Sport Related Concussion and Head Injuries

Guidelines For Parents And Athletes

• Head injuries are among the most serious types of injuries that occur among athletes. Fortunately, serious injuries are rare.
• Careful attention to any head injury by parents, coaches, and medical professionals can help prevent complications from developing.
• Skull fractures are uncommon and are unrelated to brain damage or concussion. Brain damage from head injuries is uncommon in sports.
• After any significant head injury, the athlete should NOT be left alone and for the first 24 hours should be awakened every 2-3 hours during sleep to be checked.

Statistics

• 20% of the 1.5 million head injuries that occur in the United States each year are sports-related.
• Approximately one tenth of sports-related injuries require hospitalization.
• 20% of high school football players and 40% of college football players will get a head injury at some point in their career.
• Those who have had a head injury are at 2 to 4 times greater risk of having another.
• Sports most likely to result in concussion: boxing, field hockey, football, ice hockey, lacrosse, martial arts, rodeo, soccer, and wrestling.

Definitions

Concussion refers to a head injury in which there is bruising of the brain, but not permanent damage or bleeding. It may occur with or without loss of consciousness.

Common symptoms include:

• Confusion
• Headache
• Nausea
• Vomiting
• Dizziness
• Unsteadiness
• Feeling "in a fog"

Grading of Concussions - American Academy of Neurology

Grade I: confusion lasting <15 minutes without loss of consciousness: may return to play if all symptoms clear completely and athlete has normal sideline evaluation during rest and exertion after 30 minutes

Grade II: confusion lasting >15 minutes without loss of consciousness: may play after 1 week if all symptoms clear completely

Grade III: loss of consciousness, even for seconds: may play after 1 month if all symptoms clear completely

Confusion Is Present If Any Of The Following Are Affected

Test for attention:

• Ask athlete to repeat a series of numbers forward and backward and name the months backward.
• Most high school athletes should be able to repeat about 7 numbers forward and five numbers backward two out of three times.

Test for amnesia: Ask the athlete the following:

• name of the opponent
• score of the game
• period or quarter that injury occurred in
• sequence of events that preceded the injury

Test for mental status: Ask the athlete the following:

• What he/she did prior to game
• Time, date, home address and phone number
• Ask child to memorize and minutes later to recall three to five words (immediate recall memory)

What To Watch For After A Head Injury

Normal signs in the first 2 days include:

• Fatigue and desire for extra sleep (but can be easily awakened during sleep)
• Headache (should be fairly mild and not worsening)
• Nausea and vomiting (occasional - not persistent)
• Problems with thinking, concentration, and attention span (this may persist for up to a year or more)

Signs that suggest the need for immediate medical attention include:

• Marked change in personality--often with confusion and irritability
• Worsening headache, especially if associated with nausea or vomiting
• Numbness, tingling, or weakness in the arms or legs, changes in breathing pattern, or seizure
• Eye and vision changes (double vision, blurred vision, unequal-sized pupils)

Preventing Head Injuries

• Understand grades of concussions and follow "return to play" guidelines above.
• A player with symptoms should never be permitted to return to play!
• Insist on the best possible equipment (especially properly fitted head gear) and WEAR IT!
• Always follow safe sports techniques and avoid risks: no head-down tackling (spearing); no diving into water of unknown depth; use care during gymnastic routines; avoid use of trampolines; wear a helmet for all biking and street skating.
• Follow-up with your pediatrician after ANY head injury.

American Academy of Pediatrics, Section on Sports Medicine and Fitness