Sports-Related Concussions in Youth Improving the Science, Changing the Culture (2014) / Chapter Skim
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, in October 2012, convened the Committee on Sports-Related Concussions in Youth to review the science of sportsrelated concussions in youth from elementary school through young adulthood, including military personnel and their dependents, and to prepare a report on that topic based on that review. The committee was charged with reviewing the available literature on concussions within the context of developmental neurobiology, specifically relating to the causes of concussions, their relationship to impacts to the head or body during sports, the 1
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Nevertheless, existing data suggest that sports-related concussions represent a significant public health concern. It has been estimated that as many as 1.6 million to 3.8 million sports- and recreation-related traumatic brain injuries (TBIs)
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. Available data show that among male athletes in the United States at the high school and collegiate levels, football, ice hockey, lacrosse, wrestling, and soccer consistently are associated with the highest rates of reported concussions (Datalys Center, 2013a,b; Gessel et al., 2007; Hootman et al., 2007; Lincoln et al., 2011; Marar et al., 2012)
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during military training. Concerning concussions sustained by military personnel ages 18 to 21 who play intramural or service academy sports, there is no reason to suspect that the concussion risks are different from those for nonmilitary athletes of the same age, although military service academies require certain physical training activities, such as combatives and ropes courses, and offer other activities, such as boxing, that may pose a high risk of concussion (Kelly, 2013; Wolfe, 2013)
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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.
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Speakers included experts in: the diagnosis, management, and rehabilitation of concussed youth athletes, including their reintegration into academic and athletic settings; the 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 concussions. To help address the portion of its charge concerning concussions among military personnel and their dependents, an area for which there is little published research, the committee heard from experts on concussions in military and service academy training programs.
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Concussion Definition and Surveillance Needs The National Collegiate Athletic Association Injury Surveillance System and High School RIOTM (Reporting Information Online) data systems are the only ongoing, comprehensive sources of sports-related injury data, including data on concussions, in youth athletes.
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However, little research has been conducted specifically on changes in the brain following concussions in youth, and little research has attempted to evaluate differences in such changes between female and male youth. Research using newer noninvasive imaging techniques in the first hours and days following injury may help to improve understanding of the neurobiology of concussion.
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Preliminary evidence indicates that, in addition to the number of concussions an individual has sustained, the time interval between concussions may be an important factor in the risk for and severity of subsequent concussions. Risk Factors for Sports-Related Concussions, Post-Concussion Syndrome, and Chronic Traumatic Encephalopathy There are normal changes in brain structure, blood flow, and metabolism that occur with brain development that may influence the susceptibility to and prognosis following concussions in youth.
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The marketing of some protective devices designed specifically for youth athletes, such as mouthguards and soccer head gear, has included statements that these devices reduce concussion risk without sufficient scientific foundation to support such claims. Because of the nonlinear relationship between the mechanical input and injury risk, reductions in a specific biomechanical parameter, such as head acceleration, by a particular protective device do not correspond to an
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Although additional research across a variety of sports is needed, some studies involving youth ice hockey and soccer players have shown that the enforcement of rules and fair play policies contributes to reductions in the incidence of sports-related injuries, including concussions. In response to concerns about the long-term consequences of repetitive head impacts, several organizations have called for a "hit count" in youth sports, which is defined as a limit on the amount of head contact a particular player experiences over a given amount of time.
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In group studies these tests have been shown to be useful for tracking cognitive recovery for up to 2 weeks post injury, with a majority of concussions considered to be resolved by that time. The results of reliability studies for computerized neuropsychological tests are quite variable, with some studies demonstrating adequate reliability and others indicating less than adequate reliability.
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Similarly, there is little evidence regarding the efficacy of cognitive rest following concussion or to inform the best timing and approach for return to cognitive activity following concussion, including protocols for returning students to school. There are no randomized clinical trials testing the efficacy of psychosocial or psychopharmacological treatments for children and adolescents with post-concussion symptoms and prolonged recovery.
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2013a. NATA NATION Preliminary Concussion Rates, 2010-2012.
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The Department of Defense should conduct equivalent research for sports and physical training, including combatives, at military service academies and for military personnel. Recommendation 5.
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2008. Gulf War and Health: Volume 7: Long-Term Consequences of Traumatic Brain Injury.
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In Mild Traumatic Brain Injuries in Children and Adolescents: From Basic Science to Clinical Management, edited by M Kirkwood and K
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