Concussions in Sports

In order to give guidance to the medical profession on the management of concussions from sports, the American Medical Society for Sports Medicine (AMSSM) issued a position paper in the January, 2013 issue of its publication “Clinical Journal of Sports Medicine”.  This issue has gained national attention with the recognition of the relationship between head trauma and long term neurologic injury, and the well publicized autopsy of NFL star Junior Seau.

Concussion is defined as a traumatically induced disturbance of brain function.  It is estimated that almost 4 million concussions occur in competitive sports in the United States annually, with the highest incidence in football, hockey, rugby, soccer and basketball.  Diagnosed by clinical evaluation, all such events should be evaluated by a trained professional, who will use objective and validated checklists and assessment tools to evaluate severity. A history of a concussion is associated with a higher risk of a future concussion.

Any athlete suspected of having a concussion should be immediately removed from play and evaluated urgently. Imaging, including CT scan, is sometimes but not always indicated. No athlete with a concussion should be allowed to return to competition on the same day. After having had an appropriate evaluation, the athlete should not return to exercise or sport until all symptoms (headache, dizziness, nausea, ringing in the ear, tiredness, etc) have resolved. Return to sports participation should be monitored and gradual in nature, with cessation if symptoms recur. While the majority of concussions resolve within 7 to 10 days, in some cases symptoms will persist for weeks, or months, or longer.  Cases with such prolonged symptoms are termed “post concussion syndrome” and are more likely associated with some level of permanent brain injury.

Helmets, both hard (football, lacrosse and hockey) and soft (soccer, rugby) are best suited to reduce impact injuries (fractures, lacerations, bleeding) but have not been shown to reduce the incidence and severity of concussions. The same is also true of mouth guards. This is NOT to say that such equipment should not be worn consistently.

There is increasing evidence that recurrent concussions contribute to an entity called “chronic traumatic encephalopathy), with depression, mood changes, headaches and a risk for suicide.

In the end, there is no way to prevent concussions in active children and athletes.  It is important, however, if your child participates in a sport, for you to speak with the school and/or coach about their perspective on head trauma, their policies regarding the evaluation of possible head trauma during competition, and the role safety plays in their sports program.  If your child does suffer some level of head trauma, make sure you visit your pediatrician for advice on the timing of a return to future activity.