Posted Sept 12, 2010
Fairfield pediatrician Michael Lee used to see a handful of young athletes with concussions each year. Four, maybe five kids would come into his office annually after sustaining a head injury while participating in sports.
But today, the number of children and their families that seek his services for treatment of a concussion has risen dramatically.
“Now, I can’t keep up with them,” said Lee, also president of Pediatric Healthcare Associates in Fairfield.
Lee’s experience, it seems, isn’t an uncommon one. A new study, published in the American Academy of Pediatrics’ journal Pediatrics, showed that between 1997 and 2007, emergency department visits for concussions by 8- to 13-year-olds in organized team sports doubled. For 9- to 14-year-olds involved in sports, emergency room visits for concussions over that same 10-year period increased by more than 200 percent.
To Lee, the spike in emergency room visits isn’t a shock. However, he doesn’t believe the jump means these types of injuries are happening more frequently. It simply means people are more aware of the symptoms and seriousness of concussions.
“Concussions have always been there,” he said. “It’s only as people become more knowledgeable that they’re reporting it more often.”
The study comes at a time when concern about sports-related concussions is at a fever pitch, and many states, including Connecticut, have enacted laws aimed at protecting student athletes. Dr. James G. Linakis, a pediatrician and one of the study’s co-authors, said one of the purposes of the research was to keep concussions — particularly their effect on young children — in the limelight.
“We’re trying to put out there that concussions are a serious issue,” said Linakis, associate director of pediatric emergency medicine at Rhode Island Hospital’s Hasbro Children’s Hospital.
Increased awareness, increased concern
A concussion is a type of traumatic brain injury, usually caused by a bump, blow or jolt to the head. As many as 3.8 million sports and recreation related concussions occur in the United States each year, according to the Centers for Disease Control and Prevention. Symptoms can include headache, nausea, vomiting, balance problems, double vision, blurry vision, sensitivity to light and noise and confusion.
If an individual is believed to have sustained a concussion, he or she should be evaluated immediately by an appropriate health care professional. In the case of an athlete, he or she should immediately be pulled from playing if a concussion is suspected. When not treated properly, concussions can carry serious long-term risks, including serious brain damage or even death.
The study published in Pediatrics used a variety of sources, including the National Electronic Injury Surveillance System and the National Sporting Goods Association, to track emergency room visits for concussions in both high school and pre-high school students. Linakis said one of the main goals of the study was to see how prevalent concussions are among grade school-aged children. Though there has been much discussion of concussions among high school and adult athletes, there has been less of a focus on young athletes.
“Kids at that age are engaging in individual and team sports,” Linakis said. “And they are getting bonked on the head.”
Indeed, the study found that of the 502,000 children 8 to 19 who visited emergency rooms with concussions between 2001 and 2005, about 35 percent were made by children 8 to 13.
Despite the jump in emergency department visits, the study didn’t see an increase in sports participation between 1997 and 2007. In fact, participation in the top five organized sports — football, basketball, baseball, soccer and hockey — actually decreased by about 13 percent.
Linakis said there’s no clear reason for the jump in concussion-related emergency room visits during the study period, but he does have theories. Like Lee, he thinks awareness is a factor.
“Concussion really has come to the forefront fairly recently,” he said. “There is this increased information. Coaches are more sensitive to the issues. Parents are more sensitive to the issues. And they’re more likely to bring kids to the emergency room.”
Laws aim to protect
Local neurologist Dr. Peter McAllister agreed that the attitude toward concussions has vastly changed in the past few years. “In the past, kids who got ‘dinged’ or ‘got their bell rung,’ the coaches often said ‘Oh, it’s OK to go back and play,’ ” said McAllister, director of the Headache Center and Concussion Center at Associated Neurologists of Southern Connecticut, with offices in Fairfield and Milford.
Today, the mindset of many coaches and parents has changed, particularly in light of such phenomena as second-impact syndrome, which occurs primarily in athletes younger than 21. It happens when an athlete sustains a second bump, blow or other impact before he or she has fully recovered from a previous concussion. Serious consequences can result, including paralysis or death.
Growing concerns about the repercussions of concussions has led many states to pass laws aimed at protecting young athletes. These include Connecticut, which recently passed a law requiring coaches to remove student-athletes diagnosed with or believed to have a concussion from sports participation. Students would be removed from all team activities involving physical exertion, including practices, games and other competitions, until they receive written clearance from a licensed health care professional trained in the evaluation and management of concussions.
The law went into effect July 1. It also requires coaches to complete a training course regarding concussions and head injuries. The training was developed by the Connecticut Coaching Education Program, an alliance of the Connecticut Interscholastic Athletic Conference, the Connecticut Association of Athletic Directors and the Connecticut High School Coaches Association.
Fred Balsamo, director of the Connecticut Coaching Education Program, said since May roughly 6,000 coaches have received the training out of a total of between 7,500 to 8,000 in the state.
The course teaches coaches the specifics of the new law, the signs and symptoms of concussion, the chemical effects of a concussion on the brain and the responsibilities of a coach regarding concussions. Balsamo said the part of the law requiring coaches to pull students with diagnosed or suspected concussions from play will be taken seriously.
“I feel confident that in Connecticut the majority of our coaches will heed the warning and do the right thing,” he said.
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