Are Pediatric Concussion Rates Under-Counted?

A growing concern that pediatric concussions may be consistently under-counted and not being properly addressed? -JR

Are Pediatric Concussion Rates Undercounted?

​BY FRAN KRITZ

The number of pediatric concussions in the United States each year may be undercounted by as much as 80 percent, according to a study by researchers from both the Children's Hospital of Philadelphia (CHOP) and the US Centers for Disease Control and Prevention (CDC). The study, published last month in JAMA Pediatrics, also found that many concussions occur in children under age 12, younger than had been thought.

Study Parameters

Researchers reviewed data from CHOP's electronic health records, identifying and analyzing more than 8,000 concussion diagnoses from July 2010 to June 2014 among children up to age 17 who received their primary care in the CHOP healthcare network. During that period, primary care visits for pediatric concussions increased by 13 percent, while emergency department (ED) visits for concussions decreased by 16 percent.  Eighty-two percent of the pediatric patients had their first concussion visit at a primary care site, 12 percent at the ED, 5 percent with a specialist such as a sports medicine physician, neurologist, or trauma specialist, and 1 percent were directly admitted to the hospital.

"We learned two important things from this study," says Kristy Arbogast, PhD, lead author of the study and co-scientific director of CHOP's Center for Injury Research and Prevention. "First, four in five of this diverse group were diagnosed at a primary care practice—not the emergency department. Second, one-third were under age 12, and therefore represent an important part of the concussion population that is missed by existing surveillance systems."

Advice for Parents

(Relative - JR) Rest—both physical and cognitive—is key to recovery from a concussion, but parents often need guidance as to what activities their child can and cannot do while resting to help speed recovery, says Dr. Giza. Both the American Academy of Neurology  and the American Academy of Pediatrics have issued guidelines for assessment of and recovery from concussions in the last few years.

The CDC has an online concussion treatment and recovery information called Heads Up, which includes a fact sheet for parents.

FULL ARTICLE HERE:  

Are Pediatric Concussion Rates Under-Counted?

A growing concern that pediatric concussions may be consistently under-counted and not being properly addressed? -JR

Are Pediatric Concussion Rates Undercounted?

​BY FRAN KRITZ

The number of pediatric concussions in the United States each year may be undercounted by as much as 80 percent, according to a study by researchers from both the Children's Hospital of Philadelphia (CHOP) and the US Centers for Disease Control and Prevention (CDC). The study, published last month in JAMA Pediatrics, also found that many concussions occur in children under age 12, younger than had been thought.

Study Parameters

Researchers reviewed data from CHOP's electronic health records, identifying and analyzing more than 8,000 concussion diagnoses from July 2010 to June 2014 among children up to age 17 who received their primary care in the CHOP healthcare network. During that period, primary care visits for pediatric concussions increased by 13 percent, while emergency department (ED) visits for concussions decreased by 16 percent.  Eighty-two percent of the pediatric patients had their first concussion visit at a primary care site, 12 percent at the ED, 5 percent with a specialist such as a sports medicine physician, neurologist, or trauma specialist, and 1 percent were directly admitted to the hospital.

"We learned two important things from this study," says Kristy Arbogast, PhD, lead author of the study and co-scientific director of CHOP's Center for Injury Research and Prevention. "First, four in five of this diverse group were diagnosed at a primary care practice—not the emergency department. Second, one-third were under age 12, and therefore represent an important part of the concussion population that is missed by existing surveillance systems."

Advice for Parents

(Relative - JR) Rest—both physical and cognitive—is key to recovery from a concussion, but parents often need guidance as to what activities their child can and cannot do while resting to help speed recovery, says Dr. Giza. Both the American Academy of Neurology  and the American Academy of Pediatrics have issued guidelines for assessment of and recovery from concussions in the last few years.

The CDC has an online concussion treatment and recovery information called Heads Up, which includes a fact sheet for parents.

FULL ARTICLE HERE:  

Increase in concussions seen in Ontario's children

A study showed that concussions in Ontario's children significantly increased between 2003 and 2010.

The number of children and youth treated for concussions in both emergency departments and physician's offices in Ontario increased significantly between 2003 and 2010, with falls, hockey and skating injuries identified as the leading causes of pediatric concussion, according to a new joint study out of York University and the Institute for Clinical Evaluative Sciences (ICES).

The study," A population-based study of pediatric emergency department and office visits for concussions from 2003 to 2010," published in the journal Paediatrics & Child Health, analyzed all visits related to a concussion by school-aged youth (three to 18 years) in Ontario from 2003 to 2010.

"This study is the first to examine pediatric concussions evaluated in both emergency departments and physicians' offices," says York University Professor Alison Macpherson, the study's lead author. "By examining all of the pediatric concussions evaluated in multiple facilities, we were able to minimize the issue of under-reporting and obtain a more accurate number of concussions treated in Ontario."

Between 2003 and 2010, researchers found a total of 88,688 pediatric concussions were treated in either an emergency department or a physician's office, and there was a significant trend in both locations. The total rate of concussions per 100,000 increased from 466.7 to 754.3 (for boys), and from 208.6 to 440.7 (for girls) during the study period. The numbers also showed that over time more children were being evaluated in physician's offices than emergency departments.

When the sources of concussion were broadly examined, falls were found to be the most common cause of concussion in an emergency department, representing 34 per cent of all emergency department visits, followed closely by exposure to force (25.5 per cent) and motor vehicle collisions (12.3 per cent). When specific causes were examined in more detail, hockey and skating -- common sports in North America -- were the most common causes of concussions that were treated in an emergency department.

"Our findings reinforced that falls in general are the most common cause of pediatric concussions, and that evidence-based prevention initiatives to help reduce the incidence of concussion are warranted -- particularly in sports and recreation programs," says senior scientist and chief science officer at ICES, Dr. Astrid Guttmann, the study's senior author. "Sports-related concussions can be minimized by taking preventive action, such as reducing body checking in hockey or wearing a helmet while cycling."

Macpherson says that future studies can attempt to differentiate between the true incidence of concussions and an increase in those seeking a health evaluation due to increased awareness of concussion and subsequent health consequences.

Read more here

Athletes worsen after recovering from concussion and returning to exercise

A study showed that athletes who have recovered from a concussion can worsen after returning to exercise.

Athletes who seem to have recovered from a concussion may actually show a subtle worsening in a particular mental ability after they return to exercise, a small study suggests.

The findings come from a study of 19 high school athletes who suffered a concussion and then got medical clearance to return to physical activity -- most often football, although a few were on soccer, wrestling or volleyball teams.

Researchers found that for 12 of those athletes, a particular mental ability that had been improving post-concussion reversed course once they were up and moving again.

Specifically, the athletes' ability to simultaneously walk and do simple mental tasks "regressed," the researchers report in the journal Medicine & Science in Sports & Exercise.

In real-life terms, that means walking down the street while talking to a friend would be a bit harder, explained Li-Shan Chou, one of the researchers on the study.

The shift would be too subtle for a person to actually notice, said Chou, a professor of human physiology at the University of Oregon in Eugene.

But he and his colleagues were able to detect the regression in lab tests where the athletes walked while performing basic mental tasks -- like listening to a spoken word, then saying whether it was a high or low pitch.

What does it all mean? That's not clear, said Kenneth Podell, a concussion expert who was not involved in the study.

For one, since the study group was so small, the findings need to be replicated in larger studies to know whether they are "real," according to Podell, co-director of the Houston Methodist Concussion Center in Texas.

He also questioned how the athletes could show an improvement in their test performance early on, when they were "most concussed," but then worsen after all their other signs and symptoms had improved.

Chou agreed that the implications of his findings are unclear. For now, he said the study highlights the importance of giving concussions time to heal.

"Have patience, and give the brain time to recover," Chou added.

According to the American Academy of Neurology (AAN), more than 1 million athletes in the United States suffer a concussion each year.

Concussion symptoms include headache, dizziness, nausea, ringing in the ears, fatigue and confusion -- though these problems may not become noticeable until hours after the jolt to the head. And contrary to popular belief, concussions usually do not cause unconsciousness.

When athletes are recovering from a concussion, the "standard of care" is to gradually return them to physical activity before they can get back on the field, Podell said.

In fact, all 50 states and the District of Columbia now have some kind of law on youth concussions, protecting athletes from returning to the playing fields too soon.

But there is no "set timeline" for safe return to play, according to the AAN. And judging recovery is subjective, Chou said, because it involves asking patients how they feel.

The current findings are based on 19 high school athletes who were periodically assessed for two months after sustaining a concussion. All returned to physical activity, with medical clearance, during that time.

Chou's team found that once they were active again, 12 of the athletes showed some reversal in their ability to walk and perform mental tasks simultaneously. The problem showed up as a subtle change in their walking speed or balance.

Still, Podell said, it's not clear what to make of that. Even if the athletes' gait did regress when they first started physical activity, it might have been "fine" by the time they got back into their sport, he noted.

"The take-away for parents is, the return from concussion is complex, and the best clinical practice calls for a slow and gradual return to activity under the guidance of professionals," Podell said.

But it's not only physical activity that matters, he added. Concussed kids should also take a break from mental stress and only gradually return to schoolwork.

"Just because a student-athlete is ready to exercise does not mean they are 100-percent ready for a full load at school," Podell said.

Read more here

CDC's Heads Up app helps to spot symptoms of concussions in children

Summer concussions are from falls and accidents. I see many water sport induced brain injuries.

 If your child is not right, trust your instincts. Trust your child if they feel they are not right. See a physician! - JR

An app created by the CDC helps to spot symptoms of concussions in children.

Need a primer on how to spot the signs of a concussion for your child? The Centers For Disease Control and Prevention's Heads Up app will help you learn how to recognize the signs and symptoms, and what to do if you think a child has a concussion or other serious brain injury.

This is crucial information that you can find easily in the app to act quickly if needed. Children and teen athletes are more susceptible to concussion than older athletes, and they have an increased risk compared to adults for traumatic brain injury with greater severity and prolonged recovery due to their developing brains.

The app says that signs and symptoms generally appear soon after an injury, but the seriousness of the injury and some symptoms may not appear for hours or days. In rare cases of a hematoma (a collection of blood in the brain), you would need to take your child immediately to the emergency room. If a child does suffer from a concussion, there is information on recovery, such as when to return to school and sports.

This app can also help you pick the right helmet for your child's activity, including what to look for and what to avoid. For example, you can choose hockey to find out about the correct size and fit, tips for finding a good helmet, and how long it should last.

Besides sports, there are safety tips to prevent brain injuries at home, playground, cars, homes, and bikes.

Lastly, the CDC encourages to share information on concussions with others. In May, President Obama at the Healthy Kids and Safe Sports Concussion Summit called for the end of the culture in youth sports where kids are encouraged to “suck it up” after sustaining head injuries.

“We have to change a culture that says you suck it up,” said President. “Identifying a concussion and being able to self-diagnose that this is something that I need to take care of doesn’t make you weak - it means you’re strong.”

Read more here

Children's concussion symptoms stay after injury

A study shows that the symptoms of concussions in children stay long after the injury occurrence.

Kids who suffer a concussion can have lingering effects long after the physical symptoms fade away, U.S. researchers report.

In a study from the emergency medicine division at Boston Children's Hospital, doctors found that, while headache, dizziness and blurry vision can appear right after a concussion, emotional and mental symptoms, such as irritability and frustration, show up much later and stay longer.

"Patients and their families should expect the physical symptoms that they experience after a head injury to get better over the next few weeks, but that emotional symptoms may come on later, even as the physical symptoms subside," said lead researcher Dr. Matthew Eisenberg.

"Only by knowing what symptoms can be expected after a concussion can we help reassure patients and families that what they experience is normal, know when to seek additional help, and make sure that children are taking appropriate precautions in regard to school and sports to achieve a full recovery," Eisenberg added.

For the study, published online May 12 and in the June print issue of Pediatrics, Eisenberg's team used questionnaires to keep track of 235 children and young adults, aged 11 to 22, who suffered a concussion and went to a pediatric emergency department.

The patients were followed for three months after their injury, or until all their symptoms were gone. During that time they were asked about symptoms, sports activity, and school and athletic performance.

The most common physical symptoms were headache, dizziness and fatigue, which tended to start right after the injury and got better over time. Most also had mental symptoms, such as difficulty concentrating and taking longer to think, the researchers found.

While most children recovered within two weeks after the injury, 25 percent still had headache a month after their injury, the investigators found.

In addition, more than 20 percent suffered from fatigue, and nearly 20 percent reported taking longer to think for a month after their concussion.

For many, emotional symptoms -- such as frustration and irritability -- were not as common right after the injury, but developed later, the study authors noted.

Dr. John Kuluz, director of traumatic brain injury and neurorehabilitation at Miami Children's Hospital, said, "It takes longer than people think to fully recover from a concussion. My experience is that kids who still have symptoms two weeks after a concussion are going to have a very hard time, and it's going to be a struggle to get them to the point where they have no symptoms."

In addition to physical and mental rest, Kuluz believes in treating the symptoms. He prescribes ibuprofen and other medications to relieve headache, and melatonin and other drugs to help patients sleep.

Kuluz also recommends physical therapy to help children recover. Therapy includes working on balance and helping with any vision problems. "Therapy also helps you find your threshold for exertion. Many of my kids find that very helpful," he said.

He also recommends keeping children out of school for a couple of days after the injury and then gradually letting them get back to a normal routine.

"Keeping a child out of school for too long will have a negative effect on their mental health. They will become anxious, they'll become irritable, because they worry about falling behind," he said. "But if they go back too soon without teachers being aware of their condition, they can fail, and it happens a lot."

Kuluz tries to get kids back to school for half a day or as much as they can tolerate until they get better. Children should not start sports again until all symptoms have disappeared and then only gradually, he added.

If a child still has symptoms two or three days after a concussion, Kuluz recommends seeing a doctor who is experienced in dealing with concussions or going to a concussion clinic.

Read more here

Causes of childhood concussion in rural versus urban areas

A study of causes of childhood concussions in rural versus urban areas shows that children living in rural areas get concussions from motorized vehicles and children living in urban areas get concussions from sports.

Researchers at Western University (London, Canada) have found youth living in rural areas are more likely to sustain concussions from injuries involving motorized vehicles such as all-terrain vehicles and dirt bikes, whereas youth living in urban areas suffer concussions mostly as a result of sports. Hockey accounts for 40 per cent of those injuries. The study which reveals where and how children are receiving concussions is published in the Journal of Trauma and Acute Care Surgery.

Dr. Doug Fraser, a scientist with the Children's Health Research Institute at Lawson Health Research Institute and Tanya Charyk Stewart, the Injury Epidemiologist for the Trauma Program at Children's Hospital, London Health Sciences Centre (LHSC) and their team tracked all the youth under the age of 18 who presented to the LHSC emergency departments with a concussion over a six year period. There were 2,112 paediatric concussions, with a steady increase in number treated each year.

"It was important for us to learn about who is getting injured, where they're getting injured, and why they're getting injured. Once you answer those questions, then you can implement targeted injury prevention programs," says Dr. Fraser, an associate professor in the Departments of Paediatrics, Physiology & Pharmacology and Clinical Neurological Sciences at Western's Schulich School of Medicine & Dentistry.

Concussions are a particular concern for children and adolescents because their brains are still developing and they are more susceptible to effects of a head injury. The goal following this research is to create injury prevention programs that target and educate those at high risk of sustaining a concussion.

Concussions can often be predictable. Along with properly following the rules of the sport and wearing the protective equipment, Charyk Stewart suggests, "In sports, if you have been hit, then just get off the field immediately and stop play. If you are experiencing any symptoms, be seen by a doctor."

Dr. Fraser explained what to look for in a child who has experienced a head injury, "Watch the person carefully. In young children look for symptoms like, irritability or an inability to console the child. If the care giver has any concerns at all; if a person has any symptoms whatsoever in conjunction with an injury, they should immediately go and be seen by a doctor. Better safe than sorry, so be seen."

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A blood test may help diagnose concussions

This article discusses research that claims that a blood test could be a non-subjective way to diagnose a concussion.

A report Monday in the journal Pediatrics says kids who suffer concussions should lay off reading, homework and video games. By giving their brains a rest, most can recover in 20 to 50 days, about twice as fast as those who keep doing those activities.

We also have news regarding how concussions are diagnosed. Researchers are developing a test that could be a game changer.

Quarterback Taylor Kelly of the Arizona State Sun Devils understands the mindset of college football players when it comes to injuries: They are going to want to keep playing.

"Guys just want to go out and play it, you know?  They don't care if their heads are a little banged up," Kelly said.

Neurologist Dr. Javier Cardenas specializes in brain injury. He says overcoming the reluctance of athletes to admit symptoms is only one of the problems in diagnosing concussions.

"Right now when we identify a concussion it is purely subjective. We look at symptoms. Do they have headaches? Do they have dizziness? There is no objective information. Having something objective is the holy grail of concussion," said Cardenas.

This season, Kelly and his teammates took part in a study trying to find a better way to detect concussion. Riddell, the athletic equipment company, supplied the team with helmets that measure all head impacts during practices and games. Then, after every game, the players gave samples of their blood, saliva and urine.

These are now being analyzed at the Translational Genomics Research Institute in Phoenix to see whether evidence of head trauma shows up in body fluids as a so-called biomarker.

Brain cells contain generic material call microRNA. Normally, tiny spheres containing that material break off and make their way into the spinal fluid, then the bloodstream. During a concussion, the bran actually bounces against the skull, and researchers believe the impact can cause changes in the microRNA, changes they hope can be detected in blood tests.

TGen scientists are comparing the RNA in each player's body fluids with the impact data from his helmet to see if they match up.

"It might be that we can actually protect players. So identify players who are at risk but have them take it easy, sit out more, based how their biomarkers are rising over time," said Kendall Van Keuren-Jenses, a member of the research team.

The scientists have data illustrating how the technology might have helped one of the players in the study.

The graphic shows the head impacts recorded in his helmet over several weeks. One hit was the equivalent of four times the punch b a heavyweight boxer – the hardest impact received by any player in the study. He continued to play, and was diagnosed with a concussion 10 days later.

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Children May Need Gradual Transition Back to Academics After Concussion

The American Academy of Pediatrics claims that once a child has a concussion, he or she may need a gradual transition back to school and academic classes.

This article is helpful in that it details accommodations.

I have some trouble with the assertions about rest. JR

A concussion should not only take a student athlete off the playing field -- it may also require a break from the classroom, according to a new clinical report from the American Academy of Pediatrics (AAP).

In the clinical report, "Returning to Learning Following a Concussion," released Sunday, Oct. 27 at the AAP National Conference & Exhibition in Orlando, the AAP offers guidance to pediatricians caring for children and adolescents after suffering a concussion.

"Students appear physically normal after a concussion, so it may be difficult for teachers and administrators to understand the extent of the child's injuries and recognize the potential need for academic adjustments," said Mark Halstead, MD, FAAP, a lead author of the clinical report. "But we know that children who've had a concussion may have trouble learning new material and remembering what they've learned, and returning to academics may worsen concussion symptoms."

Research has shown that a school-aged student usually recovers from a concussion within three weeks. If symptoms are severe, some students may need to stay home from school after a concussion. If symptoms or mild or tolerable, the parent may consider returning him or her to school, perhaps with some adjustments. Students with severe or prolonged symptoms lasting more than 3 weeks may require more formalized academic accommodations.

The AAP recommends a collaborative team approach to help a student recovering from a concussion. This team should consist of the child or adolescent's pediatrician, family members and individuals at the child's school responsible for both the student's academic schedule and physical activity. Detailed guidance on returning to sports and physical activities is contained in the 2010 AAP clinical report, "Sport-Related Concussion in Children and Adolescents."

A symptom checklist can help evaluate what symptoms the student is experiencing, and how severe they are.

"Every concussion is unique and symptoms will vary from student to student, so managing a student's return to the classroom will require an individualized approach," said Dr. Halstead. "The goal is to minimize disruptions to the student's life and return the student to school as soon as possible, and as symptoms improve, to increase the student's social, mental and physical activities."

Because relatively little research has been conducted on how concussion affects students' learning, the AAP based its report primarily on expert opinion and adapted it from a concussion management program developed at the Rocky Mountain Hospital for Children, Center for Concussion in Denver, Colo. The AAP calls for further research on the effects and role of cognitive rest after concussion to improve understanding of the best ways to help a student recovering from a concussion.

Read more here

Self-reporting concussions in youth sports is dealing with a "culture of resistance"

Youth sports are currently trying to deal with the "culture of resistance" that has formed around self-reporting concussions.

Young athletes in the U.S. face a "culture of resistance" to reporting when they might have a concussion and to complying with treatment plans, which could endanger their well-being, says a new report from the Institute of Medicine and National Research Council. The report provides a broad examination of concussions in a variety of youth sports with athletes aged 5 to 21. Overall, reported concussions rates are more frequent among high school athletes than college athletes in some sports -- including football, men's lacrosse and soccer, and baseball; higher for competition than practice (except for cheerleading); and highest in football, ice hockey, lacrosse, wrestling, soccer, and women's basketball. Concussion rates also appear higher for youths with a history of prior concussions and among female athletes.

Although the committee that wrote the report examined useful scientific information to inform its study, it discovered that research about youth concussions is limited. To address these gaps in knowledge, the committee identified several areas for further research, including establishing a national surveillance system to accurately determine the number of sports-related concussions, identifying changes in the brain following concussions in youth, conducting studies to assess the consequences and effects of concussions over a life span, and evaluating the effectiveness of sports rules and playing practices in reducing concussions.

"The findings of our report justify the concerns about sports concussions in young people," said Robert Graham, chair of the committee and director of the national program office for Aligning Forces for Quality at George Washington University, Washington, D.C. "However, there are numerous areas in which we need more and better data. Until we have that information, we urge parents, schools, athletic departments, and the public to examine carefully what we do know, as with any decision regarding risk, so they can make more informed decisions about young athletes playing sports."

The committee found little evidence that current sports helmet designs reduce the risk of concussions. It stressed that properly fitted helmets, face masks, and mouth guards should still be used, because they reduce the risk of other injuries -- such as skull fractures; bleeding inside the skull; and injuries to the eyes, face, and mouth. The marketing for some protective devices designed for youth athletes, such as mouth guards and headbands for soccer, has advertised that these devices reduce concussion risk, but there is a lack of scientific evidence to support such claims, the committee said.

The committee examined scientific literature on concussion recognition, diagnosis, and management and found that the signs and symptoms of concussion are usually placed into four categories -- physical, cognitive, emotional, and sleep -- with patients experiencing one or more symptoms from one or more categories. Typically, youth athletes recover from a concussion within two weeks of the injury, but in 10 percent to 20 percent of cases concussion symptoms persist for a number of weeks, months, or even years. A potentially concussive injury requires removing the athlete from play, caring for the injury appropriately in both the acute stage and during the recovery process, and returning to play only when he or she has recovered demonstrably and is no longer having any symptoms, the committee said. An individualized treatment plan that includes physical and mental rest may be beneficial for recovery from a concussion, but current research does not indicate a standard or universal level and duration of rest needed. Athletes who return to play before their brain has fully healed may place themselves at increased risk for prolonged recovery or more serious consequences if they sustain a second brain injury.

The committee examined data on the effects of single and multiple concussions and found some observed impairments in the areas of memory and processing speed. It also determined that a history of previous concussions is a predictor of increased risk for future concussions, although the extent to which the risk is increased is unknown. In several studies, the number and severity of concussion symptoms is greater in athletes with a history of two or more concussions. Additionally, athletes with a history of prior concussions may have more severe subsequent concussions and may take longer to recover. The time interval between concussions may also be an important factor in the risk for and the severity of subsequent concussions. Whether repetitive head impacts and multiple concussions sustained in youth lead to long-term neurodegenerative disease, such as Chronic Traumatic Encephalopathy (CTE), remains unclear.

The committee reviewed surveys of retired professional athletes, which provided some evidence that a history of multiple concussions increases risk for depression. In a survey of more than 2,500 retired professional football players, approximately 11 percent reported having a prior or current diagnosis of clinical depression. Very little research has evaluated the relationship between concussions and suicidal thoughts and behaviors. There currently are no data to evaluate this relationship because existing post-concussion symptom evaluations do not assess suicidal thoughts.

Some studies have shown that enforcement of sports rules by coaches and officials and adherence to these rules by players may help reduce the incidence and severity of sport-related concussions in youths. Several organizations have called for a "hit count" in youth sports to limit the amount of head contact a particular player should experience over a given amount of time. While the concept of limiting the number of head impacts is fundamentally sound, the committee found that implementing a specific threshold for the number of impacts or the magnitude of impacts per week or per season is without scientific basis.

The committee included additional noteworthy findings in the report:

• The reported number of individuals aged 19 and under treated in U.S. emergency departments for concussions and other non-fatal, sports- and recreation-related TBIs increased from 150,000 in 2001 to 250,000 in 2009.
• Football, ice hockey, lacrosse, wrestling, and soccer are associated with the highest rates of reported concussions for U.S. male athletes at the high school and college levels.
• Soccer, lacrosse, and basketball are associated with the highest rates of reported concussions for U.S. female athletes at the high school and college levels. Women's ice hockey at the collegiate level has the highest rate of reported concussions.
• Youths with a history of prior concussion have higher rates of reported sports-related concussions.
• Among military personnel, mild traumatic brain injuries, of which concussions are one category, represent about 85 percent of all TBIs.
• Among military personnel, about 80 percent of mild TBIs do not occur in the deployed setting and are commonly caused by automobile crashes involving privately owned and military vehicles, falls, sports and recreation activities, and military training.

Read more here

No helmet can prevent concussions, regardless of manufacturer's claims

A study by the American Academy of Pediatrics claims that regardless of claims made by manufacturers, no specific helmet can prevent or reduce incidence of concussions.

While many football helmet and mouth guard manufacturers claim that their equipment will lessen impact forces and reduce concussion risk, neither a specific brand nor a higher cost were associated with fewer concussions in adolescent athletes, according to an abstract presented Monday, Oct. 28 at the American Academy of Pediatrics (AAP) National Conference and Exhibition in Orlando.

"Our preliminary findings suggest that neither any specific brand of football helmet nor custom mouth guards result in fewer concussions in kids who use them," said lead co-investigator Margaret Alison Brooks, MD, MPH, FAAP. "Despite what manufacturers might claim, newer and more expensive equipment may not reduce concussion risk. So is it worth the significant extra cost to families and schools?"

Each year, approximately 40,000 sport related concussions (SRC) occur in U.S. high schools. In the abstract, "Association of Helmet Brand and Mouth Guard Type with Incidence of Sport Related Concussion in High School Football Players," researchers tested various mouth guard brands, including custom-fit mouth guards, and new and older football helmets.

The study involved 1,332 football players at 36 high schools during the 2012 football season.Players completed a pre-season demographic and injury questionnaire, and athletic trainers recorded incidence and severity of SRC throughout the year.

Helmets worn by players were manufactured by Riddell (52 percent), Schutt (35 percent) and Xenith (13 percent). The helmets were purchased in 2011-2012 (39 percent), 2009-2010 (33 percent) and 2002-2008 (28 percent). Mouth guards worn by players included generic models provided by schools (61 percent) and specialized mouth guards (39 percent) custom fitted by dental professionals or specifically marketed to reduce SRC.

A total of 115 players (8.5 percent) sustained 116 SRCs in 2012.There was no difference in SRC rate based on the type of helmet worn, or the year the helmet was purchased. Concussion severity (based on the number of days lost from play) was no different for players wearing Riddell, Schutt or Xenith helmets. The SRC rate for players who wore a specialized or custom-fitted mouth guard was higher than for players who wore a generic mouth guards.

Properly maintained and fitted helmets remain important to prevent skull fractures and scalp lacerations in football players, said Dr. Brooks. However, "because the brain is floating freely inside the skull, I think most experts doubt whether it is possible to ever develop a helmet design that can prevent concussion."

Read more here

Why childhood concussions are concerning for parents

This article discusses symptoms of childhood concussions and what should be done to treat
them.

Kids will be kids — running around, scraping knees and occasionally bonking their heads on the table. But what if a more serious head injury occurs? How do these injuries affect a still-growing brain?

Health officials recommend precautions like using seat belts, wearing helmets and practicing other safe habits in order to prevent childhood concussions.

According to the US National Library of Medicine (NLM), concussions technically involve a short loss of normal brain function after a head injury, but the term is often used by people to describe any minor head or brain injury.

Concussions often occur as sports injuries, or after a blow to the head or hitting the head during a fall.

Concussion symptoms might not start immediately after the injury occurs and may even take weeks or days to develop. Common symptoms include headache, neck pain, nausea, ringing in the ears, dizziness, tiredness or generally feeling "in a daze."

"Doctors use a neurologic exam and imaging tests to diagnose a concussion," wrote NLM. "Most people recover fully after a concussion, but it can take some time. Rest is very important after a concussion because it helps the brain to heal."

According to the United States Bone and Joint Initiative (USBJI), organizers of World Pediatric Bone and Joint Day, as many as 3.8 million sports-related concussions occur every year in the US.

"The effect of concussion on developing brains is of particular concern," explained USBJI. "Children with concussion, particularly multiple concussions, are at high risk for developing headaches and suffering from impaired memory, cognitive function, attention, or other behavioral changes. Concussions occur in all sports with the highest incidence in football, hockey, rugby, soccer, and basketball."

In an interview with dailyRx News, Kevin Crutchfield, MD, Director of the Comprehensive Sports Concussion Program at the Sandra and Malcolm Berman Brain & Spine Institute of LifeBridge Health in Baltimore, Maryland, agreed that concussions in children are more worrisome.

"Every time you have a concussive blow to the head, you are killing brain tissue," said Dr. Crutchfield. "If that tissue is still developing, you actually start to limit the capacity of the brain."

Dr. Crutchfield explained that the brain grows and develops by creating a network of connections. And brain cells that are damaged through injury are unable to form connections as a part of this growth process.

"We don't know for sure the ramifications of this, but we can assume that a child with damage to the brain's tissue may not be able to do cognitive tasks they might have been able to do otherwise," said Dr. Crutchfield.

Dr. Crutchfield also warned that brain swelling is a bigger risk for children who experience a concussion than it is for older patients.

"The biggest piece of advice I can give to parents is, if your kids are participating in any activity (sports or otherwise) where they are getting recurrent injuries, they aren't doing it safely and maybe it's not the best activity for them," Dr. Crutchfield told dailyRx News. He mentioned that kids, like adults, have different builds and bodies and what is safe and healthy for some is not always safe and healthy for others.

The Centers for Disease Control and Prevention (CDC) suggests that parents make sure their child wears a seatbelt when riding in a car and uses a child safety seat or booster seat as necessary. CDC also recommends that helmets be worn during activities like riding a bike or scooter, using skates or a skateboard, riding a horse, skiing, batting or running bases in baseball or softball and while playing a contact sport like football, ice hockey or boxing.

NLM recommends seeking medical attention if symptoms of a concussion get worse or include things like seizures, trouble walking or sleeping, weakness, numbness, troubles with coordination, continued vomiting or nausea, confusion or slurred speech.

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