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Concussions in High School Athletes. By Dr. Leyen Vu Resident Physician, St. Peter Hospital Sept. 28, 2010. Definition: Concussion. Change in mental status caused by a traumatic episode with or without loss of consciousness.

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Concussions in high school athletes

Concussions in High School Athletes

By Dr. Leyen Vu

Resident Physician, St. Peter Hospital

Sept. 28, 2010


Definition concussion
Definition: Concussion

  • Change in mental status caused by a traumatic episode with or without loss of consciousness.

    • May be caused by blow to the head or anywhere else on the body with an impulsive force on head

    • Most commonly no loss of consciousness


How often do concussions occur in sports
How Often Do Concussions Occur in Sports?

  • 300,000 sports related concussions each year

  • Most common sports: football, ice hockey, soccer, boxing, rugby.

    • 10% of college and 20% of high school football players suffer head injuries each season

    • Only 4-5% of players report symptoms.

      • 63.4% football

      • 10.5% wrestling

      • 6.2% girls basketball

  • 14% had repeat concussion during same season


Who gets more concussions
Who Gets More Concussions?

  • Males more likely than females

    • 2-3 times more likely




The science2
The Science

  • Children have weaker neck and shoulder muscles compared to adults

    • More of the impact is absorbed by the head and less by the upper body.

  • Most brain scans are still normal



Signs of a concussion1
Signs of a Concussion

  • Immediate

    • Confusion

    • Double vision, seeing stars

    • Not feeling right

    • Amnesia

      • Can’t remember the play, quarter, score

  • Later on

    • Headache

    • dizziness

    • Change in mood


Signs of a concussion2
Signs of a Concussion

  • Vacant Stare

  • Slower to answer questions

  • Can’t focus

  • Disorientation (walking in wrong direction)

  • Poor coordination

  • Poor memory

  • LOSS OF CONSCIOUSNESS


Sideline detection of concussion
Sideline Detection of Concussion

  • Suspected concussions need evaluation

  • May be unrecognized by non medical personnel

    • More than 80% of people with a previous concussion did not recognize it as such

  • Just asking time and date not adequate

  • “When in doubt, sit them out”


Standard assessment of concussion sac
Standard Assessment of Concussion (SAC)

  • Test at beginning of season and immediately after injury

    • Decline in 1 point 76-94% accurate in detecting concussion


Other tools
Other Tools

  • Brief Questionairre

    • What is your name?

    • What is the name of this place?

    • Why are you here?

    • What month are we in?

    • What year are we in?

    • In what town/suburb are you in?

    • How old are you?

    • What is your date of birth?

    • What time of day is it? (morning, afternoon, evening)

    • Three pictures are presented for subsequent recall


Other tools1
Other Tools

  • 1 wrong answer suggests concussion


Management
Management

  • Any athlete with suspected concussion MUST be removed from game/event

    • Cannot return to play on same day

    • Does not matter how mild concussion symptoms are!!!


Management1
Management

  • When to go to Hospital

    • Loss of consciousness

    • Suspected broken skull

      • Black eyes, bruising behind ears

    • Ear drainage

    • 2 or more episodes of vomiting

    • Significant neurologic impairment


Complications of concussions
Complications of Concussions

  • Bleeding in the brain

  • Second Impact Syndrome

    • Occurs when a second head injury occurs before 1st concussion can fully heal

    • Causes brain swelling

    • Can be deadly

    • Rare


Management2
Management

  • General Principles:

    • A player should not return to play until symptoms have resolved completely, both at rest and during activity

    • Younger athletes have longer recovery time and a more conservative approach should be taken

    • All suspected concussions should have medical evaluation by physician before returning to play


Management3
Management

  • Athlete should not be left alone after concussion

    • Need to monitor for worsening condition


How to return to play
How To Return to Play

Stepwise return to play (Vienna, 2001)

Day 1 - No activity and rest until no symptoms (i.e. headache dizziness, etc.)Day 2 – May start light aerobic exercise if no symptoms Day 3 - Sport-specific training Day 4 - Noncontact drills Day 5 - Full-contact drills Day 6 - Game play


How to return to play1
How To Return to Play

  • Day 1: complete brain rest (i.e. no reading, video games)

  • If you have symptoms at any level, you have to go back to the level where you have no symptoms .


Impact testing
IMPACT Testing

  • Neuropsychological test

    • Measures:

      • Attention span

      • Memory

      • Reaction Time

      • Non verbal problem solving

  • Considered a “cornerstone of concussion management”

  • Can be given by coach, trainer, anyone who is trained to administer test


Impact testing1
IMPACT Testing

  • May be able to detect subtle signs of a concussion

  • Can follow the accumulative effects of multiple concussions over time

  • Need Baseline test prior to injury to compare

  • Still being researched

  • Cannot alone determine return to play.


Long term consequences of multiple concussions
Long Term Consequences of Multiple Concussions

  • Alzheimers Disease

  • Parkinsons

  • Depression

  • Permanent memory problems

  • Long term brain damage

  • Vertigo



Chris henry cincinnati bengals
Chris Henry, Cincinnati Bengals

  • Chronic Brain Injury

  • Did not suffer any

    “documented” concussions

    in college or NFL


Zackery lystedt law
ZackeryLystedt Law

  • Passed May 14, 2009

  • Requires all school districts to work with the WIAA to develop guidelines to educate coaches, youth athletes, and parents of the nature and risk of concussion and head injury

  • Requires an informed consent must be signed by parents and youth athletes recognizing risk of concussions

  • Requires that a youth athlete who is suspected of sustaining a concussion or head injury be removed from play. “When in doubt, sit them out”

  • Requires a written clearance from licensed health care provider prior to returning to play.

  • http://www.king5.com/sports/high-school/Sports-Head-Injuries-83303332.html


Prevention
Prevention

  • Specialized helmets or mouthpieces- no clear benefit

  • May be more harmful

    • Athlete has false sense of security and changes behavior of play.


Summary
Summary

  • Concussions are much more common than previously believed

  • Players with concussions (even mild) should be removed from play

  • Stepwise approach to return to play

  • Must be seen by a medical professional and preferably get IMPACT testing prior to return

  • Long term mental effects of repeated concussions

  • New laws in place in Washington



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