2. High School Concussions
Over 50% of concussed high school football
athletes do NOT report their injury to medical
personnel
McCrea, M., Hammeke, T., Olsen, G., Leo, P., and Guskiewicz, K.M.
(2004). Unreported concussion in high school football players:
implications for prevention. Clin. J. Sport Med. 14, 13–17.
3. Collegiate Concussions
Soccer, lacrosse, basketball, softball, baseball, and gymnastics
14,591 injuries in male and female athletes
5.9% of all injuries were classified as concussions
Males Game Injury Rate / 1000 exposures
Soccer
Lacrosse
Basketball
1.40
1.46
0.47
Females
Soccer
Lacrosse
Basketball
2.10
1.05
0.73
4. Perceptions
Survey 300 players, 100 coaches, 100 parents, 100 ATCs
If a player complains of a headache , should return to play?
Players 55%, Coaches 33%, ATC 30%, Parents 24%
Percentage who would play a concussed star in a title game?
Players 54%, ATC 9%, Parents 6.1%, Coaches 2.1%
Level of concern for concussions (1 = most concerned; 4 = least)
Players 3.5, Coaches 2.4, Parents 2.1, ATC 1.6
Is a good chance of playing in the NFL worth a decent chance of
permanent brain damage?
Players 44.7%, Coaches 19.4%, Parents 15%, ATC 10%
5. Classification of concussions
A concussion is a concussion
There is no such thing as a mild concussion
No grading system
Most symptoms resolve in a short period of 7-10 days
Post concussive symptoms may be prolonged in children
6. Symptoms
Headache (83%)
Dizzy (65%), dazed, fog
Light and sound sensitivity
Visual disturbances
“Everything seems slow”
“My colors changed”
Teammate, “Eric’s not right, coach”
Appearance can be delayed several hours
7. Physical Signs
You do not have to lose consciousness
Amnesia (“Doc, I don’t remember the first half”)
Emotional labile (crying, talkative)
Poor balance
Difficulty concentrating
Difficulty remembering
8. On-Field Evaluation
Standard emergency management
Exclude cervical spine injury
Return to play determined by a physician
“When in doubt, sit them out”
No player shall return to play the same day
Sideline assessment of concussion (SCAT2)
Monitor for any deterioration over time
9. Concussion Management
Complete physical and cognitive rest until symptom free
No sports
No horseplay
No school, if necessary
No texting, video games, internet, TV, driving
Graded program of exertion prior to full return to play
10. Exertion effects
Symptoms are worsened by
physical activity
mental effort
environmental stimulation
emotional stress
11. Post-concussion syndrome
Risk factors for complicated recovery
Re-injury before complete recovery
Over-exertion early after injury
Significant stress
Unable to participate in sports
Medical uncertainty
Academic difficulties
Prior or comorbid condition
Migraine
Anxiety
ADHD, LD
12. Multiple Concussions
Second Impact Syndrome
A concussion prior to recovery from a prior concussion
Athlete is still symptomatic
Mostly males < 21 years old
Rapid increase in intracranial pressure
Rare but almost always fatal
Cumulative effects
Risk of concussion is 4-6 times greater after one concussion
Risk is 8 times greater after sustaining two concussions
Prolonged or incomplete recovery
Increased risk of later depression or dementia
How many is too many ?
13. Graduated return to play protocol
Day 1
Day 2
Day 3
Day 4
Day 5
Light aerobic exercise
Light jog/stroll, stationary bicycle
Goal: elevate HR
Sport-specific exercise
Running drills in basketball
Goal: add movement
Non-contact training drills
Passing and shooting, light resistance training
Goal: coordination, cognitive load, valsava
Full contact practice only after physician clearance
Return to competition
Any symptoms at any stage, return to complete rest
14. Mechanism of Injury Hockey
Body checking
86% of all injuries in 9 – 15 year old
Contact leagues
4x injury rate, 12x fracture rate
45% legal body checks, 8% illegal body checks
Direct fatality and injury rates for football are half of hockey
Spinal cord injury and brain injury rate
2.6 per 100,000 high school hockey players
.7 per 100,000 high school football players
15. Helmets and Mouth Guards
Helmets prevent skull fractures
Helmets do not prevent concussions, they cause
concussions
Mouth guards prevent dental injuries
Mouth guards do not prevent concussions
Hinweis der Redaktion
246 certified athletic trainers recorded injury and exposure data for high school varsity athletes participating in boys' football, wrestling, baseball and field hockey, girls' volleyball and softball, boys' and girls' basketball, and boys' and girls' soccer at 235 US high schools during 1 or more of the 1995-1997 academic years.
A cohort study of collegiate athletes using the National Collegiate Athletic Association (NCAA) Injury Surveillance System; certified athletic trainers recorded data during the 1997–2000 academic years. To compare sex differences regarding the incidence of concussions among collegiate athletes during the 1997–1998, 1998–1999, and 1999–2000 seasons. Example year2000, male 20 concussions / 32,836 game exposures = game injury rate of .61