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Practice management changes needed to prevent pediatric sports-related concussions
Recent studies have shown a fourfold increase in diagnosed concussions among high school athletes. Changes in management practices and education are necessary to prevent these adverse incidents, according to study data published in Clinical Pediatrics.
The CDC reports an estimated 3.8 million sport-related traumatic brain injuries occur each year, many of them concussions. Approximately 30% of pediatric concussions diagnosed in the ED are sports-related.
Diagnoses typically come from physician-administered neuropsychological tests or computerized neurocognitive assessments. Computerized assessments are designed to supplement clinical history, physical examination and balance assessment, but are not the sole determinant of diagnosis. Emily Hanson, BS, of Boston Children’s Hospital, and colleagues suggest high school athletes receive neurocognitive assessments during preseason, so that neurological information can be compared with information obtained after an incident occurs.
Other suggested precautions include neck strengthening exercises, preparing for collision, and using mouth guards, helmets and other protective equipment.
Concussions are more likely to be recognized if the patient experiences severe symptoms, such as loss of consciousness, convulsion and imbalance. Minor symptoms such as disorientation, slight imbalance and confusion should be taken just as seriously, according to Hanson and colleagues.
Disclosure: The researchers report no relevant financial disclosures.
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This is an excellent review of the current state of knowledge regarding sport-related concussion. The authors highlight recently published data on the sport with the highest incidence of concussion for boys (football, ice hockey and lacrosse) and girls (soccer, lacrosse, field hockey, and basketball) and reiterates the importance of anticipatory planning during the preseason for any personnel involved with caring for student athletes on the field of play, including preseason neurocognitive and balance assessments. The diagnosis of acute concussion on the sidelines remains challenging and often the physical examination may appear normal, with subtle deficits in balance sometimes remaining undetected.
In our experience, we are finding a more directed evaluation of the vestibule-oculomotor system, assessing smooth pursuits, saccades and the vestibule-ocular reflexes, often identifies deficits in patients with acute concussion and is useful in sideline assessment (Master C. Pediatr Ann. 2012;4:362-363). Management after the injury includes physical and cognitive rest, which is generally sufficient for the majority of student athletes followed by a gradual return to play.
The authors of this study remind us that there remains limited evidence for the effectiveness of any athletic equipment in the prevention of concussions. There may be some benefit in core neck strengthening and rule changes in the sport, and there has been an explosion in concussion legislation across the country, with all states in the Union except Mississippi having laws on the book at the close of 2013. It remains to be determined, however, whether these interventions have any impact on decreasing the incidence of sports-related concussions.
