Concussions in Youth Sports

03/29/2016

Healthy Living - March 29, 2016
Mark Allen, MD - Acadia Hospital

 
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In the last ten years, there has been a dramatic (> 400%) increase in reported sports-related concussions in high school, and the topic is nearly always in the media. The excellent PBS Frontline documentary “League of Denial” and recent feature-length film “Concussion” detail the controversy of the NFL suppressing evidence about concussions in its own players, who later developed health problems, including Chronic Traumatic Encephalopathy (CTE). Even President Obama has spoken out about the issue, noting that he “would not let [his] son play pro football” and that “we have to change a culture that says you suck it up.”
 
What is a sports-related concussion?
It is a mild Traumatic Brain Injury (mTBI) that either results directly from a hit to the head, face, or neck, or indirectly from a hit to another part of the body that is transmitted to the head.  A concussion is usually rapid in onset and resolves spontaneously – most result in no long-term effects.  One common misconception is that a concussion is not a concussion unless there is loss of consciousness or blacking out. This is wrong. A concussion may occur with altered consciousness to ANY degree – usually short-term disorientation. Common symptoms include dizziness, headache, and nausea.
 
So that sounds bad, but what’s the real concern?
Think of a concussion like a sunburn. The more you get, the more problems that may arise over time.  The earlier you get them, the more damage that can be done to a developing brain.  The primary issue is that there is no single verifiable concussion test.  There is no blood test.  There is no brain imaging study.  The fancy neuropsychological tests (like the IMPACT test) are controversial and not without flaws. A concussion is one of very few medical disorders that are diagnosed simply by reported history.

Concussions affect each child differently. Sometimes symptoms may last weeks to months or longer (this is called Post-Concussive Syndrome). The most dangerous event occurs when a child has a second concussion before the first one heals – this is called Second Impact Syndrome (SIS), which can be serious, and sometimes fatal. This is why it is SO important to monitor for signs of a concussion, as the initial concussion does NOT need to be severe, and it is most commonly found in younger athletes.
 
Do helmets help?
They certainly help with blunt force trauma, but unfortunately, they do not prevent the brain from rattling around inside the skull (rotational injury), which leads to the concussion.
 
Dizzying Numbers:
- 90% of concussions go unreported and undiagnosed in contact sports
- Only 50% of athletes report concussive symptoms
- 33% of athletes do NOT know concussive symptoms (and are likely poor reporters due to their impaired judgment)
 
How can I spot a possible concussion?
  • Kid gets hit in the head/body and says he/she “doesn’t feel right”
  • Appearing dazed/confused
  • Moving clumsily
  • Slowly answering questions
  • Losing consciousness
  • Mood/behavior/personality changes
  • Having problems recalling events both before and/or after a hit/fall
  • Headache
  • Nausea/vomiting
  • Dizziness/blurry vision
What should I do if my child has a possible concussion?
  • Remove child from play
  • Keep child out of play the day of the injury
  • Have child seen by health care provider who is experienced in evaluating for concussions
  • Have the child only return to play and/or school following permission from health care provider
  • Do NOT try to judge severity of the concussion yourself
  • The brain needs time to heal after a concussion.
How is a concussion treated?
  • Rest
  • Decreasing sound and light stimulation
  • Conservative usage of pain-relieving medications
How can parents/coaches educate themselves? Take-Home Points:
  • Without accurate measurements nor standardized data, concussions will be both under- and overdiagnosed
  • Parents should be cautious but need to weigh the benefits of sports participation (positive peer relationships, teamwork, exercise, behavioral activation) with the potential risk of head injury.
  • “When in doubt, sit ‘em out.”