Concussion In Adolescents

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     There is increasing recognition of how frequent and how serious concussion can be in adolescents. Almost 10% of all high school sports injuries are concussions. It is estimated that almost 4 million brain injuries a year occur as a result of sports trauma. Females seem to have a higher rate of concussion than males and children are more susceptible to concussion than adults. The reported rate of concussion is probably smaller than the actual rate because coaches, trainers and physicians sometimes don’t recognize the subtle signs of concussion and because athletes who want to play will often underreport their symptoms.

     A simple definition of concussion is impaired brain function caused by trauma. You cannot see a concussion on an X-ray or CT scan. Those studies show swelling, bleeding and other forms of brain damage, but a concussion is defined by how it affects the brain. Even loss of consciousness does not correlate directly with the severity of the concussion or the duration of the concussion symptoms.

     The sport having the greatest risk of concussion is football with hockey, lacrosse, basketball and soccer as runners-up. Bicycle accidents are another common cause. Helmets and other protective gear are effective in preventing facial, eye, dental and severe brain injuries, but it is not statistically clear that they decrease the risk of concussion. However, elimination of body checking in hockey, helmet to helmet contact in football and heading the ball in soccer have been shown to decrease the risk of concussion (allowing players to head the ball increases the risk of head-to-head collision).

     The symptoms of concussion are headache (often made worse with activity), confusion, disorientation, memory loss (for events before or after the accident), dizziness and vomiting. Longer-term symptoms are depression, poor concentration, and behavior changes. If the symptoms last for more than two weeks, it is called post-concussion syndrome. If the symptoms are getting progressively worse, more serious brain injury is possible and the child needs to be evaluated (or re-evaluated) by his caregiver.

     The treatment for concussion is rest. It is not recommended to take non-aspirin pain medications immediately after an injury because of the risk of bleeding in the brain. Any activity (video gaming, listening to loud music, etc) that makes the headache worse should be avoided. If activity makes the headache worse, PE should be avoided. The athlete may be sensitive to light and need to wear dark glasses.

     If a concussion is suspected, an athlete should not return to play for the rest of the game - "if in doubt, sit it out". The athlete needs to be assessed by his caregiver before returning to further activity. Headache and nausea need to be totally gone before returning to the sport and the athlete needs to be back to the level of mental performance he was at before the injury. This can be tested with on-line evaluation tools that measure ability to concentrate but no single test should be used to determine whether an athlete can return to play. All symptoms must be taken into account. Once the symptoms have totally resolved, the athlete should slowly return to activity but should stop if symptoms return. Multiple concussions have been related to a permanent decrease in school performance and should be considered grounds for retiring from the sport.

     If an athlete gets another head trauma before the symptoms from the first concussion are resolved, there is a risk for something called “second impact syndrome”. This is a rapid, severe swelling of the brain that is rare, but is almost 50% fatal. Its cause is unknown.