On October 30, the Institute of Medicine issued a shocking report on sports-related head injuries among children and young adults. The report evaluated injuries to sports participants aged 5 to 21; it entailed a 15-month investigation into sports-related concussions sustained by young athletes in the United States. The report noted that these individuals face a “culture of resistance” to reporting when they might have a concussion, which could endanger their well-being,
A group of 17 scientists examined the causes of concussions and evaluated the effectiveness of protective equipment. The investigators also reviewed screening, diagnosis, treatment, and long-term consequences of blows to the head. They found that, overall, reported concussions rates are more frequent among high school athletes than college athletes in some sports, including football, men’s lacrosse and soccer, and baseball. Furthermore, the rates were higher for competition than practice (except for cheerleading); they were highest in football, ice hockey, lacrosse, wrestling, soccer, and women’s basketball. Concussion rates also were higher for individuals with a history of prior concussions and among female athletes.
The committee found minimal evidence that current sports helmet designs reduce the risk of concussions. Despite that finding, the committee stressed that properly fitted helmets, face masks, and mouth guards should still be used, because they reduce the risk of other injuries, such as skull fractures, brain hemorrhage, as well as injuries to the eyes, face, and mouth. The committee noted that marketing for some protective devices designed for youth athletes, such as mouth guards and headbands for soccer, has advertised that these devices reduce concussion risk; however, but there is a lack of scientific evidence to support such claims.
The committee conducted a review of scientific literature focused on concussion recognition, diagnosis, and management; it found that the signs and symptoms of concussion are usually placed into four categories: physical, cognitive, emotional, and sleep. Typically, the patients experienced one or more symptoms from one or more categories. Young athletes usually recover from a concussion within two weeks of the injury; however, in 10-20% of cases concussion symptoms persist for a number of weeks, months, or even years. The committee stressed that if an athlete suffers a possible concussion, he or she should be removed from the playing field and receive immediate medical attention that should continue through the recovery period. Returning to the playing field should only occur after recovery has occurred and symptoms have resolved. They caution that athletes who return to play before their brain has fully healed may place themselves at increased risk for an extended recovery period or more serious consequences if they suffer a second brain injury.
The committee reviewed data on the effects of both single and multiple concussions; it found reports of impairments in the areas of memory and processing speed. Some studies noted that a history of previous concussions is a predictor of increased risk for future concussions; however, the reports could not define the degree of increase. In addition, several studies noted that the number and severity of concussion symptoms is greater in athletes with a history of two or more concussions.
On a positive note, the committee found that some studies reported that enforcement of sports rules by coaches and officials as well as adherence to these rules by players may help reduce the incidence and severity of sport-related concussions in youths. The committee also reviewed studies of retired professional athletes; these provided some evidence that a history of multiple concussions increases risk for depression. A survey of more than 2,500 retired professional football players found that approximately 11% reported having a prior or current diagnosis of clinical depression.
Other significant findings of the report were:
- The reported number of individuals aged 19 and under treated in US emergency departments for concussions and other non-fatal, sports- and recreation-related TBIs increased from 150,000 in 2001 to 250,000 in 2009.
- Football, ice hockey, lacrosse, wrestling, and soccer are associated with the highest rates of reported concussions for US male athletes at the high school and college levels.
- Soccer, lacrosse, and basketball are associated with the highest rates of reported concussions for US female athletes at the high school and college levels. Women’s ice hockey at the collegiate level has the highest rate of reported concussions.
- Youths with a history of prior concussion have higher rates of reported sports-related concussions.
- Among military personnel, mild traumatic brain injuries, of which concussions are one category, represent about 85% of all traumatic brain injuries.
- Among military personnel, about 80% of mild traumatic brain injuries do not occur in the deployed setting and are commonly caused by automobile crashes involving privately owned and military vehicles, falls, sports and recreation activities, and military training.
The committee noted that, despite the information they obtained, research regarding youth concussions is limited. Therefore, it identified several areas for further research:
- Establishing a national surveillance system to accurately determine the number of sports-related concussions.
- Identifying changes in the brain following concussions in youth.
- Conducting studies to assess the consequences and effects of concussions over a life span.
- Evaluating the effectiveness of sports rules and playing practices in reducing concussions.