Sport-related concussions have achieved a tremendous amount of attention in recent years. Due in part to several serious concussions among high-level athletes as well as intense debate about the long-term ramifications of these injuries, there has been much media interest in the subject. This increased attention has increased awareness of concussions among athletes even down to the high school level. Unfortunately, there seems to be less understanding of the incidence and significance of concussions in youth sports.
In Pediatrics, the official journal of the American Academy of Pediatrics, Lisa Bakhos et al. present a study examining sports-related concussions resulting in visits to emergency departments across the country. The authors argue that, “numerous concussion experts have stressed the need for research on the young athlete, especially with the increasing number of sports activities available, the increasing competitiveness of youth sports, and the increasing intensity of practice and play times.” It has also been theorized by experts in head trauma that concussions may be a more serious injury in younger athletes than in their older counterparts. Not only are children’s brains still developing, and thus are more likely to have neurocognitive disturbances after a concussion, but also might require less force to cause the same symptoms in a child than an adult. Finally, the rare case reports of “second impact syndrome” have primarily been in young athletes.
The authors in this study performed a retrospective review of the National Electronic Injury Surveillance System. The data is collected from a sample of hospitals across the country in order to provide an estimate of national incidence of injuries that are treated in United States hospital emergency departments. The authors divided patients treated for concussions into two groups based on age, with the pre-high school group comprise of children ages 8 to 13, and the high school group comprised of children ages 14 to 19. They also grouped concussions based on cause, such as all sport-related and organize team sport-related.
How and when concussions occur in the NFL
Data on sport-related concussions presenting to emergency rooms
This study found very interesting results when looking at the emergency department visits for concussions nationwide from 2001 to 2005:
• In both groups of patients (children from ages 8 to 19), there were approximately 502,000 emergency department visits for concussion.
• 35% of all visits for concussion occurred in the 8- to 13-year-old age group.
• About half of all visits for concussion from ages 8 to 19 were sport related.
• 58% of all concussions in the 8- to 13-year-old group or sport related.
• Among organized team sports, the greatest number of concussions resulted from football, basketball, baseball, soccer, and ice hockey (in that order).
• One in every 1000 pre-high school children and 3 of 1000 high-school children playing one of the top five concussion sports sustained a concussion.
• Among the younger athletes, the concussion rate was highest for ice hockey (approximately 10 concussions per 10,000 children playing ice hockey). Football had the second highest concussion rate.
• Visits for organized team sports related concussions among the 8- to 13-year-olds doubled from 1997 to 2007 despite a decrease in overall participation in these team sports over the same period.
Age and sport-related concussions
The older athletes (the high school-aged athletes) had an overall greater number of emergency department visits for sport related concussions compared to the pre-high school athletes. However, the younger athletes still had a large percentage of the overall number of sport-related concussions. It does not seem that the dramatic increase in sport-related concussions in both the age groups can be attributed to an increased level of participation, as there was an overall decline in participation over the same period of time.
Reasons for increased concussion rates
I think there are likely several factors at play with this increased concussion rate in young athletes and the authors mention several of these factors. It could be that youth sports are getting more competitive. There has been a trend towards increasing specialization of young athletes, meaning that athletes are switching to playing one sport only at an early age. Consequently, the athletes may be faster and stronger, leading to more traumatic injuries. Also, practices and games might be more intense now that they were many years ago. As the authors note, the increased number of concussions may also be due to an increased awareness of concussions and a higher number of them reported in the database.
Concussions and football helmets that don’t fit
I think this is an important study, and hopefully it will raise awareness that sport-related concussions are not just an injury of older athletes. Young children can suffer concussions as well and they can be very serious injuries. There many key take-home points, in my opinion. First, as sports medicine physicians struggle to create return to play guidelines for high school, college, professional athletes, the same guidelines need to be created for young athletes, and these may differ from those of older athletes. Sports medicine physicians and primary care physicians need to become more involved in education. Speaking to coaches and parents and the athletes themselves about the risks of concussions in sports, teaching ways to identify when a concussion has occurred, and emphasizing urgent treatment will become crucial. Physicians can also work with coaches and parents to develop prevention strategies appropriate for each sport, such as the authors’ recommendation to pad goalposts in soccer. Finally, further research into the effect of concussions on developing brains is definitely needed.
See my post on concussions for further information regarding signs and symptoms, treatment, and return to play of this common injury.