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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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