Treating Traumatic Brain Injury in Young Athletes
For many young athletes, concussion or mild traumatic brain injury (mTBI), may always be a risk.
However, by educating players, coaches and parents about the factors that contribute to concussions and affect recovery from these injuries, clinicians may be able to improve treatment choices and minimize the rate and severity of sports-related brain injuries in the pediatric population.
Increasing participation in youth sports can help lower rates of childhood obesity, but it also increases the risk of injuries.
There are approximately 30 million to 45 million children and adolescents between age 6 years and age 18 years who participate in organized sports, and more than half of these compete in multiple sports.1 According to the National Federation of State High School Associations, approximately 7.7 million students participating in sports during the 2011-2012 school year.2
The CDC reports that sports- and recreation-related mTBIs have increased by 60% over the past decade, and emergency departments (EDs) treat an estimated 173,285 of these injuries among children and adolescents, from birth to age 19 years.3 A 2012 study looked at data from the High School Reporting Information Online injury surveillance system, a representative sample of 100 schools with injury incidence data for 20 different sports, and found that concussions represented 13.2% of all reported sports-related injuries.4
A 10-year examination of 25 high schools found that the rate of reported concussions increased more than fourfold between 1998 and 2008.5 The authors went on to note that these increases may have been partly attributable to increased awareness, reporting, and diagnosis of concussions.
Despite increased incidence and awareness of TBI in the child and adolescent population, the research on sports-related concussions specific to children and adolescents is lagging behind.6
This dearth of research takes on added significance when combined with the knowledge that the evidence clearly shows that children and adolescents take longer to recover after a concussion than their adult counterparts.
What Is a Concussion?
The American Academy of Neurology defines a concussion as any trauma-induced alteration in mental status that may or may not include a loss of consciousness. A consensus statement released following the third International Conference on concussion in sport noted that a concussion could be defined as, "a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces."7
Common features that can be used to describe the nature of a concussive head injury include:
- May be caused either by a direct blow to the head, face or neck, or a blow elsewhere on the body with an impulsive force transmitted to the head
- Typically results in the rapid onset of short-lived impairment of neurologic function that resolves spontaneously
- May result in neuropathologic changes, but the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury
- Results in a graded set of clinical symptoms that may or may not involve loss of consciousness. Resolution of the clinical and cognitive symptoms typically follows a sequential course. In a small percentage of cases, however, post-concussive symptoms may be prolonged
- No abnormality on standard structural neuroimaging studies is seen in concussion7
With such diverse definitions, it is little wonder that considerable confusion about concussions exists among clinicians, researchers, coaches, parents and players.