Concussions account for nearly 15 percent of all sport-related injuries in high school athletes, according to researchers at Children's Hospital Boston. But who takes the lead role in managing those injuries and in deciding when an athlete can return to play, as well as how the injuries are managed, can vary widely.
These findings, reported by William Meehan, III, MD, of the Sports Concussion Clinic at Children's Hospital Boston, along with colleagues at Nationwide Children's Hospital, stem from a review of the largest national sample to date of athletes sustaining concussions in high school sports, published in the November issue of The American Journal of Sports Medicine.
Awareness of the problem of sport-related injuries, especially concussions, has grown dramatically in recent years, largely due to studies illustrating the scope of the long-term cognitive and neurological damage that can result from such injuries.
What the medical and athletic communities together currently lack, though, are evidence-based guidelines for diagnosing and managing concussions suffered by athletes at sporting events, especially those at the high school level. The medical resources high school teams have at their disposal can differ greatly from those available to professional or college teams.
Recognizing the paucity of published data available on who manages concussions on the high school sports field and how they are managed, Meehan and his colleagues conducted an exhaustive review of data in the High School Reporting Information Online (HS RIO) database. This injury surveillance system tracks reports from 192 U.S. high schools on athletes participating in 20 sports. All of the participating schools employ athletic trainers, who submit weekly reports of injuries sustained on the practice and/or playing field.
In their paper, Meehan’s team describe variability in how high school athletes receive care following a concussion – which accounted for nearly 15 percent of the 7,257 injuries captured in the HS RIO system during the 2009-10 school year. The majority of athletes in the sample were examined by medical professional – an athletic trainer, a physician, or both – following their injury. Of the athletes who saw a physician, 60 percent saw only a primary care doctor.
Almost 20 percent of athletes underwent a CT scan after their concussion, while 3 percent were assessed via MRI. “We see imaging selection as a particular opportunity for improvement,” Meehan said. “There is growing recognition in medicine of the need to limit kids’ cumulative radiation exposure, which would argue for assessing concussions by MRI rather than CT.”
“We also noted increased use of computerized neuropsychological testing over the previous academic year,” Meehan added. “It would be wonderful to see more AT’s and physician trained on the use and administration of these tests.” Such tests, which can help judge whether an athlete has completely recovered from the neurological aspects of a concussion, are a relatively recent and low-cost addition to the sports medicine toolkit.
With the descriptive statistics in hand, Meehan suggests that steps aimed at reducing the numbers of concussions are key. He also recommends that only physicians or athletic trainers should make the call as to when a concussed athlete can return to play. “We know from other studies that only about 42 percent of U.S. high schools employ an athletic trainer, and just in the HS RIO data we found that non-medical professionals make the return-to-play decision for 2.5 percent of concussions,” Meehan said. “This is cause for concern, because if the athlete’s symptoms haven’t completely resolved, putting them back on the field puts them at serious risk.”
The study was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the U.S. Center for Disease Control and Prevention (CDC), the National Federation of State High School Associations, the National Operating Committee on Standards for Athletic Equipment, EyeBlack, and Don-Joy Orthotics.