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Spring 2014 Vol. 13 Number 2

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Concussions and Young Athletes

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The Growing Concern Over Sports-Related Head Injuries

Sports-related concussions have become a high-profile public health concern in recent years. With estimates of approximately 1.6 million to 3.8 million concussions and other traumatic brain injuries (TBIs) occurring in the U.S. each year during sports and recreational activities -- likely a conservative approximation due to underreporting -- parents worry about their children playing certain sports and whether the equipment being used adequately protects them.

Despite increased attention, confusion and debate persist about factors such as how to define a concussion, how multiple concussions affect an athlete's vulnerability to future injury, when it is safe for a player to return to sports, and the effectiveness of protective devices and other interventions in reducing the incidence and severity of concussive injuries. To offer some clarity, the Institute of Medicine and National Research Council conducted a review of the science relating to sports-related concussions in youths ages 5 to 21.

The committee that wrote the report found that football, ice hockey, lacrosse, wrestling, soccer, and women's basketball consistently are associated with the highest rates of concussion. In addition, young people with a history of prior concussions as well as female athletes in general display higher concussion rates. The report recommends that the Centers for Disease Control and Prevention establish and oversee a national surveillance system to accurately determine the incidence of sports-related concussions among youths.

Concussions are reported more frequently among high school athletes than college athletes in several sports, the committee observed. Even so, young athletes confront a "culture of resistance" to reporting when they might have a concussion and to complying fully with treatment plans, which could endanger their well-being. Once a concussion is recognized and diagnosed, its management is of vital importance. A potentially concussive injury requires removing the athlete from play, caring for the injury appropriately in both the acute stage and during the recovery process, and returning to play only when the athlete is fully recovered, the committee said. Athletes who return to play before their brain has healed entirely may place themselves at increased risk for prolonged recovery or more serious consequences if they sustain another head injury. However, there is no universal time frame for recovery, and the National Institutes of Health and the U.S. Department of Defense should support research to establish specific metrics and markers for concussion diagnosis, prognosis, and İsvedoliver/iStock/Thinkstock recovery in youth and to inform the creation of age-specific, evidence-based guidelines for managing short- and long-term consequences of concussions, the report recommends.

There is little evidence that current sports helmet designs reduce concussion risk, and no evidence that other devices, such as mouth guards and headbands for soccer, do so. Nevertheless, properly fitted helmets, face masks, and mouth guards should still be worn because they reduce the risk of other injuries, such as skull fractures and facial and dental injuries, the committee stressed.

Moreover, the National Collegiate Athletic Association should work with the National Federation of State High School Associations and other youth sports governing groups to conduct a rigorous scientific evaluation of the effectiveness of age-appropriate techniques, rules, and playing and practice standards in reducing sports-related concussions and impacts, the report says. Several sports organizations have previously developed limits on the amount of head contact a particular player should experience over a given period of time, and although this practice makes intuitive sense, it is currently without scientific basis.

-- Dana Korsen & Jennifer Walsh

Sports-Related Concussions in Youth: Improving the Science, Changing the Culture. Committee on Sports-Related Concussions in Youth; Board on Children, Youth, and Families; Institute of Medicine and National Research Council (2014, 356 pp.; ISBN 978-0-309-28800-2; available from National Academies Press, tel. 1-800-624-6242; $64.00 plus $5.00 shipping for single copies).

The study committee was chaired by Robert Graham, director, National Program Office, Aligning Forces for Quality, and department of health policy, School of Public Health and Health Services, George Washington University, Washington, D.C. The study was funded by the Centers for Disease Control and Prevention; CDC Foundation with support from the National Football League; U.S. Department of Defense; U.S. Department of Education; Health Resources and Services Administration; National Athletic Trainers' Association Research and Education Foundation; and the National Institutes of Health.

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