Rate of Young Athletes With Concussion Increases in the ED

Dr. Walter added, “I think it is also important to recognize that because we have learned more about concussion diagnosis, treatment, and complications, the treatment that coaches and parents received when they had a concussion themselves at a young age is likely different [from treatment] today.” Many parents and coaches don't think concussion is a big deal because they had one when they were younger and they “toughed it out” and “are fine now,” said Dr. Walter, program director of pediatric and adolescent sports medicine at Children's Hospital of Wisconsin in Milwaukee.

The authors acknowledged the lack of published baseline neuropsychological data on children younger than 12 years, and noted that assessment by a neuropsychologist might be helpful for children who have had more than one concussion, or whose postconcussive symptoms persist for several months.

Dr. Halstead emphasized the following take-home tips for clinicians:

▸ Never should young athletes return to play on the day of their concussion, nor should they return to play until they are symptom free both at rest and at exertion.

▸ A concussion is an injury to the brain, and rest is paramount. “If an athlete injures an ankle or knee and cannot run on it, we wouldn't think twice about resting that injury until it healed. Why should we treat the brain any differently?”

▸ Doctors are interested in getting an athlete back to play and activity as soon as possible. “But we need to be smart about it and make sure it is safe for that young athlete first.”

▸ Continue to educate everyone involved — coaches, parents, teachers, and athletes — in preventing and managing sports-related concussions.

None of the researchers mentioned in this story had any financial conflicts to disclose.

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Awareness Drives Rise in Reports

I'm not surprised by the increase in reports of concussions in young athletes. And because not every kid with a concussion goes to the ED, there are even more injuries occurring that are not being reported.

I think greater awareness and better diagnosis are the main reasons why the number of sports-related concussions is rising. Until 10 years ago, the medical literature focused only on concussions that involved loss of consciousness. But what we have learned in the past decade is that the subtleties of this injury are absolutely critical for diagnosis. (My 2003 paper shows that amnesia or memory loss around the time of the concussion is 10 times more predictive than a loss of consciousness.) Changes in the way we define the injury are driving the rise in reported concussions in young athletes.

As we continue to peel the onion on concussion, we realize that it is an extremely complex injury. We now have animal models that help show what happens in the brain after a concussion. This knowledge base has accumulated at warp speed over the last 10 years, and with that has come better recognition, better management, and better understanding of the injury, as well as more concern.

Most importantly, neurocognitive testing is becoming more widely used as a way to assess sports-related concussion, and it is the key to why there is so much attention now being paid to the injury: We now have a way to measure it by collecting baseline data. The sensitivity and specificity of such tests are impressive.

One of the keys to improving the management of pediatric concussion is to get knowledge related to this injury, as well as its many assessment tools, into pediatric offices. Clinics are available around the United States to help pediatricians who want to incorporate neurocognitive testing into their practices. The American Academy of Pediatrics' report by Dr. Halstead and Dr. Walter lists several assessment tools, and it includes other valuable, relevant information about managing sports-related concussions in young athletes.

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MICHAEL COLLINS, PH.D., is the assistant director of the sports medicine concussion program at the University of Pittsburgh Medical Center. He coauthored the Centers for Disease Control and Prevention's “Heads Up: Brain Injury in Your Practice” tool kit for physicians. He disclosed that he is a cofounder of ImPACT, a computerized neurocognitive testing tool.