Concussions in younger athletes on the rise

Bakhos L. Pediatrics. doi:10.1542/peds.2009-3101.

Research from Hasbro Children’s Hospital finds visits to emergency departments for concussions that occurred during organized team sports have increased dramatically over a 10-year period, and appear to be highest in ice hockey and football.

The number of sports-related concussions is highest in high school-aged athletes, but the number in younger athletes is significant and rising, noted authors of a study published in the September 2010 issue of Pediatrics.

Top five sports

A review of national databases of emergency department (ED) visits found 502,000 visits for concussions in children aged 8 to 19 years in the period from 2001 through 2005; of those 65% were in the 14- to 19-year-old age group and 35% in the 8- to 13-year-old age group, according to a Hasbro Children’s Hospital press release. Approximately half of all the ED visits for concussions were sports-related with approximately 95,000 of those visits were for concussions that occurred from one of the top five organized team sports: football, basketball, baseball, soccer and ice hockey. The researchers also noted that in the period from 2001 through 2005, approximately four in 1,000 children aged 8 to 13 years and six in 1,000 aged 14 to 19 years had an ED visit for a sport-related concussion.

Lisa Bakhos, MD, lead author of the study stated, “Our data show that older children have an overall greater estimated number of ED visits for sport-related concussion compared to younger children. Younger children, however, represent a considerable portion of sport-related concussions, approximately 40%.”

Doubled incidence

The researchers found that ED visits for organized team sport-related concussions doubled over the studied time period and increased by more than 200% in the 14- to 19-year-old age group, while overall participation decreased by 13% during the same time period. Bakhos commented in the release, “What was striking in our study is that the number of sport-related concussions has increased significantly over a 10-year period despite an overall decline in participation. Experts have hypothesized that this may be due to an increasing number of available sports activities, increasing competitiveness in youth sports, and increasing intensity of practice and play times. However, the increasing numbers may also be secondary to increased awareness and reporting.”

James Linakis, MD, PhD, a pediatric emergency medicine physician with Hasbro Children’s Hospital and senior author of the paper, noted “Our assessment highlights the need for further research and injury prevention strategies into sport-related concussion. This is especially true for the young athlete, with prevailing expert opinion suggesting that concussions in this age group can produce more severe neurologic after-effects, such as prolonged cognitive disturbances, disturbed skill acquisition and other long-term effects.”

Guidelines

Despite the apparent increase in concussions in youth athletes, there are no comprehensive return-to-play guidelines for young athletes, the authors noted. Also, there are no evidence-based management guidelines for the treatment of these injuries, while there is agreement that young children cannot be managed in the same way as older adolescents.

Linakis, who is also a physician with University Emergency Medicine Foundation and an associate professor at The Warren Alpert Medical School of Brown University, stated, “Children need not only physical, but cognitive rest, and a slow-graded return to play and school after such injuries. As a result of this study, it is clear that we need more conservative guidelines for the management of younger children who suffer concussions.” Return-to-play assessments might include such strategies as neuropsychological testing, functional MRI, visual tracking technology and balance dysfunction tracking.

Bakhos concluded, “What this research tells us is that we need additional studies to provide guidance in management, prevention strategies and education for practitioners, coaches and athletes.”