The Institute of Medicine issued a report Oct. 30 reviewing the science on youth concussions and recommended actions to reduce their occurrence and consequences.
The report cautioned that, while existing research provides useful information, much is still unknown about the extent of the problem, how to diagnose, manage and prevent concussions, and their short- and long-term effects. These areas remain confusing and controversial for parents, coaches,physicians and policy-makers alike.
UW injury expert Dr. Frederick Rivara, a professor who holds the Seattle Children’s Endowed Chair in Pediatrics, was vice-chair of the committee, which was chaired by Dr. Robert Graham, director of the National Program Office of Aligning Forces for Quality at George Washington University.
The committee examined current findings on sports-related concussions in youth from elementary school age through young adulthood. They looked at studies, too, of concussions in military personnel and their dependents.
Several sponsors supported the Institute of Medicine and the National Research Council in convening the committee. They included the Centers for Disease Control and Prevention and the CDC Foundation, which received funding for the study from the National Football League. Other sponsors were the Department of Defense, Department of Education, U.S. Health Resources and Services Administration, National Academies, National Athletic Trainers Association Research and Education Foundation, and National Institutes of Health.
The data available on the incidence of sports concussions suggest that, among male athletes at in high school and college sports, football, ice hockey, lacrosse, wrestling and soccer led in the incidence of concussions. Among female high school and college students, soccer, lacrosse, basketball and ice hockey were linked with the highest rates of concussions. The frequency of concussions among younger athletes, or those in intramural and club sports, is not known.
The lack of data on the overall incidence of sports-related concussions in youth prompted the Institute of Medicine committee to call for the Centers of Disease Control and Prevention to establish a national surveillance to collect information on concussive injuries, including those in youth age 5 to 21.
The committee observed that little research has been conducted on changes in the brain after concussions in youth, or on the differences in brain effects between males and females. The diagnosis and treatment of concussions, and measurements of recovery, have also not been settled, the report said. In addition, the effects of repetitive brain injuries and multiple concussions are still unclear.
The committee recommended that the National Institutes of Health and the Department of Defense conduct studies of the short- and long-term effects of concussions on quality of life and daily activities. The committee said it believes it is critical to include predictors and modifiers of these outcomes, including the influences of socioeconomic status, race and ethnicity, gender, and co-existing conditions.
Better-designed safety equipment, they noted, might also protect youth from concussions. The committee found only limited evidence that current helmet designs reduce the risk of sports-related concussion.
In its other recommendations, the committee called for enforcing standards for safe play and for teaching of age-appropriate techniques in youth sports. They also asked for national college and high school athletic governing bodies to evaluate how playing standards might affect the incidence of concussions. The group suggested that the Department of Defense conduct similar research for sports and physical training at military academies and for military personnel.
The committee cited data showing that, among military personnel, mild traumatic brain injuries, of which include concussions, represent about 85 percent of all traumatic brain injuries, About 80 percent of their mild traumatic brain injuries did not occur in battle, but were commonly the result of automobile accidents and falls or happened during sports and recreational activities or military training.
The experts emphasized changing sports and military cultures that make injured young people reluctant to report their injuries. The serious nature of concussions and the health threats they post, the committee believes, needs to be heeded.