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Concussion Rates Are Rising in Younger Athletes Aged 8-13 Years

Publish date: September 1, 2010
By
Heidi Splete

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Awareness, Research Drive Increase

I'm not surprised by the increase in reports of concussions in young athletes. And because not every kid with a concussion goes to the emergency department, there are even more injuries occurring that are not being reported.

I think greater awareness and better diagnosis are the main reasons why the number of sports-related concussions is rising. Until 10 years ago, the medical literature focused only on concussions that involved loss of consciousness. But what we have learned in the past decade is that the subtleties of this injury are absolutely critical for diagnosis.

For example, loss of consciousness is actually less predictive than loss of memory. (I published a paper in 2003 showing that amnesia or memory loss around the time of the concussion is 10 times more predictive than a loss of consciousness.) Changes in the way we define the injury are driving the rise in reported concussions in young athletes.

As we continue to peel the onion on concussion, we realize that it is an extremely complex injury, and that there are more problems in those who are injured—particularly kids. Also, we now have animal models that help show what happens in the brain after a concussion. This knowledge base has accumulated at warp speed over the last 10 years, and with that has come better recognition, better management, and better understanding of the injury, as well as more concern.

Most importantly, neurocognitive testing is becoming more widely used as a way to assess sports-related concussion, and it is the key to why there is so much attention now being paid to the injury: We now have a way to measure it by collecting baseline data. The sensitivity and specificity of such tests are impressive.

One of the keys to improving the management of pediatric concussion is to get knowledge related to this injury, as well as its many assessment tools, into pediatric offices. Clinics are available around the United States to help pediatricians who want to incorporate neurocognitive testing into their practices. The American Academy of Pediatrics' report by Dr. Halstead and Dr. Walter lists several assessment tools, and it includes other valuable, relevant information about managing sports-related concussions in young athletes.

MICHAEL COLLINS, PH.D., is the assistant director of the sports medicine concussion program at the University of Pittsburgh Medical Center. He also coauthored the Centers for Disease Control and Prevention's “Heads Up: Brain Injury in Your Practice” tool kit for physicians.


 

Approximately 40% of emergency department visits for sports-related concussions in young athletes occurred in children aged 8–13 years, based on data from concussion-related ED visits in the United States between 2001 and 2005.

There are two main concerns about sports-related concussion in younger children, compared with college athletes and adults, lead author Dr. Lisa L. Bakhos said in an interview. Dr. Bakhos conducted the study while she was a teaching fellow at Brown University in Providence, R.I. (Pediatrics 2010 Aug. 30 [doi:10.1542/peds.2009–3101]).

"First, many parents, coaches, teachers, and other adults feel that because these athletes are so young, they could not possibly get seriously hurt. As we have seen time and time again, this is, of course, not the case," said Dr. Bakhos, who is currently an emergency physician at the Jersey Shore University Medical Center in Neptune, N.J.

In addition, more data have surfaced about cognitive deficits in older children after concussion, she said, "which leads to conjecture that younger children would suffer the same — if not more — deficits long term."

However, the link between sports-related concussion and cognitive deficits needs further study, she commented.

The American Academy of Pediatrics has just released a new clinical report, "Sport-Related Concussion in Children and Adolescents" to aid in this effort (Pediatrics 2010 Aug. 30 [doi:10.1542/peds. 2010–2005]).

To get a better picture of the scope of sports-related concussion in young athletes, Dr. Bakhos and her colleagues reviewed data from the NEISS (National Electronic Injury Surveillance System) from 1997 through 2007, and from the NEISS-AIP (All-Injury Program) from 2001 through 2005.

The NEISS system allows researchers to investigate injury- and product-related ED visits.

In 2001–2005, approximately half of all ED visits for concussion across older and younger age groups were related to sports, including 58% of visits in children aged 8–13 years and 46% of visits in those aged 14–19 years.

Put another way, approximately 4 in 1,000 children aged 8–13 years and 6 in 1,000 of those aged 14–19 years went to the ED for a sports-related concussion.

During the 10-year period of 1997–2007, ED visits for the most popular organized team sports (football, ice hockey, soccer, basketball, and baseball) doubled in 8- to 13-year-olds and increased by more than 200% in 14- to 19-year-olds.

"The take-home message for pediatricians is, take concussion seriously even in the very young athlete," said Dr. Bakhos. "Children with concussion should be followed just as closely as a child with a sprained ankle or a broken bone. Return-to-play guidelines should be followed closely and stressed to parents."

"We as pediatricians should also stress to parents the importance of concussion prevention in sport as well, mostly [by] the use of helmets at all times," she emphasized.

The study was limited by the exclusion of sports-related concussions that were treated in non-ED settings, and by the underreporting of sports-related concussions by young athletes, their parents, and their coaches, the researchers noted.

But the rise in sports-related concussions in younger and older children suggests the need for more research and guidance in preventing and treating these injuries, they added.

To help clinicians manage sports-related concussions in young athletes, the AAP published a new clinical report that "outlines the current state of knowledge on pediatric and adolescent sport-related concussions," wrote lead authors Dr. Mark E. Halstead and Dr. Kevin D. Walter, on behalf of the AAP's Council on Sports Medicine and Fitness. It includes the SCAT 2 (Sport Concussion Assessment Tool 2), a standardized method of evaluating concussion in athletes aged 10 and older.

The report outlines recommendations regarding sports-related concussion, including the following:

▸ Stay off the field. Even if symptoms subside, young athletes should never return to play on the same day they have a concussion. Younger athletes need more recovery time and a more conservative approach than do college or professional athletes.

▸ See a doctor. Any children or adolescents who suffer concussions during sports should be medically cleared by a physician before they return to activity.

▸ Rest mind and body. All young athletes should refrain from physical activity until they are asymptomatic at rest and when active. Rest includes mental as well as physical rest.

Some evidence suggests that cognitive exertion — including doing homework, watching TV, and playing video games — can exacerbate symptoms post concussion.

In the last few years, several states have passed laws requiring educational materials about sports-related concussion for school-aged athletes, coaches, and parents. The state laws were a consideration, but the AAP began working on the report before the first law was passed, said Dr. Halstead, director of the sports concussion program in the department of orthopedics at Washington University in St. Louis.

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