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Prevention of Concussion: What Works, What Doesn’t and What’s Next April 30, 2013

VSCC & Rawlings Concussion Education Program. Prevention of Concussion: What Works, What Doesn’t and What’s Next April 30, 2013. Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation Assistant Professor of Pediatrics

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Prevention of Concussion: What Works, What Doesn’t and What’s Next April 30, 2013

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  1. VSCC & Rawlings Concussion Education Program Prevention of Concussion: What Works, What Doesn’t and What’s NextApril 30, 2013 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation Assistant Professor of Pediatrics Medical Director, Program for Injury Prevention in Youth Sports (PIPYS) Vanderbilt University Medical Center Team Physician Vanderbilt & Belmont Universities Nashville Sounds & Nashville Predators

  2. Disclosures • NO commercial relationships • Research & Educational funding • NIH U54 Institutional Clinical & Translational Science Award

  3. Objectives Review basic principles of injury prevention Discuss best evidence available for prevention of sports concussion Empower you to create a safer sporting environment and culture for youth athletes

  4. Injury Prevention 101

  5. Categories of Prevention • Primary • Preventing the injury from happening • Secondary • Reducing a possible injury’s severity • Tertiary • Working for the best outcome after an injury

  6. Injury Prevention is a Team Sport

  7. Emery CA et al. CJSM, 2006. Safety cannot be delegated, it is a shared responsibility of… • Parents • Coaches • Youth athletes • Safety advocates • Athletic trainers • Schools • Health professionals

  8. Approaches To Prevention Clinical Care Research

  9. Three More E’s • Evaluation • Economic incentives • Empowerment

  10. Strategies for Concussion Prevention

  11. Concussion Prevention: Equipment Football Helmets Mouth Guards Head Gear

  12. Football Helmet Ratings: STAR Evaluation System Virginia Tech National Impact Database. May 2012. • 5 Stars • Riddell 360 • Rawlings Quantum Plus • Riddell Revolution Speed • 4 Stars • Schutt ION 4D • Schutt DNA Pro + • Rawlings Impulse • Xenith X1 • Ridell Revolution • Rawlings Quantum • Riddell Revolution IQ • 3 Stars • Schutt Air XP • Xenith X2 • 2 Stars • Schutt Air Advantage • 1 Star • Riddell VSR4 • 0 Stars • Adams A2000 Pro Elite Reduction in concussion risk

  13. Mouth Guards • Effects of mouth guards on dental injuries and concussion in college basketball. • Labella et al. MSSE, 2002. (LOE 2) • Findings: • No difference in concussion rate • Significantly lower rate of dental trauma

  14. Head Gear in Soccer • Withnall et al. BJSM, 2005. • Three equipment types tested • No attenuation of mechanical forces due to heading ball • 33% reduction in acceleration forces from direct head-to-head contact • Further evidence needed for effect on injury or concussion prevention

  15. Navarro RR. Curr Sports Med Reports, 2011.

  16. McIntosh AS et al. BJSM, 2011. Summary of Helmet Benefits in Sports

  17. Headgear Fitting • Important across sports • A well maintained, properly fitted helmet required to provide advertised level of protection to athlete • Serious head injury (not concussion) • Frequently inspect equipment for wear and tear including cracks, defects and loss of proper fit • Hands-on demonstration • Rawlings

  18. Courtesy: Julie Gilchrist, MD, FAAP CDR, US Public Health Service Division of Unintentional Injury Prevention CDC’s “Heads Up” Initiative Goal: Improve prevention, recognition, and response to concussion among young athletes

  19. Targeting Youth Sports “Heads Up: Concussion in Youth Sports” • 2007 • 26 member partnership • Target = volunteers, parents • Content: • Audience ready & appropriate • Fact sheets for coaches, parents, and athletes • Clipboard • Magnet • Poster • Concussion quiz

  20. CDC Unpublished Data Evaluation: Youth Sports Toolkit • Changed knowledge, attitudes, behavior • 63% viewed concussion more seriously • 77% reported more skill in indentifying potential concussions • 72% educated others: athletes, parents, other coaches

  21. Targeting High School Sports “Heads Up: Concussion in High School Sports” • 2005, 2010 • 14 organization collaboration • Target = coaches • Content: • Personal story video • Guide for coaches • Wallet card • Clipboard sticker • Posters • Fact sheets for parents and athletes

  22. New Online Trainings for Coaches (Developed 2010) Youth Sports Coaches High School Coaches • > 200,000 completed sessions Football Coaches

  23. 2010 Based on national needs assessment 31 organization collaboration Target = school personnel/officials Content: Fact sheets Symptom checklist Magnet Poster Laminated card Concussion in Schools (K-12) “Heads Up to Schools: Know Your Concussion ABCs” 3 months = 230,000 copies Prevention, Recognition, Response…RECOVERY

  24. “Heads Up: Brain Injury in Your Practice” Targeting Primary Care Physicians • 2003, 2007 • 15 agency cooperative • Content: • Diagnosis, management & referral recommendations • ACE symptom evaluation tool • ACE Care Plan • “Concussion in Sports” palm card • Patient education materials

  25. Targeting Emergency Care Providers Acute Care Setting: “Updated Mild Traumatic Brain Injury Guidelines for Adults” Coming attractions… Pediatric MTBI guidelines!!! • 2008 clinical guidelines • Pocket card for clinicians • Wallet card for patients • Patient discharge handout • Integrated into electronic discharge and clinician education systems Implementation > 85% US ER’s

  26. Sport-Specific Information • Extensive collaboration • National sports governing bodies • Football, lacrosse, volleyball, hockey, soccer, baseball, softball, rugby, field hockey • NCAA • Educational resources • Policy change • Tournament PSA’s • NFL/NFLPA • Locker room posters • Youth version • Postseason/Times Square PSA’s More to come…

  27. Obtaining Copies of the Materials All materials are available at NO COST at: www.cdc.gov/Concussion.

  28. Educational Programs & Rule Changes • Adherence to rules & limit illegal play • 6.4% of overall injuries in 9 HS sports were related to rules transgressions (98,066 injuries/yr) • Collins CL et al. InjPrev, 2008. (RIO) • Teaching proper fundamentals & technique • Tackle with head up (↓head/neck trauma) • Heading in soccer (developmental readiness) • Educational & Awareness campaigns • Improved knowledge & attitudes

  29. Emergency Action Plan (EAP) • All organizations should have in place • Detailed instructions for all contingencies and potential persons responding to an emergency • Include concussion protocols (CAP) • Include a map of the facilities • Practice

  30. Concussion Prevention Efforts:Take Home Increased awareness of risk Use of preventive gear and behaviors Institute & adhere to preventive policies/rules Improved coaching of skills Strict officiating Enhanced recognition and response

  31. Program for Injury Prevention in Youth Sports (PIPYS) A Game Plan for Safety and Health in the Young Athlete

  32. Overview • One of the first of its kind established in the nation (2011) • Multidisciplinary partnership • Dedicated solely to the pediatric and adolescent aged athlete • Addressing all aspects of injury prevention and safety in youth sports • Research, education, community outreach, social & political action, clinical care

  33. Thank You • http://www.childrenshospital.vanderbilt.org/sportssafety • www.vanderbiltsportsmedicine.com • www.vanderbiltconcussion.com

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