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Same day 'return to play' after concussion common among youth athletes
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SAN FRANCISCO — Although concussion guidelines recommend removal from play following injury, 38% of youth athletes return to play same day, leaving them at risk to worsening symptoms, according to findings presented at the 2016 AAP National Conference and Exhibition.
“We need to emphasize the message, ‘when in doubt, sit them out – and keep them out – until full recovery,” researcher Shane D. Miller, MD, FAAP, pediatric sports medicine specialist at the Texas Scottish Rite Hospital for Children, said in a press release.
While laws have been established in most states to prevent exacerbation of sports-related concussions among children – including the “Zackery Lystedt Law,” the first to require a “removal and clearance for Return to Play” for injured athletes – Miller noted that several of his patients reported they returned to play following a concussion without being cleared by a medical professional.
To determine how many youth athletes returned to play on the same day as their initial injury, Miller and Meagan Sabatino, senior clinical research coordinator at the Texas Scottish Rite Hospital for Children, conducted a retrospective review of patients (n=185) treated for concussion at a pediatric sports medicine center over a 10-month period.
Among patients treated for concussion (133 males; 52 females; mean age 14.1; range 7-18), the researchers identified that 46.5% (n=86) sustained a concussion while playing football and 16.2% sustained a concussion while playing soccer.
According to study results, 71 (38%) patients reported returning to play on the same day as initial injury, with 52 of the 133 males (39.1%) reported returning to sport after initial injury in comparison to 19 out of 52 females (36.5%).
“We believe that there are varying reasons, including the culture of resistance, that are playing a role in these findings,” Sabatino said in an interview. “As 38% of patients returning on the same day of their injury is a very high and unexpected number, we hope to find out more about why this is occurring as we continue our data collection.”
The researchers found that patients who returned to play right away reported less severe symptoms of dizziness (P=.04) and balance problems (P=.01) on the day of original injury. At the first clinic visit, however, these patients were statistically more likely to report nausea, dizziness, balance issues, sensitivity to light and noise, trouble concentrating, pressure in the head, feeling slowed down, and confusion (P < .05).
Research also showed patients had more trouble falling asleep at initial clinic visit (P=.049).
“We need to continue to emphasize the dangers of going back to play without proper rest and care,” Sabatino told Infectious Diseases in Children. “Also, recognizing the signs and symptoms of a concussion is key for parents, coaches, athletic trainers, team physicians and athletes to know – we need to continue to educate the community. Additionally, highlighting stories like those of Zachary Lystedt and Natasha Helmick may help youth athletes understand that they are not invincible.”—by Savannah Demko
Reference:
Miller SD, et al. Abstract 319134. Presented at: AAP National Conference and Exhibition; Oct. 21-25, 2016; San Francisco.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Dennis A. Cardone, DO
All athletes need to be removed immediately from a game when a concussion is suspected. No athlete should return to play on the same day after sustaining a concussion or a suspected concussion. Athletes should not be allowed to return to play until cleared by a physician and until being completely asymptomatic and completing the 'return to play' protocol. An athlete that returns to play while still having signs and symptoms related to a concussion is at increased risk for: sustaining another concussion; “second impact syndrome” which can have catastrophic consequences including death; a more complicated and prolonged course of recovery; and long-term consequences. Most importantly, we should be educating players, parents and coaches regarding the consequences of returning to play too quickly after sustaining a concussion.
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