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1 Introduction
Pages 19-54

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From page 19...
... ; rule changes designed to reduce the risk of head injury (e.g., Pop Warner Little Scholars, 2012, p. 44; USA Hockey, 2011, p.
From page 20...
... . The 17-member committee included experts in the areas of basic neuroscience, neuropathology, clinical expertise with head trauma in pediatric populations, sports medicine, emergency medicine, cognitive and educational psychology, psychiatry, bioengineering with an emphasis in pediatric biomechanics, youth sports organization representatives, active duty military training, epidemiology, statistics or statistical analysis and evaluation, and health communication (Appendix B)
From page 21...
... The report will include a section focused on youth sport concussion in military dependents as well as concussion resulting from sports and physical training at Service academies and recruit training for military personnel between the ages of 18 and 21. Recommendations will be geared toward research funding agencies (NIH, CDC, AHRQ, MCHB, DoD)
From page 22...
... , the committee chose to use the term "concussion" throughout the report. However, given the variable use of the terms "concussion" and "mild traumatic brain injury" in the literature, the committee decided to use whichever term was used by the source when referring to specific studies or articles.
From page 23...
... On the question of which activities should be regarded as "sports related," the committee recognized that sports can be competitive or recreational, including everything from football and cheerleading to mountain climbing and extreme sports, and it further recognized that concussions can result from other types of physical activity that are not traditionally considered sports, such as playground activities, physical education classes, and ropes and combatives courses during military training. Thus, the committee
From page 24...
... has notable limitations. As noted already, the poorly defined and inconsistent use of terminology (e.g., "concussion," "mild traumatic brain injury")
From page 25...
... Speakers included experts in the diagnosis, management, and rehabilitation of concussed athletes, including their reintegration into academic and athletic settings; genetic and neurogenetic sources of increased risk; the development of biomarkers and imaging technologies for concussion diagnosis and evaluation; protective equipment safety standards and effectiveness; and the role of sports rules and training in the prevention of sports-related concussion. The committee also heard from active duty military experts specializing in concussion policy and care and a representative from service academies specializing in training programs; stakeholder representatives, including athletes, parents, coaches, and officials; and representatives from youth sports organizations, such as the National Collegiate Athletic Association, the National Federation of State High School Associations, and the Amateur Athletic Union.
From page 26...
... . The Federal Interagency Traumatic Brain Injury Research (FITBIR)
From page 27...
... and sources of data (emergency departments, athletic trainers, coaches, parents) and differences in what is being measured (concussions, mTBIs, all TBIs)
From page 28...
... A study using data from 15 National Collegiate Athletic Association (NCAA) sports found that between the 1988-1989 and 2003-2004 academic years, the overall reported concussion rate doubled, from 1.7 to 3.4 per 10,000 athletic exposures2 (AEs)
From page 29...
... Operated by the U.S. Consumer Product Safety Commission, NEISS-AIP is an expansion of the National Electronic Injury Surveillance System (NEISS)
From page 30...
... with 24-hour emergency •  2001 to date departments (EDs) in the United States and its territories NCAA ISS •  ample of NCAA schools S •  CAA athletes N (NCAA Injury Surveillance across the three divisions, System)
From page 31...
... INTRODUCTION 31 Source of Data Strengths Limitations •  Medical record •  age groups All •  nly injuries treated in EDs O abstraction •  sports and All •  njuries seen in EDs may be I recreational activities more severe •  ationally representative N •  nly captures primary diagnosis O ED data over time (years) •  ariability in diagnosis of V concussion •  ariable data on mechanism V and circumstances of injury, including injuries involving sporting equipment in non-sports scenarios being categorized as sports-related •  umber of injuries only; cannot N be used to calculate injury rate •  eports by R •  ncludes participation I •  nly college-age athletes O athletic trainers data; can be used to at participating calculate injury rate •  imited to 16 competitive L programs sports •  ncludes data on I mechanism of and •  oes not account for differences D circumstances of injury in playing time (e.g., practice vs.
From page 32...
... .6 One positive aspect of NEISS-AIP is that it provides nationally representative ED data over a long period of time. However, a major limitation of using NEISS-AIP to estimate the incidence of sports-related concussion is that it captures data only on individuals treated in EDs, whereas many concussions are treated by athletic trainers, physicians, and other qualified personnel in other venues, and many concussions are not reported at all (Gilchrist et al., 2011; Hinton, 2012)
From page 33...
... . In 2004, the NCAA injury surveillance program began using an online reporting system, and in 2009, the Datalys Center for Sports Injury Research and Prevention, Inc., assumed management of the program (Datalys Center, 2013b)
From page 34...
... . Data are collected by athletic trainers on male and female participants in 25 sports from the first day of official pre-season practice through the final day of any postseason competition (personal communication with Datalys Center for Sports Injury Research and Prevention, Inc., September 23, 2013)
From page 35...
... The Datalys Center for Sports Injury Research and Prevention, Inc., assumed management of the NCAA injury surveillance program in 2009. dRate calculated with fewer than 30 raw frequencies.
From page 36...
... . As with the NCAA ISS, the High School RIO captures participation data in terms of athletic exposures, permitting the calculation of injury rates for the sports it tracks, although it too does not take into account differences in playing time among athletes.
From page 37...
... and NATA NATION (2010-2012) indicate higher reported concussion rates among high school versus college athletes in football, men's lacrosse, men's soccer, and baseball (Table 1-2; Datalys Center, 2013a,b)
From page 38...
... In general, reported concussion incidence is consistently higher in competition than in practice for both male and female athletes across all sports and age groups (Gessel et al., 2007; Hootman et al., 2007; Marar et al., 2012) .7 In addition, the two studies of concussion incidence among youth football players also show a higher rate of concussion in competition than in practice (Kontos et al., 2013; USA Football, 2013b)
From page 39...
... .9 In addition, women's ice hockey has one of the highest rates of reported concussions at the college level (Agel and Harvey, 2010; Datalys Center, 2013b; Hootman et al., 2007) , but no data are reported on the incidence of reported concussion for female athletes at the high school level.
From page 40...
... 1,028 (6.2) aPercent of emergency department visits for nonfatal TBI by age and sex.
From page 41...
... However, there are limited epidemiologic data on rates and types of injuries experienced by those participating in extreme sports. A prospective survey of 249 downhill mountain bike riders showed an overall injury rate of 16.8 injuries per 1,000 hours of exposure (Becker et al., 2013)
From page 42...
... . Although there is no reason to suspect that military personnel ages 18 to 21 who play intramural or service academy sports have different concussion risks than nonmilitary athletes of the same age participating in the same activities do, military service academies, such as West Point, require physical training activities, such as combatives and ropes courses, and offer other activities, such as boxing, that are not generally available at other collegiate institutions and that pose a high risk of concussion (Kelly, 2013; Wolfe, 2013)
From page 43...
... Consensus has emerged that individuals suspected of having sustained a concussion should be immediately removed from the activity in which they are engaged and should not return to physical activity until they have been cleared by a health care provider knowledgeable about concussion diagnosis and management (Giza et al., 2013; Halstead et al., 2010; Harmon et al., 2013; McCrory et al., 2013a)
From page 44...
... The military has acknowledged the need for a culture change, as reflected in such efforts as teaming up with the National Football League to increase awareness about TBI and to effect a culture change in which military personnel and athletes are willing to seek help (and not be stigmatized) if they experience concussive symptoms (AP, 2012; Vergun, 2012)
From page 45...
... immediate removal from play of any youth athlete suspected of having sustained a concussion or head injury; and (3) a requirement that an athlete who has been removed from play be evaluated by and receive written clearance from a health care professional trained in the evaluation and management of concussion before returning to play.
From page 46...
... and addressed issues pertaining to the development of and compliance with standards for "youth football helmets, reconditioned helmets, and new helmet concussion resistance." The 2011 bills died in committee, but similar legislation, the Youth Sports Concussion Act of 2013, was introduced in the House and Senate in May 2013 (H.R.
From page 47...
... • The National Collegiate Athletic Association Injury Surveillance System and High School RIO™ (Reporting Information Online) data systems are the only ongoing, comprehensive sources of sports-related injury data, including data on concussions, in youth athletes.
From page 48...
... 2009. Heads up: Facts for physicians about mild traumatic brain injury (mTBI)
From page 49...
... csm.2010.08.006. Datalys Center (Datalys Center for Sports Injury Research and Prevention, Inc.)
From page 50...
... 2013. Progress in developing common data elements for traumatic brain injury research: Ver sion two -- the end of the beginning.
From page 51...
... 2008. Gulf War and Health: Volume 7: Long-Term Consequences of Traumatic Brain Injury.
From page 52...
... I Maas, on behalf of The Demographics and Clinical Assessment Working Group of the International and Interagency Initiative toward Common Data Elements for Research on Traumatic Brain Injury and Psychologi cal Health.
From page 53...
... 2008. Accuracy of mild traumatic brain injury diagnosis.
From page 54...
... 2013. West Point health care providers focus on brain injury prevention, diagno sis, treatment.


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