Although sports are a great way for children and teens to stay healthy while learning important team-building skills, there are risks to pushing the limits of speed, strength and endurance. All athletes – no matter their age – who push the limits sometimes don’t recognize their own limitations—especially when they’ve had a concussion. For parents whose children engage in sports activities that expose them to concussions, a new study underscores the medical need to sideline athletes with possible concussions rather than allowing them to continue playing.
As reported today by CBS Interactive Inc., the American Academy of Neurology has published new guidelines on how to manage concussions sustained during athletics. Published in the March 18, 2013 edition of the Academy’s journal, Neurology, the Academy offers a simple message for doctors and coaches (and parents) if their players get a head injury: when in doubt, keep them out.
Such a conclusion was reached after Academy researchers spent thousands of hours reviewing all scientific studies published through June 2012. The Academy’s older concussion guidelines from 1997 had assigned grade scores based on concussion severity, which ranged from Grade 1 — described by players as having their “bell rung” – to Grade 3 concussions, which caused loss of consciousness. Under the old guidelines, a person with a Grade 1 concussion would be allowed back in to the game if they were symptom-free within 15 minutes, while a player with a Grade 3 concussion may have to wait 1-2 weeks.
The new guidelines move away from those grades completely and urge doctors to diagnose each case on an individual basis. “Among the most important recommendations the Academy is making is that any athlete suspected of experiencing a concussion immediately be removed from play,” co-lead guideline author Dr. Christopher C. Giza, a neurologist at the David Geffen School of Medicine and Mattel Children’s Hospital at UCLA, said in a news release. “There is no set timeline for safe return to play.”
In the United States, an estimated 3.8 million athletes sustain a sports-related traumatic brain injury each year, many of whom seek no immediate medical treatment. The new guidelines say athletes with a suspected concussion should be lifted from the game immediately and can’t return until a licensed health care professional trained in concussions allows them to return to play — slowly — after all symptoms are gone. Evidence reviewed by the guideline authors showed kids take longer to recover from a concussion than college athletes, so a more conservative approach is recommended when deciding if a child or teen athlete should return to play.
Signs and symptoms of a concussion include a dazed stare, headache, sensitivity to light and sound, changes to reaction time, balance, memory, speech (like slurring), judgment and coordination. Contrary to common perception, loss of consciousness — or a “blackout” — only occurs in less than 10 percent of cases. Doctors and other licensed health professionals should use a checklist while looking for these symptoms and whether the athlete has a history of concussions at a younger age, which may make recovery take longer.
Some sports are more likely to cause a concussion than others, the researchers added. Concussion risk is greatest in football and rugby, followed by hockey and soccer. There is no clear evidence that one type of mouth guard or helmet can better reduce risk than another, so the academy urges football players to make sure their helmet fits properly and is well-maintained.
Young women and girls are at greatest risk for concussion when playing soccer and basketball, according to the guidelines. The sports with the lowest risk for concussions include baseball, softball, volleyball and gymnastics.
Athletes who have suffered a concussion are at significant risk for getting another concussion within 10 days. That’s another reason it’s so important to have a professional check for symptoms. “If in doubt, sit it out,” urged Dr. Jeffrey S. Kutcher, an associate professor of neurology with the University of Michigan Medical School in a press release. “If headaches or other symptoms return with the start of exercise, stop the activity and consult a doctor.”
The news gets worse for those who have had multiple concussions or longer exposure to concussions in their chosen sports. Those who have the ApoE4 gene, which has been linked to Alzheimer’s risk, also appear to be at greater risk for cognitive impairment following their playing days, such as chronic traumatic encephalopathy (CTE).
The Academy’s new guidelines are endorsed by the NFLPA (player’s association) and National Athletic Trainers Association, among other groups. Based on these guidelines, the bottom line is to keep athletes of all ages – and especially younger athletes – off the field if there’s any chance they still have lingering symptoms from a head injury. To quote Dr. Kutcher, “You only get one brain; treat it well.”
As parents, we cannot allow coaches caught up in the spirit of competition to place our children who may have a concussion at risk for insisting they play because they seem to be symptom-free.
For more information on concussions and the new guidelines, see the American Academy of Neurology’s website.