Multiple hits over time can cause concussion

Joseph D. Smucker, MD

This study underscores the importance of serious consideration of every person who has a traumatic event to his or her head.

As Stemper et al findings suggest, there is still a lot of variability in the data we have. Previous research has suggested that not every athlete is the same with respect to these injuries — some athletes are affected by a single injury, and other athletes can be hit multiple times and not be impacted in the short-term. Prior studies have also shown differences between age groups when it comes to concussion symptoms, and self-reporting of injury has also been an issue. So while the idea of treating athletes as they come in to a primary care physician’s office is important, this variability makes it difficult for PCPs because there is not a universal protocol, or a “this is what we always do,” or “this is the one and only test to use” type of approach that can drive the PCP down the road to a correct diagnosis.

The most encouraging thing we are seeing is a recognition of the importance of head trauma in athletic participation. As we consider these injuries and report on our experiences, it is the collective hope that athletic participation will become safer, while allowing athletes an opportunity to enjoy participation in their sport. The balance of healthy athletes and reasonable changes in sporting activities to minimize a significant effect on the enjoyment of sport is a shared goal in primary and specialty health care.

Until such a universal protocol can be established, at the time of injury PCPs should ask the individual with the concussion or sports-related head injury questions like “What field are we playing on?”, “What quarter is it?”, “How far along in the game are we?”, and “Who participated in the last scoring play?”, since these patients will typically have problems with their short-term memory, despite being neurologically normal. PCPs may also consider use of the Sport Concussion Assessment Tool, currently in its 5th edition (SCAT5), to determine if a patient is indeed concussed.

Jaclyn Demeter, PA-C, MPAS

This study brings to greater light the fact that concussions and their neurological impact should be looked at collectively in health care and sport rather than as isolated events. To expound upon the data analyzed by Stemper et al, a concussion may result from hits throughout a season, rather than a single forceful contact. It also reinforces the idea that repetitive hits to the head and neck can serve as insults to the brain and can lead to a concussion that can end a patient’s season and sometimes their career.

Health care is so much more than just diagnosing and treating patients — it is about educating patients, too. In some ways, these injuries should be looked at in the global context of athlete health and age/level-based participation. We need to treat these injuries in the population from which they come, rather than appropriating data from other sources of trauma literature or personal experience. Since we still do not know how many hits can cause long-lasting neurological impact, and since the symptoms of such neurological damage are not always readily apparent, primary care physicians can use this study to inform coaches and players. Reinforcing the idea of playing safely during both practice and game settings, including avoiding head-first contact, may allow a patient to continue participation in their sport with a decreased risk of injuries.