Contact sports can be fun and rewarding. But, if your child participates in a contact sport, he or she does run the risk of suffering a mild traumatic brain injury, or concussion. In fact, 20 percent of all high school football players suffer brain injuries each season! Other sports such as gymnastics, skiing, and horseback riding also raise the risk of brain injury. Basically, anytime you put yourself in a position to collide, fall, or otherwise bang your head, you increase your risk for suffering a concussion. It has been estimated that 300,000 sports-related concussions occur every year. This statistic may be alarming, but should not stop you from allowing your child to participate. It does mean that you should be especially careful to be sure your child is carefully fitted with appropriate protective equipment such as correctly fitting helmets (when appropriate to wear) and that he or she is instructed in safe sporting techniques (for example knowing the correct technique to tackle another player). Parents and coaches should also be aware of the signs of more serious head injury and be knowledgeable about the reasonable medical precautions to take. Reading this article will help you do just that.
Mild traumatic brain injury is defined as head trauma with loss of consciousness, if any, that lasts for fewer than 30 minutes, and post-traumatic amnesia lasting for less than 24 hours. The term “concussion” is often used as a synonym for mild traumatic brain injury. The American Academy of Neurology has defined 3 grades of concussion. When a player hits his or her head, it is important to identify which, if any, grade of concussion the player may have because each grade is treated differently.
Common signs and symptoms of a concussion include headache, dizziness, nausea, vomiting, slurred or incoherent speech, unsteadiness, confusion, disorientation, delayed or inability to follow instructions, and poor concentration and/or attention.
Grade I (mild) concussion is defined as no loss of consciousness and symptoms of concussion lasting less than 15 minutes.
Grade II (moderate) concussion is defined as no loss of consciousness and concussion symptoms lasting for more than 15 minutes.
Grade III (severe) concussion is defined as loss of consciousness of any duration.
If a player suffers a grade I concussion, he or she may return to play after being completely free of all symptoms for 15 minutes.
If a player suffers a grade II concussion, he or she may return to play after being completely free of symptoms for one week.
If a player suffers a grade III concussion, he or she should be taken immediately to the emergency department for further evaluation. If the player had only a brief loss of consciousness (e.g. seconds), he or she may return to play after being free of all symptoms for one week. If the player had a prolonged loss of consciousness (e.g. minutes), he or she may return to play after being free of all symptoms for 2 weeks. This is assuming that the work-up in the emergency department does not show any more serious problems.
When a second concussion is suffered, the American Academy of Neurology puts forth further guidelines:
If an athlete suffers a second grade I concussion, her or she may return to play after being free of all symptoms for one week.
If an athlete suffers a second grade II concussion, the athlete may return to play after being free of all symptoms for 2 weeks.
If an athlete suffers a second grade III concussion, the athlete may return to play if asymptomatic for one month or longer.
The American Academy of Neurology does not put forth recommendations for what to do after a third concussion. However, two other prominent sources of guidelines, the Colorado Medical Society and Cantu, recommend terminating the season after a third concussion of any grade. In addition, these two societies recommend terminating the season after a second grade III concussion.
When a person suffers a concussion, he or she should be observed for at least 24 hours. This observation may generally be done at home assuming that factors such as the competency of the observer and time to reach appropriate medical care are considered. If any of the following symptoms develop, the patient should be immediately taken to an emergency room: Severe or worsening headache, somnolence or confusion, difficulties with vision, restlessness, seizures, vomiting, fever or stiff neck, urinary or bowel incontinence, weakness, numbness, or burning in any part of the body. Many doctors advocate waking the patient up every two hours for the first 24 hours after a concussion to assess for the development of these symptoms.
While patients who suffer mild concussions generally do very well and return to play without further problem, it is important to understand that a complication of concussions that often goes unrecognized is post-concussive syndrome (PCS). PCS may last anywhere from a week to 6 months after a mild head injury and is recognized by headaches that may be exacerbated by physical activity, irritability, blurred vision, dizziness, emotional or cognitive disturbances, sleep disturbances, and increased fatigue. These symptoms, when present, tend to gradually taper over days, weeks, or months.
Sports should be fun, and they are. Contact sports are full of, well…contact. Youth sports that include contact and risk of head injury should be enjoyed responsibly. Wear the proper equipment, learn the proper techniques for playing your sport and, in the unlikely event of head injury, follow the steps outlined above.
Grant Cooper, MD
New York-Presbyterian
The University Hospitals of Columbia and Cornell |
