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Tuesday, November 5, 2013

IOM Releases New Report on Youth Concussion


A new report from the Institute of Medicine on youth concussion calls for a national surveillance program that should include demographic data, pre-existing conditions, concussion history, the use of protective equipment, and the impact of monitoring devices, as well as the qualifications of individuals making concussion diagnoses. 

Visits to emergency departments for concussions and other non-fatal, sports- and recreation-related traumatic brain injury (TBI) among players ages 19 and under jumped from 150,000 in 2001 to 250,000 in 2009. This statistic — as well as the severe dearth of research on concussions and subconcussive injuries in younger athletes, and a “culture of resistance” pervading youth sports — make a strong case for a nationwide surveillance program on the incidence of such injuries in youths between the ages of 5 to 21 years, an Institute of Medicine (IOM) panel has concluded.  

       In its 306-page report, the Committee of Sports-Related Concussions in Youth, which is affiliated with the IOM, called on the Centers for Disease Control and Prevention (CDC) to undertake such a surveillance program.

      "Concussion is an injury that needs to be taken seriously,” IOM Committee Chairman Robert Graham, MD, who directs the Aligning Forces for Quality national program office at George Washington University, told reporters at a news briefing on the report on Oct. 30. “If an athlete has a torn ACL on the field, you don't expect him to tape it up and play."

      In reviewing the existing research on concussion in young players, the committee found some data on youth concussions in high school sports injuries, but “very little” on younger children, said panelist Tracey M. Covassin, PhD, associate professor of kinesiology at  Michigan State University in East Lansing.

"Constantly, we came to this place where there's just nothing about kids,” she said. “We have to start doing better studies."

     Susan Margulies, PhD, professor of bioengineering at the University of Pennsylvania, said the most critical research needs include data on vulnerability timelines for younger children and the potential differences in the biomechanics of concussions at younger ages. Equally important is the need to educate players, parents, coaches, and others on the risks of head impacts, including those that do not result in a concussion, she said.

“We need an objective surveillance system,” she said. “We have no data on timelines for vulnerability, but we know that [injury] thresholds vary with age.”

At a time when many school districts face budget cuts, the purchase of better and more protective helmets may be less of a priority.

     While media attention on concussions in professional and collegiate sports, notably football, have raised awareness of the problem, and rules and protocols been widely implemented for these older players, these changes have yet to trickle down to youth sport leagues, for the most part, where there remains a “culture of resistance" among younger athletes, coaches, and even parents, she told reporters. This is due, to some extent, to peer pressure and reticence among young players to let their teammates down.

       But the main problem is the overall lack of data, the report emphasized.

      “Until we have that information, we urge parents, schools, athletic departments, and the public to examine carefully what we do know…so they can make more informed decisions about young athletes playing sports," said Dr. Graham.

     Some neurologists who are involved in the AAN Sports Neurology Section expressed disappointment to Neurology Today that the report did not offer anything new and that neurologists did not participate on the committee. They identified key areas that require more research. For the full discussion, stay tuned for our Nov. 21 issue of Neurology Today. For now, see our previous coverage of concussion: