Head Injuries in Youth Sports -- January 11, 2010 -- Dr. Allen Sills - NewsChannel5.com | Nashville News, Weather & Sports

Head Injuries in Youth Sports -- January 11, 2010 -- Dr. Allen Sills

Head Injuries in Youth Sports
January 11, 2010
Dr. Allen Sills

Traumatic brain injuries (TBI) contribute to a substantial number of deaths and cases of permanent disability annually. The Centers for Disease Control estimates that at least 5.3 million Americans, about 2 percent of the U.S. population, currently have a long-term or lifelong need for help to perform activities of daily living as a result of a TBI.

The severity of a TBI may range from "mild," i.e., a brief change in mental status or consciousness to "severe," i.e., an extended period of unconsciousness or amnesia after the injury. Approximately 75 percent of TBIs that occur each year are concussions or other forms of mild TBI.

Recent data shows that, on average, approximately 1.4 million people sustain a TBI each year in the United States. Of those:

• 50,000 die;
• 235,000 are hospitalized; and

• 1.1 million are treated and released from an emergency department.

Among children ages 0 to 14 years, TBI results in an estimated

• 2,685 deaths;
• 37,000 hospitalizations; and

• 435,000 emergency department visits.

The number of people with TBI who are not seen in an emergency department or who receive no care is unknown.

Groups at Risk

• Males are about twice as likely as females to sustain a TBI.
• The two age groups at highest risk for TBI are 0 to 4 year olds and 15 to 19 year olds.
• Adults age 75 years or older have the highest rates of TBI-related hospitalization and death.
• Certain military duties (e.g., paratrooper) increase the risk of sustaining a TBI.
• African Americans have the highest death rate from TBI.
• TBI hospitalization rates are highest among African Americans and American Indians/Alaska Natives.

CONCUSSIONS

A concussion is a type of traumatic brain injury, or TBI, caused by a bump, blow or jolt to the head that can change the way your brain normally works. Concussions also can occur from a blow to the body that causes the head to move rapidly back and forth. Even a "ding," "getting your bell rung," or what seems to be mild bump or blow to the head can be serious.

Concussions can occur in any sport or recreation activity. So, all coaches, parents, and athletes need to learn concussion signs and symptoms and what to do if a concussion occurs.

How Can I Recognize a Possible Concussion?

To help recognize a concussion, watch for the following two things among your athletes:

• A forceful bump, blow or jolt to the head or body that results in rapid movement of the head.

AND

• Any change in the athlete's behavior, thinking or physical functioning.

Athletes who experience any of the signs and symptoms listed below after a bump, blow or jolt to the head or body should be kept out of play the day of the injury and until a health care professional, experienced in evaluating for concussion, says they are symptom-free and it's OK to return to play.

Signs Observed by Coaching Staff

• Appears dazed or stunned
• Is confused about assignment or position
• Forgets an instruction
• Is unsure of game, score or opponent
• Moves clumsily
• Answers questions slowly
• Loses consciousness (even briefly)
• Shows mood, behavior, or personality changes
• Can't recall events prior to hit or fall
• Can't recall events after hit or fall

Symptoms Reported by Athlete

• Headache or "pressure" in head
• Nausea or vomiting
• Balance problems or dizziness
• Double or blurry vision
• Sensitivity to light
• Sensitivity to noise
• Feeling sluggish, hazy, foggy or groggy
• Concentration or memory problems
• Confusion
• Does not "feel right" or is "feeling down"

Remember, you can't see a concussion and some athletes may not experience and/or report symptoms until hours or days after the injury. Most people with a concussion will recover quickly and fully. But for some people, signs and symptoms of concussion can last for days, weeks or longer.

What Should I do if a Concussion Occurs?

If you suspect that an athlete has a concussion, implement an action plan:

1. Remove the athlete from play. Look for signs and symptoms of a concussion if your athlete has experienced a bump or blow to the head or body. When in doubt, keep the athlete out of play.

1. Ensure that the athlete is evaluated by a health care professional experienced in evaluating for concussion. Do not try to judge the severity of the injury yourself. Health care professionals have a number of methods that they can use to assess the severity of concussions. As a coach, recording the following information can help health care professionals in assessing the athlete after the injury:

• Cause of the injury and force of the hit or blow to the head or body
• Any loss of consciousness (passed out/knocked out) and if so, for how long
• Any memory loss immediately following the injury
• Any seizures immediately following the injury
• Number of previous concussions (if any)

1. Inform the athlete's parents or guardians about the possible concussion. Make sure they know that the athlete should be seen by a health care professional experienced in evaluating for concussion.

1. Keep the athlete out of play the day of the injury and until a health care professional, experienced in evaluating for concussion, says they are symptom-free and it's OK to return to play. A repeat concussion that occurs before the brain recovers from the first—usually within a short period of time (hours, days, or weeks)—can slow recovery or increase the likelihood of having long-term problems. In rare cases, repeat concussions can result in edema (brain swelling), permanent brain damage, and even death.

What Can I Do to Prevent Concussions?

As a coach or parent, you play a key role in preventing concussions and responding properly when they occur. Here are some steps you can take to help prevent concussions and ensure the best outcome for your athletes, the team, league or school.

Preseason

Check with your league, schoo, or district about concussion policies. Concussion policy statements can be developed to include a commitment to safety, a brief description about concussion, and information on when athletes can safely return to play. Parents and athletes should sign the concussion policy statement at the beginning of each sports season.

Create a concussion action plan. To ensure that concussions are identified early and managed correctly, have an action plan in place before the season starts. This plan can be included in your school or district's concussion policy.

Educate athletes and other parents or coaches about concussion. Before the first practice, talk to athletes and parents, and other coaches and school officials about the dangers of concussion and potential long-term consequences of concussion. Explain your concerns about concussion and your expectations of safe play. Remind athletes to tell coaching staff right away if they suspect they have a concussion or that a teammate has a concussion.

During the Season: Practices and Games

Insist that safety comes first.

• Teach and practice safe playing techniques.
• Encourage athletes to follow the rules of play and to practice good sportsmanship at all times.
• Make sure athletes wear the right protective equipment for their activity (such as helmets, padding, shin guards, and eye and mouth guards). Protective equipment should fit properly, be well maintained, and be worn consistently and correctly.

Teach athletes it's not smart to play with a concussion. Rest is key after a concussion. Sometimes athletes, parents, and other school or league officials wrongly believe that it shows strength and courage to play injured. Discourage others from pressuring injured athletes to play. Don't let your athlete convince you that they're "just fine."

Work closely with league or school officials. Be sure that appropriate individuals are available for injury assessment and referrals for further medical care. Enlist health care professionals (including school nurses) to monitor any changes in the athlete's behavior that could indicate that they have a concussion. Ask athletes or parents to report concussions that occurred during any sport or recreation activity. This will help in monitoring injured athletes who participate in multiple sports throughout the year.