» Concussions in High School Athletes

Concussions in High School Athletes

If you ever watched the Three Stooges on television, at least once per episode, Moe would take Curly and Larry and smack their heads together. It's a wonder they didn't suffer from a concussion. That type of head-to-head collision is what accounts for three-fourths of all sports concussions.

Recent attention on sports concussions has resulted in a database called the High School Reporting Information Online (HS RIO) surveillance system. Athletic trainers at 100 pre-selected high schools from around the United States enter data each week on all sports-related injuries.

Information is entered on any athlete (male or female) participating in football, soccer, basketball, wrestling, baseball, volleyball, or softball who suffers an injury during their sport activity.

Not just concussions, but any injury is reported along with the date it occurred, age and sex of the player, and type of injury. Information on the specific symptoms, date the athlete returned to play, and medical treatment received is also recorded.

In this study, physicians from the Sports Concussion Clinic at Children's Hospital in Boston, Massachusetts report on the 544 concussions reported to the surveillance system. All cases occurred among high school athletes for the 2008-2009 year. After analyzing the data they could see that injuries of this type occur equally in every year of the high school experience (freshman through senior years).

Most concussions occured during competitive play (rather than during practice). More than half were the result of football action. The most common mechanisms of injury was contact with another player (three-fourths of all concussions), contact with the field or playing surface (15.5 per cent), or collision with a piece of playing equipment (e.g., goal posts, bleachers).

How can you tell if an athlete has suffered a concussion? The first clue comes from symptoms such as headache, blurred vision, nausea and vomiting, sleepiness and dizziness. Other symptoms can include difficulty concentrating, feeling in a fog or feeling slowed down, ringing in the ears, irritability, and sensitivity to noise.

Loss of consciousness is a very important signal that something serious has happened. But being "knocked out" isn't necessary to have a concussion. Headache is the most common symptom but some players aren't aware of any symptoms.

Symptoms resolve within the first 24 to 36 hours for most athletes. Symptoms persisting beyond a week are not uncommon. These usually clear up within a month's time. Only a small percentage of athletes (1.5 per cent) report symptoms lasting more than 30 days.

The immediate question after a collision is whether or not that player can return-to-play right away and if not, when can he or she get back into action? Symptoms offer some guidance but there are reports of deaths among athletes who failed to report symptoms and went back to play right away.

To avoid the deadly consequences of concussion, medical experts recommend computerized neuropsychologic (NP) testing. This type of test includes questions that evaluate the athlete's brain function including memory, attention, language, and visual-spatial skills. The NP test provides a comparison to expected norms for each task and a baseline from which to measure changes or progress after injury.

Data from the surveillance system for the 2008-2009 year showed that players who took the neuropsych (NP) test were less likely to return to sports play the same day as the injury. In fact, they didn't return to their sport for the first week after their injury. And a curious pattern emerged from this data: football players (the sports athlete most likely to sustain a concussion) were the least likely to be tested.

That last bit of news raised more than a few eyebrows. There is concern that football players are more likely than any other sports athletes to avoid reporting symptoms in an effort to stay in the game.

If this is true, there is much that needs to be done to protect athletes possibly through mandatory testing or even just education about the seriousness of this injury. Long-term studies are needed to see if there are later effects of concussions that don't show up for 5, to 10 to 20 years (or longer).

The safety of the player has to be the number one priority. Athletes should not be allowed to return to play until it is safe to do so. Neuropsychologic (NP) testing is one way to assure that players get the protection and treatment they need after a significant head injury.

Reference: William P. Meehan III, MD, et al. High School Concussions in the 2008-2009 Academic Year. In The American Journal of Sports Medicine. December 2010. Vol. 30. No. 12. Pp. 2405-2409.

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