High School Concussions in the 2008-2009 Academic Year

Meehan, William P.; d’Hemecourt, Pierre A.; Comstock, R. Dawn

doi:10.1177/0363546510376737

Cited by 277 publications

(212 citation statements)

References 28 publications

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“…This time period was chosen because symptoms resolve within 1 month in 70% to 90% of youth with SRRCs. 6,[16][17][18][19] We conducted a sensitivity analysis using alternate exclusion periods of 2 weeks and 3 months to determine how different time periods affected the estimate. We used 2 weeks as the shortest period based on typical symptom resolution.…”

Section: Figurementioning

confidence: 99%

Sports- and Recreation-Related Concussions in US Youth

et al. 2016

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The incidence of sports-and recreation-related concussions (SRRCs) in the United States is unknown. More than 44 million youth participate in sports annually, thus understanding the frequency of SRRCs in children is important on a population level. Our objective was to determine the number of SRRCs occurring annually among US youth ≤18 years old. METHODS:We identified SRRCs using 3 national databases: MarketScan, National Electronic Injury Surveillance System, and National High School Sports Related Injury Surveillance System, Reporting Injury Online. We determined the number of SRRCs seen in health care settings (outpatient, inpatient, and emergency department) and SRRCs reported to certified high school athletic trainers (ATCs). We used these data and findings in recently published literature to generate a national estimate of SRRCs. RESULTS:We estimate that between 1.1 and 1.9 million SRRCs occur annually in US children aged ≤18 years. Most children with SRRCs, 511 590 to 1 240 972, were not seen in health care settings. Of children with SRRCs seen in health care settings, most were seen as outpatients with 377 978 visits, compared with between 115 479 and 166 929 ED visits, and between 2886 and 4936 hospitalizations. CONCLUSIONS:This study provides the most accurate and precise estimate to date of the number of concussions among US children annually. SRRCs are a common injury in children. Providers in all health care settings need to be trained in concussion care. There is a need for better surveillance to enhance our understanding of the epidemiology of concussions in youth. Dr Bryan conducted the data gathering and analysis with Dr Rowhani-Rahbar and led the manuscript writing; Dr. Rowhani-Rahbar conducted the data gathering and analysis with Dr Bryan and contributed to the manuscript preparation and intellectual content; Dr Comstock provided data and feedback on manuscript preparation; Dr Rivara conceived of the study and supervised throughout data gathering, analysis, and manuscript preparation; and all authors approved the fi nal manuscript as submitted. WHAT'S KNOWN ON THIS SUBJECT: Sports-and recreation-related concussions (SRRCs) are a common source of morbidity in children. Many of these injuries are not treated within health care settings. It is unknown how many SRRCs occur annually in the US. DOI WHAT THIS STUDY ADDS:We estimate between 1.1 and 1.9 million SRRCs occur annually in US children ≤18 years old. The magnitude of this number emphasizes the need for better national injury surveillance of the incidence of SRRCs.by guest on May 10, 2018 http://pediatrics.aappublications.org/ Downloaded from BRYAN et alConcussions, a form of traumatic brain injury (TBI), are common in children, with sports and recreation as a leading cause in this age group. 1, 2 The incidence of sports-and recreation-related concussions (SRRCs) in the United States is unknown; however, most epidemiologic studies indicate that a large number of SRRCs occur each year. [3][4][5][6][7] More than 44 million youth participate in ...

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Section: Figurementioning

confidence: 99%

Sports- and Recreation-Related Concussions in US Youth

et al. 2016

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“…Mild traumatic brain injury (mTBI) remains one of the most common reasons children present for medical care in the United States, [1][2][3] and concerns about its effects on the developing brain have led to a large number of recent studies examining pediatric concussion. Despite this, the expected course of individual postconcussive symptoms in children has not been well described.…”

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confidence: 99%

Duration and Course of Post-Concussive Symptoms

2014

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OBJECTIVES: To examine the incidence, duration, and clinical course of individual post-concussive symptoms in patients presenting to a pediatric emergency department (ED) with a concussion. METHODS: We conducted secondary analysis of a prospective cohort study of patients 11 to 22 years old presenting to the ED of a children’s hospital with an acute concussion. The main outcome measure was duration of symptoms, assessed by the Rivermead Post-Concussion Symptoms Questionnaire (RPSQ). Patients initially completed a questionnaire describing mechanism of injury, associated symptoms, past medical history, and the RPSQ, then were serially administered the RPSQ for 3 months after the concussion or until all symptoms resolved. RESULTS: Headache, fatigue, dizziness, and taking longer to think were the most common symptoms encountered at presentation, whereas sleep disturbance, frustration, forgetfulness, and fatigue were the symptoms most likely to develop during the follow-up period that had not initially been present. Median duration of symptoms was the longest for irritability (16 days), sleep disturbance (16 days), frustration (14 days), and poor concentration (14 days), whereas nausea, depression, dizziness, and double-vision abated most quickly. One month after injury, nearly a quarter of children still complained of headache, >20% suffered from fatigue, and nearly 20% reported taking longer to think. CONCLUSIONS: Among patients presenting to a pediatric ED after a concussion, physical symptoms such as headache predominate immediately after the injury, emotional symptoms tend to develop later in the recovery period, and cognitive symptoms may be present throughout.

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“…Defining the pathophysiology of pediatric SRC is paramount, given the high incidence of this injury, [1][2][3][4][5][6]40 considerable recent lay press attention, and the potential for short-and long-term impact on health and well-being. 13,16,[41][42][43][44][45][46][47] To study similarities and differences between pediatric and adult SRC, we evaluated a small cohort of children with SRC and healthy controls, using ImPACT neurocognitive testing and MRI measures of brain structure, metabolism, organization, and blood flow.…”

Section: Discussionmentioning

confidence: 99%

“…If a concussed child returns too quickly to strenuous physical activity or experiences a second SRC, symptoms and neuropsychological testing deficits frequently worsen. 3,6,14,30,40,96 Investigators have demonstrated measurable biological indicators of this vulnerability in animals 97,98 and human adults. 27 Furthermore, catastrophic outcomes such as the second impact syndrome (death resulting after a second concussive type injury) have been attributed to probable loss of cerebral autoregulation.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Sports-Related Concussion Produces Cerebral Blood Flow Alterations

2011

PEDIATRICS

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WHAT'S KNOWN ON THIS SUBJECT:The pathophysiology of pediatric sports-related concussion (SRC) is largely unknown. Studies of concussed adults have identified neuronal and axonal injury and time-limited metabolic disruptions. An experimental animal model has also demonstrated physiologic perturbations, including reduced cerebral blood flow (CBF). WHAT THIS STUDY ADDS:Using MRI techniques, we found no evidence of neuronal, axonal, or metabolic disruptions in 12 children with SRC. However, when compared with controls, statistically significant alterations in CBF were defined and frequently persisted beyond 30 days after injury.abstract OBJECTIVE: The pathophysiology of sports-related concussion (SRC) is incompletely understood. Human adult and experimental animal investigations have revealed structural axonal injuries, decreases in the neuronal metabolite N-acetyl aspartate, and reduced cerebral blood flow (CBF) after SRC and minor traumatic brain injury. The authors of this investigation explore these possibilities after pediatric SRC. PATIENTS AND METHODS:Twelve children, ages 11 to 15 years, who experienced SRC were evaluated by ImPACT neurocognitive testing, T1 and susceptibility weighted MRI, diffusion tensor imaging, proton magnetic resonance spectroscopy, and phase contrast angiography at ,72 hours, 14 days, and 30 days or greater after concussion. A similar number of age-and gender-matched controls were evaluated at a single time point. RESULTS:ImPACT results confirmed statistically significant differences in initial total symptom score and reaction time between the SRC and control groups, resolving by 14 days for total symptom score and 30 days for reaction time. No evidence of structural injury was found on qualitative review of MRI. No decreases in neuronal metabolite N-acetyl aspartate or elevation of lactic acid were detected by proton magnetic resonance spectroscopy. Statistically significant alterations in CBF were documented in the SRC group, with reduction in CBF predominating (38 vs 48 mL/100 g per minute; P = .027). Improvement toward control values occurred in only 27% of the participants at 14 days and 64% at .30 days after SRC.CONCLUSIONS: Pediatric SRC is primarily a physiologic injury, affecting CBF significantly without evidence of measurable structural, metabolic neuronal or axonal injury. Further study of CBF mechanisms is needed to explain patterns of recovery.

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High School Concussions in the 2008-2009 Academic Year

Cited by 277 publications

References 28 publications

Sports- and Recreation-Related Concussions in US Youth

Sports- and Recreation-Related Concussions in US Youth

Duration and Course of Post-Concussive Symptoms

Pediatric Sports-Related Concussion Produces Cerebral Blood Flow Alterations

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