Concussion / Head Injuries

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Concussions are head injuries causing a temporary brain dysfunction rather than a structural injury.  The CDC estimates that there are as many as 3.8 million sports related head injuries in children and adults yearly, resulting in a large number of emergency room visits.  Children may be more vulnerable to concussions than adults with contact sports such as football, rugby, lacrosse, hockey, and soccer leading the way.

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Symptoms and Signs

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It should be noted that symptoms and signs may change over a period of time, and athletes may minimize or deny their presence in order to continue playing.  Quite often they can be subtle and go unnoticed.

Initial assessments of athletic injuries occur right on the field of play with standard emergency principles by trained coaching staff and personnel.  Specific evaluations focusing on detecting deficits in orientation, memory and concentration, which can be found in various concussion assessment tools accessed by trained staff.

 ACE: ACUTE CONCUSSION EVALUATION CARE PLAN

 SCAT 3: SPORT CONCUSSION ASSESSMENT TOOL #3

Baseline pre-participation studies including ImPACT Testing can be helpful especially when repeated and compared to those after injury.  Our office currently offers these online tests and many are scheduled in conjunction with a school/sports physical exam.

 

Medical Care

Indications for seeking emergent medical evaluation include but are not limited to:

  • Loss of Consciousness
  • Confusion/Disorientation
  • Headache increasing in severity or persisting
  • Visual disturbance (i.e., blurred, loss or double vision)
  • Vomiting (persistent or intractable)
  • Asymmetric or unequal numbness or weakness of extremities

Brain imaging studies (CAT scans or subsequent MRI’s) may be ordered if a physician suspects or is concerned about a structural brain injury.  However, with many injuries such scans may not always be required.

 

Complications of Concussions

Complications appear to occur more frequently with repeat injuries and may include:

Post concussive syndrome

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This complication can persist over a long period of time,with younger athletes being at increased risk for development of this state.

Second Impact Syndrome

Rare in young athletes but carries a high mortality and complication rate.  Occurring in the context of a player sustaining another injury having not fully recovered from an initial one, participating while continuing to be symptomatic, potentially leading to increased intracranial pressure (“brain swelling”), brain herniation, collapse and respiratory failure.

Chronic Traumatic Encephalopathy and More

A long-term consequence of repetitive head injuries, which is, associated with adult onset Alzheimer’s disease, initially seen in boxers but recent evidence suggests that this may be occurring in professional football.  There also may be some association with traumatic brain injury and the development of suicidal ideation among those potentially having underlying psychiatric disorders. 

Treatment and Management of Concussions

REST
No player should be permitted to play with symptoms.  Minimizing academic and general daily workload activities can be helpful. Some advocate “cocoon therapy” which is in essence cognitive brain and physical rest until the patient feels better.  Your pediatrician will assist in making the right decision for your child when an injury occurs.  General measures include:

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Return to play is determined on an individual basis.  The National Federation of State High School Associations provides suggested guidelines.

SUGGESTED GUIDELINES FOR MANAGEMENT OF CONCUSSIONS IN SPORTS

Tired of reading!  Then here’s an easy take home message in a video for you and your young athlete:

The  3 “R’s “ on Concussions :

Video Link