A Perspective From the Middle East on the Topic of Concussion

Abstract

Background: Concussion is the most prevalent form of traumatic brain injury. Western countries debate it as a public health issue. Middle Eastern (ME) countries lag behind with a concussion incidence surveillance of 25% that of European countries. 
 
 Objective: The purpose of our study was to review concussion resulting from traumatic brain or sports injuries in civilian nationals of the ME.
 
 Methods: We carried out PubMed literature search of all related articles in the past thirty years using search terms reflecting concussion and sports injuries in ME countries of Bahrain, Egypt, Iran, Iraq, Israel, Jordan, Kuwait, Lebanon, Oman, Palestine, Qatar, Saudi Arabia, Syria, Turkey, United Arab Emirates, and Yemen. 
 
 Results: 72 articles met our search criteria with relatively little data found on concussion within the parameters of this review. However, the reports that were found were diverse. Israel, Turkey and Iran led in publications. Motor vehicle accidents were the leading cause of concussion from TBI (50-57%) followed by domestic injuries (30-40%) and sports injuries at 4-7%. Extremity injuries were most commonly reported unlike head injuries often invisible and underreported. Male gender, young children, pedestrian and car traffic accidents, lack of protective gear, cell phone use, impulsive behaviors as well as training overload, lack of sleep, contact sports and violence were all risk factors for concussion. 
 
 Conclusions: In this review, we highlighted the nascent topic of concussion in the ME and the need for additional research dictating awareness programs and implementing new safety policies to lower morbidity and mortality across all ages.

Cross-cultural adaptation and preliminary validation of the Arabic version of the Rosenbaum Concussion Knowledge and Attitudes Survey - Student Version (RoCKAS-ST-A)

“…The exploration of the effect of the attitudes of coaches on the knowledge and attitudes of young athletes could be investigated. 7 Parents knowledge and attitude toward SRC should also be explored. Future studies should also focus on conducting larger validation studies for RoCKAS-ST-A, in which construct validity and responsiveness should be addressed.…”

“…6 The low percentage reported could be due to the lack of knowledge of this condition among athletes and physicians, which was documented in western communities. 5,7,8 To assess the knowledge and attitudes toward SRC, Rosenbaum Concussion Knowledge and Attitudes Survey -Student Version (RoCKAS-ST) was widely implemented in the literature. 9 The RoCKAS-ST questionnaire was developed in order to examine these domains in adolescents (i.e., 13-20 years old individuals).…”

“…6 The low percentage reported could be due to the lack of knowledge of this condition among athletes and physicians, which was documented in western communities. 5,7,8…”

Misdiagnosis of Pediatric Concussions in the Emergency Department

“…This is significant to identify target areas because an early and correct diagnosis of concussion helps with recovery, by allowing early implementation of treatment recommendations 19 . In addition, literature on pediatric concussions lacks in the Middle East, where the focus has been mostly on adults, major TBI, and war injuries 13 . Understanding the characteristics of pediatric concussion in this region is important because the type of sports and activities may be different from those in the United States and Europe, where concussion, attributed mostly to contact sports, has been more widely described 5 …”

“…7 Although data on concussion are abundant in North American and European countries, it lacks in the rest of the world including the Middle East. 5,13 In addition, concussion research has focused on pathogenesis and outcomes of the disease but not on the ED presentations and diagnoses, particularly in children.…”