A concussion is an alteration in mental status that may or may not involve loss of consciousness and is caused by a traumatic blow to the head. Concussions from sports are an epidemic according to the Centers for Disease Control and Prevention (CDC). A concussion can occur from any contact in a competitive sporting environment but a football collision is the most reported sport related head injury.
Symptoms of a concussion include confusion, disorientation, vacant stare, slurred or incoherent speech, memory deficits (amnesia) and any period of loss of consciousness. The American Academy of Neurology (AAN) has a three level grading system which indicates that a grade 1 concussion will exhibit symptoms for less than 15 minutes with no loss of consciousness. A grade 2 concussion will also not have loss of consciousness but symptoms will exhibit for more than 15 minutes. A grade 3 concussion is easy to recognize because the athlete will suffer unconsciousness for any period of time. It is important to note that symptoms are typically noticed right after the injury, but some might not be noticeable for days or weeks later.
The CDC reports that as many as 3.8 million sports and recreation related concussions occur in the United States each year. Between the years of 2001 and 2005 children ages 5 to 18 accounted for 2.4 million sports related emergency department visits a year with 6% involving concussion. 60% of high school concussions are related to football. For girls the leading cause of high school sports concussion is soccer.
Of important note is the appropriateness of a player returning to the game after suffering any type of blow to the head. The likelihood for further or permanent brain damage from a secondary injury is significantly higher if a player is returned to competition before full recovery. This is called secondary impact syndrome (SIS). SIS describes a situation in which a player sustains a second injury to the head before the symptoms from the first head injury have resolved.
Repetitive head injury syndrome is the result of multiple brain injuries over time. Repetitive head injury syndrome occurs when an athlete sustains multiple concussions over a period of time, even if the effects of the initial brain injury have resolved (6 — 18 month post injury). Repetitive head injury syndrome can result in long-term neurologic and functional deficits. Recently the NFL reported a study in which retired professional players showed a 3 fold increase of depression in players with a history of 3 or more concussions. A report published by Kevin Guskiewicz of the University of North Carolina indicates that past concussions increase the chances of another concussion. The study concludes that if you have three or more concussions within seven years you have a three times more risk of sustaining another injury.
Many times in the heat of competition objectivity on the part of the athlete, coaches and spectators create further harm to players by creating an unfortunate and potentially harmful bias. A policy statement on the steps to take when a player sufferers a blow to the head from contact with an opponent, a team mate, or the ground must be adhered to by a objective professional on the sidelines. With increased awareness of the long term effects of any head injury many organizations are publishing sideline assessment pamphlets. The American Academy of Neurology has a detailed sideline evaluation grid with recommendations on when it is safe for a player to return to the contest. The CDC has a good High School coach’s guide that is available free on their website. The NFL has also published a player concussion pamphlet.
If you suspect a concussion seek medical attention right away. A health care professional will be able to determine when it is safe to return to sports. Do not self assess your condition; a second concussion to an already traumatized brain can be very serious. Be sure to inform coaching staff of any other head trauma not sustained on the playing field (i.e. auto or bike accident). Previous head trauma is important to consider in the evaluation of an athlete with a suspected concussion.
Sports concussions seem common place in the American sports psyche but they should be considered a serious injury. Ways to prevent concussions include wearing the right protective equipment in the proscribed manner and ensure it is properly fitted and maintained. In addition many injuries can be prevented by practicing good sportsmanship and following all safety rules for the sport. Most importantly if a concussion is suspected ensure that appropriate sideline evaluation and medical attention is given with disregard to the heat of the competitive battle.