Context: Sport-related concussion (SRC) is a well-documented health concern for youth athletes, but less is understood about non-SRCs in this population. Researchers have indicated that non-SRCs may differ from SRCs in symptom severity, health care presentation timing, and recovery, warranting further investigation. Objectives: To (1) compare demographics, medical history, and symptom profiles and (2) examine differences in recovery metrics among active high school athletes with SRC or non-SRC. Design: Retrospective cohort study. Setting: Regional specialty concussion center. Patients or Other Participants: Athletes aged 14 to 18 years evaluated from November 2017 to April 2022. Main Outcome Measure(s): The primary exposure was concussion mechanism (SRC versus non-SRC). Primary outcomes included symptom severity, time to return to learn, symptom resolution, and return to play. Results: Of 1035 athletes, 110 (10.6%) sustained non-SRCs. Compared with SRCs, the non-SRC group had more females (63.6% versus 33.8%, P < .001) and higher psychiatric history (24.5% versus 10.4%, P < .001) and migraine history proportions (19.1% versus 9.8%, P = .001). Emergency department visits and intracranial imaging were more common for non-SRCs (38.2% versus 20.2%, P < .001; 37.3% versus 21.7%, P < .001). Athletes with non-SRCs reported greater symptom burdens at initial presentation (mean ± SD = 30.7 ± 27.0 versus 25.6 ± 23.9, t test: P = .073) and longer symptom resolution (median: 27 versus 17 days, Mann-Whitney U: P = .004) and return to play times (median: 28 versus 21 days, Mann-Whitney U: P = .049). However, the non-sport mechanism was not significantly associated with return to learn (hazard ratio = 0.870, P = .323), symptom resolution (hazard ratio = 0.861, P = .342), or return to play (hazard ratio = 0.923, P = .598) when accounting for other variables. Conclusions: In high school athletes, non-SRCs were more common in female athletes and involved higher psychiatric and migraine history proportions. Non-SRCs were associated with broader symptom profiles and longer recovery, highlighting clinically meaningful differences. Findings underscore the need for tailored care strategies, including emotional and academic support, for athletes recovering from non-SRC. Key Points A higher proportion of athletes with non-sport-related concussions were female, and they had a higher proportion of migraines, psychiatric history, and emergency department visits. Athletes with non-sport-related concussions experienced longer recovery times and more diverse symptom profiles, particularly cognitive and emotional, than those with sport-related concussions. While associated in univariate models, the non-sport-related concussion mechanism was not associated with recovery when accounting for other factors, suggesting other variables play a more prominent role in recovery.
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