By Dr. Leyen Vu

Resident Physician, St. Peter Hospital

Sept. 28, 2010

Concussions in High School Athletes

Change in mental status caused by a traumatic episode with or without loss of consciousness. May be caused by blow to the head or

anywhere else on the body with an impulsive force on head

Most commonly no loss of consciousness

Definition: Concussion

300,000 sports related concussions each yearMost common sports: football, ice hockey,

soccer, boxing, rugby. 10% of college and 20% of high school football

players suffer head injuries each seasonOnly 4-5% of players report symptoms.

63.4% football10.5% wrestling6.2% girls basketball

14% had repeat concussion during same season

How Often Do Concussions Occur in Sports?

Males more likely than females2-3 times more likely

Who Gets More Concussions?

The Science

The Science

Children have weaker neck and shoulder muscles compared to adultsMore of the impact is absorbed by the head

and less by the upper body. Most brain scans are still normal

The Science

Signs of a Concussion

ImmediateConfusionDouble vision, seeing starsNot feeling rightAmnesia

Can’t remember the play, quarter, score

Later onHeadachedizzinessChange in mood

Signs of a Concussion

Vacant StareSlower to answer questionsCan’t focusDisorientation (walking in wrong direction)Poor coordinationPoor memoryLOSS OF CONSCIOUSNESS

Signs of a Concussion

Suspected concussions need evaluationMay be unrecognized by non medical

personnelMore than 80% of people with a previous

concussion did not recognize it as suchJust asking time and date not adequate“When in doubt, sit them out”

Sideline Detection of Concussion

Test at beginning of season and immediately after injuryDecline in 1 point 76-94% accurate in detecting

concussion

Standard Assessment of Concussion (SAC)

Brief QuestionairreWhat is your name?What is the name of this place?Why are you here?What month are we in?What year are we in?In what town/suburb are you in?How old are you?What is your date of birth?What time of day is it? (morning, afternoon,

evening)Three pictures are presented for subsequent recall

Other Tools

1 wrong answer suggests concussion

Other Tools

Any athlete with suspected concussion MUST be removed from game/eventCannot return to play on same dayDoes not matter how mild concussion

symptoms are!!!

Management

When to go to Hospital Loss of consciousnessSuspected broken skull

Black eyes, bruising behind earsEar drainage2 or more episodes of vomitingSignificant neurologic impairment

Management

Bleeding in the brainSecond Impact Syndrome

Occurs when a second head injury occurs before 1st concussion can fully heal

Causes brain swellingCan be deadlyRare

Complications of Concussions

General Principles:A player should not return to play until

symptoms have resolved completely, both at rest and during activity

Younger athletes have longer recovery time and a more conservative approach should be taken

All suspected concussions should have medical evaluation by physician before returning to play

Management

Athlete should not be left alone after concussionNeed to monitor for worsening condition

Management

Stepwise return to play (Vienna, 2001) Day 1 - No activity and rest until

no symptoms (i.e. headache dizziness, etc.)

Day 2 – May start light aerobic exercise if no symptoms

Day 3 - Sport-specific trainingDay 4 - Noncontact drillsDay 5 - Full-contact drillsDay 6 - Game play

How To Return to Play

Day 1: complete brain rest (i.e. no reading, video games)

If you have symptoms at any level, you have to go back to the level where you have no symptoms .

How To Return to Play

Neuropsychological testMeasures:

Attention spanMemoryReaction TimeNon verbal problem solving

Considered a “cornerstone of concussion management”

Can be given by coach, trainer, anyone who is trained to administer test

IMPACT Testing

May be able to detect subtle signs of a concussion

Can follow the accumulative effects of multiple concussions over time

Need Baseline test prior to injury to compareStill being researchedCannot alone determine return to play.

IMPACT Testing

Alzheimers DiseaseParkinsonsDepressionPermanent memory problemsLong term brain damageVertigo

Long Term Consequences of Multiple Concussions

Long Term Consequences of Multiple Concussions

Chronic Brain InjuryDid not suffer any

“documented” concussionsin college or NFL

Chris Henry, Cincinnati Bengals

Passed May 14, 2009Requires all school districts to work with the WIAA to

develop guidelines to educate coaches, youth athletes, and parents of the nature and risk of concussion and head injury

Requires an informed consent must be signed by parents and youth athletes recognizing risk of concussions

Requires that a youth athlete who is suspected of sustaining a concussion or head injury be removed from play. “When in doubt, sit them out”

Requires a written clearance from licensed health care provider prior to returning to play.

http://www.king5.com/sports/high-school/Sports-Head-Injuries-83303332.html

Zackery Lystedt Law

Specialized helmets or mouthpieces- no clear benefit

May be more harmfulAthlete has false sense

of security and changes behavior of play.

Prevention

Concussions are much more common than previously believed

Players with concussions (even mild) should be removed from play

Stepwise approach to return to playMust be seen by a medical professional and

preferably get IMPACT testing prior to returnLong term mental effects of repeated

concussionsNew laws in place in Washington

Summary

THANK YOU!