WASHINGTON Half of parents and two in five coaches would not follow required return-to-play rules after a child suffers a hard head hit in organized sports, suggests a recent study.
“The findings underscore the need for educating both coaches and parents on consequences leading to concussion,” concluded Edward J. Hass, Ph.D., director of research and outcomes at the Nemours Center for Children’s Health Media, and his associates in their abstract presented at the annual meeting of the American Academy of Pediatrics.
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Return-to-play protocols refer to the series of steps that should be followed after a child’s head injury and before the child participates in the sports activity again, pulling them out of the practice or game and waiting for a doctor to medically okay them before they return to the practice or the game situation. Intermediate steps include ensuring the child can do aerobic activity, then begin strengthening activity, then start practice, and then finally enter a game situation, Dr. Hass explained in an interview.
“The implications of this work are not for the purposes of preventing a primary injury,” Dr. Hass said. “Increasing knowledge of symptoms and of what can result from concussion is not going to prevent the initial injury, but it can certainly prevent further damage to the young brain by having a child going back in before they’re healed from their concussive symptoms.”
Dr. Hass’s team conducted an online survey of 506 U.S. visitors to the KidsHealth.org website owned by Nemours, between Jan. 13, 2015, and Feb. 11, 2015. Respondents included 331 noncoach parents of children aged 18 years and under, 86 coach-parents, and 89 coaches without children – “people who were visiting our website and presumably involved in or interested in children’s health,” Dr. Hass said during his abstract presentation.
In the survey, 50% of noncoach parents and 56% of coaches reported they would follow the steps of return-to-play protocol, pulling the child out of play without a return until a medical approval. The remaining respondents would either allow the player to return if the player wanted to, have the player sit for 15 minutes and return when he or she felt okay, or only sit out the rest of the game or practice.
“These findings would suggest that 20% of the time on the field of play, you have a child who doesn’t have an advocate for brain safety,” Dr. Hass said during his presentation. The abstract notes that symptoms requiring emergency treatment “would not receive such urgency 25% to 50% of the time.”
The survey also asked about what respondents would do regarding each of several different symptoms following a head hit, using a 5-point scale for each symptom: no special care; let child rest at home; take the child to the doctor in a day or 2; call the doctor right away; or take the child to emergency care right away. Symptoms ranged from concussion symptoms, such as blurry vision, headache, walking unsteadily, vomiting, difficulty concentrating, and loss of consciousness, to unrelated concerns, such as sudden hunger or body aches.
Analysis of these answers and the question of whether the respondent would allow a child to sleep following a head hit revealed a two distinct groups, the researchers found.
“There’s clearly two different kinds of mentalities going on, the more cautious ‘take no chances’ group and the less cautious ‘watchful-waiting group,’ ” Dr. Hass said. Both groups are equally good at symptom discrimination, such as walking unsteadily or hearing a player say they have blurred vision or a headache, he said. But the watchful-waiters, 25% of the respondents and predominantly male, are less likely to follow return-to-play protocols.
“It’s lack of awareness of what the symptoms mean,” Dr. Hass said. “If the child is experiencing blurred vision, that could be a sign of concussion, and that’s a brain injury and something that requires medical attention.”
The study was funded by Dr. Hass’s employer, Nemours Center for Children’s Health Media. Dr. Hass reported no other disclosures.