Concussions in Young Athletes

By Dr. James Johnston, MD, Assistant Professor of Neurosurgery, University of Alabama at Birmingham and Children’s of Alabama.

Concussion has been in the news a lot lately, with stories detailing chronic traumatic encephalopathy and early dementia in retired NFL players and concerns about cognitive development in younger children.  Given its newly recognized prevalence and possible connection to long term neurological sequelae, prevention and recognition have become major priorities in the sports and medical communities. It is important that parents, coaches and athletic trainers know the symptoms of concussion and seek medical attention when concussion is suspected.  The most common symptoms of concussion are headache, nausea, dizziness, blurry vision and confusion.

Fewer than 10 percent of athletes who suffer from a concussion lose consciousness, and these other symptoms are often overlooked. While most people heal quickly and fully after minor head injuries, new research published in a recent issue of The American Journal of Sports Medicine http://ajs.sagepub.com/content/early/2012/04/26/0363546512444554.abstract?sid=17882163-1d9c-4b64-8b60-05865a378d18  suggests that young athletes may be particularly susceptible to the damaging effects of concussion, such as memory and attention problems, and may require more recovery time than adults. If left untreated, concussions or repeated head injuries can lead to more serious problems.

Concerns over the long-term effects of head injuries in professional athletes have prompted many states to take a more aggressive approach to ensure the safety of young players. Last year, Alabama joined more than 20 other states in passing a law that that requires removal of a player from the field of play if a concussion is suspected until he or she is examined by a licensed physician and receives written clearance for return to play.

As a result, many physicians in the community have seen more young athletes this year with suspected concussion. At Children’s of Alabama, as an example, the number of unique patients we treated for concussion increased from 51 between August 2007-July 2008 to 319 between August 2011-July 2012.

Evaluation of the concussed athlete should include a formal neurological exam and updated concussion assessment form like the Acute Concussion Evaluation (ACE) or Sports Concussion Assessment Tool (SCAT 2). Return to play should then follow a supervised incremental increase in activity without recurrence of symptoms before full return to impact sports.

In support of this effort, Children’s and UAB have established the Concussion Clinic to provide specialized medical care for young athletes, to educate parents, coaches and athletic trainers about the symptoms and management of concussion, and conduct research to better understand mild traumatic brain injury.

For more information and to obtain concussion assessment materials and return to play guidelines for young athletes, go to our website: http://www.childrensal.org/concussion. The Concussion Clinic is located at UAB Sports Medicine at Children’s of Alabama, 1600 7^th Ave. S., Birmingham. Appointments can be made by calling 205-934-1041.