan Stringer who died after sustaining multiple concussions as a varsity rugby player.2  The law ensures that concussion awareness is prevalent in athletes, parents, coaches and schools.3

Children and youth, by far, bear the burden of concussions in the population. Those between ages 10 and 19 experience the highest rates. While many concussions are a result of sport, other factors such as falls and motor vehicle collisions can be the cause of the concussion. Local research indicates children in rural populations who experience concussions are much more likely to have sustained the injury in a motor vehicle crash compared to their urban counterparts.4

There can be long lasting impacts to brain health that results from a concussion. Repeated concussion, especially one occurring before a first concussion has healed, is a significant health risk as it can cause rapid and serious brain swelling.5 Repeated concussions over time can also lead to chronic degenerative changes in the brain which can affect thinking, memory, learning, coordination, speech and emotions.6

How this Indicator was Calculated: 
Ontario Public Health Standard: 

Ontario Public Health Standards: Requirements for Programs, Services, and Accountability – Substance Use and Injury Prevention (page 55)

Population Health Assessment and Surveillance Protocol, 2018


1. Matveev R, Sergio L, Fraser-Thomas J, Macpherson AK. Trends in concussions at Ontario schools prior to and subsequent to the introduction of a concussion policy - an analysis of the Canadian hospitals injury reporting and prevention program from 2009 to 2016. BMC Public Health [Internet]. 2018 Nov 29 [cited 2019 Feb 14];18(1):1324. Available from:

2. Ministry of Tourism, Culture and Sport [Internet]. Toronto (ON): Government of Ontario, Ministry of Tourism, Culture and Sport; c2012-2019. Rowan’s law day; c2019 [modified 2018 Sep 26; cited 2019 Feb 11]; [about 2 screens]. Available from: 

3. Parachute: PREVENTING INJURIES. SAVING LIVES [Internet]. Toronto (ON): Parachute; [cited 2019 Feb 11]. Concussion; [cited 2019 Feb 11]; [about 3 screens]. Available from:  

4. Stewart TC, Gilliland J, Fraser DD. An epidemiologic profile of pediatric concussions: identifying urban and rural differences. J Trauma Acute Care Surg [Internet]. 2014 Mar [cited 2019 Feb 11];76(3):736-42. Available from: 

5. Tator TH. Concussions and their consequences: current diagnosis, management and prevention. CMAJ [Internet]. 2014 Aug 6 [cited 2019 Mar 3];185(11):975-979. Available from: 

6. Centers for Disease Control and Prevention [Internet]. Atlanta (GA): Centers for Disease Control and Prevention; [cited 2019 Feb 17]. Severe brain injury; [reviewed 2015 Feb 16; updated 2015 Feb 16; cited 2019 Feb 17]; [about 2 screens]. Available from:  

7. Centers for Disease Control and Prevention [Internet]. Atlanta (GA): Centers for Disease Control and Prevention; [cited 2019 Feb 11]. What is a concussion?; [reviewed 2017 Jan 31; updated 2017 Jan 31; cited 2019 Feb 11]; [about 2 screens]. Available from:

Last modified on: March 15, 2019

Jargon Explained

"A concussion is a type of traumatic brain injury. It is caused by a bump, blow or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells.” Centers for Disease Control 7