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. She had 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 adults feel that because these athletes are so young, they could not possibly get seriously hurt. “This is, of course, not the case,” said Dr. Bakhos, an emergency physician at the Jersey Shore University Medical Center in Neptune, N.J.
“Also, a few good studies have shown that head injury in younger children can have more long-term effects, as you are essentially damaging a developing brain,” she explained. 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, this link needs further study. The American Academy of Pediatrics has just released “Sport-Related Concussion in Children and Adolescents” (Pediatrics 2010 Aug. 30 [doi:10.1542/peds.2010-2005]).
Dr. Bakhos and her colleagues reviewed 1997-2007 data from the NEISS (National Electronic Injury Surveillance System), and 2001-2005 data from the NEISS-AIP (All-Injury Program). The NEISS system allows researchers to investigate injury- and product-related ED visits.
In 2001-2005, about 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. About 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 1997-2007 period, 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 noted.
The study was limited by the exclusion of sports-related concussions that were treated in non-ED settings, and by underreporting of sports-related concussions, the researchers noted. The AAP has 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 includes the following recommendations:
▸ Stay off the field. Even if symptoms subside, young athletes should never return to play on the same day they have a concussion. They need more recovery time than do older 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 and mental activity until they are asymptomatic at rest and when active. 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 AAP began working on the report before the first law was passed, said Dr. Halstead, director of the sports concussion program at Washington University in St. Louis. “We felt there was a need to address specifically the [pediatric] athlete and address all the recent research that has been published on this topic,” he said in an interview.
“The recommendations presented aren't significantly different from other recent documents published, but these were primarily published in sports medicine journals, which many pediatricians do not review. We wanted to bring these recommendations to the forefront to the pediatric community, and expand upon the details provided in previous documents published. We have highlighted some of the new research on neuroimaging, balance assessments, long-term complications, education, and neuropsychological testing,” Dr. Halstead said.