BIAOR 

Sports - Prevention

The Center for Disease Control and Prevention has produced a number of documents and kits about brain injury and prevention.  http://www.cdc.gov/concussion/

Heads Up to Clinicians:  Concussion Training by CDC & NFL http://preventingconcussions.org/

Head Injury Prevention - A rundown on risks and prevention of head injury in youth sports. http://www.publichealthdegree.com/resources/head-injury-prevention-in-youth-sports-an-online-guide/

Is a Helmet Worth It? How Brain Injuries Affect Different Body Functions

If you ride bicycles or motorcycles, you may have an idea of just how much crashing hurts.  Crashing or being hit while riding your bicycle can be anything from simply embarrassing to majorly painful.  New riders may think that they’re skilled enough to never crash, but there are many factors outside of their control, and the occasional crash is inevitable.  But while some crashes leave the rider with a few bruises and scrapes, some leave them with broken bones and other painful injuries.

This is why bike safety is so important.  There are so many ways that bike injuries can linger or lead to lifelong issues that to ride without the proper safety gear is very unwise.  This is especially true for those who live in a large city like New York City.  Because NYC has such a large population, there are many more people and vehicles on the streets.  It’s much more likely someone will run into you or get in your way and cause a crash.

While broken bones will hurt and take time to heal, a head injury can be even worse.  Damage to the brain can be irreversible and make it difficult to function.  It can lead to vision and hearing loss, difficulty with memory, a lack of coordination, and can even affect your heart rate and ability to breathe.   Because each section of the brain controls different parts of the body, a brain injury can affect just about anything.

bike helmet

Bicycle Injuries: Would they have been prevented with a helmet?

According to the Insurance Institute for Highway Safety, in 2009, 91% of all bicyclists killed in an accident were not wearing a helmet. That means out of the 628 riders who were killed that year, 573 of them weren’t wearing a helmet.  This wasn’t an abnormal year, either—the percentage of bikers who died in accidents and were not wearing a helmet has never been below 80% with the exception of the 2010-2012 statistics.  These statistics are actually the abnormality because, while 65 to 70% were not wearing helmets, another 16 to 17% are listed as “unknown,” meaning they may or may not have had some kind of protective headgear on at the time of the accident.

The most commonly injured bicyclist is a male over 16 years old riding without a helmet in an urban area.  Out of the 601 bikers who were killed in 2012, only 166 of them had a blood alcohol content level above .08 percent.  Most were completely sober.

What can be drawn from these statistics?  While it’s hard to say if any of the bicyclists would have survived their crash if they had been wearing a helmet (helmets cannot prevent neck or face injuries), it’s entirely possible some of them would have.

moto helmet

In many non-fatal crashes, there is a definite answer: helmets reduce damage to the brain.  According to a number of studies, head injuries account for over 60 percent of all bicycle-related injuries.  In a study done by the Bicycle Helmet Safety Institute, medical professionals reported that up to 88 percent of these head injuries that resulted in brain trauma could have been prevented had the bicyclist been wearing a helmet.

Keep a Lid On It: Wear a Helmet – How to choose or replace a helmet.

Cheap or Expensive Bicycle Helmets – How much of a difference is there?

Bicyclist Fatality Facts – Statistics gathered by the Insurance Institute for Highway Safety

Precious Protection – The evolution of helmets over the years and what designers have learned.

Safety Helmets Save Lives, Prevent Traumatic Brain Injury – How helmets protect children.

TBI 

Brain Areas and Associated Functions

Damage to the brain can lead to many different difficulties and lifelong issues.  The brain controls everything about the human body.  As such, damage to the brain can affect any part of the body, even changing a person’s behavior and abilities.  The brain can be divided into six different areas.

The brain stem is the term for the lowest part of the brain that connects to the rest of the body.  Because it connects to the neck, the brain stem is fairly vulnerable.  Damage to the brain stem can lead to many different physical problems, including a loss of balance and the ability to sleep.  It can also cause an irregular heartbeat, breathing problems, and difficulty with swallowing.  The brain stem controls blood pressure, body temperature, sweating, and digestion, too, and any or all of these functions can be affected by damage.

The cerebellum is the part of the brain that coordinates movement, balance, equilibrium, and helps with reflexes.  Those who have damage to their cerebellum may have difficulty performing complex actions or, in the case of major damage, basic actions like walking.

The frontal lobe is where much of our thinking occurs.  It controls things like how we perceive our environment, our emotions, our language, and how we understand concepts and solve problems.  A head injury that affects the frontal lobe can make it very difficult to function.

The parietal lobe handles many of our senses, including touch perception and our ability to manipulate objects.  Damage here can throw off how the senses work together.

The occipital lobes are concerned with one function: vision.  Damage to these lobes can lead to a loss of vision and blurred vision.

Finally, the temporal lobes handle hearing, memory, emotion, and the processing of verbal information.  Light damage can cause a decrease in hearing or in memory, while major damage can leave someone unable to express emotion or remember much of anything.

Understanding Brain Injury – What you should know about brain injury recovery.

How Your Brain Works – An informative slideshow from the Mayo Clinic.

Brain Basics: Know Your Brain – A look at how the brain functions.

Living with Brain Injury – The difficulties a brain injury can cause and how one can adapt.

Traumatic Brain Injury – What can happen when the brain is injured.

TBI 

Parts of The Brain and Their Functions – How will brain damage affect your functionality?

The Four Lobes – What they are and what they do.

Brain Structures and their Functions  - An online resource on the brain.

Damage to the Frontal Lobes – How an injury to the frontal lobe affects a person.

Parts of the Brain and Their Functions – Details the different sections of the brain.

Conclusion
While being injured in a bicycle crash may be inevitable, wearing a helmet can greatly reduce the chances or severity of brain damage.  In many cases, a brain injury doesn’t just affect one area—several parts of the brain can be damaged, leading to a number of different problems for the bicyclist.  Why risk that?  A helmet is a fairly inexpensive and easy to wear piece of equipment that can provide a great amount of protection.  It seems a risk that few people should be willing to take, yet many people ride their bikes without wearing a helmet.  Even worse, a number of parents let their children ride bikes without proper safety gear.  No one is too young or too old to wear a helmet.

Don’t open yourself up to brain damage from a bicycle injury.  Purchase and wear a helmet whenever you ride.

- reference: http://www.dandalaw.com/resources/is-a-helmet-worth-it/

 


Ohio University Online

 

Football - A Bloody History
Contributed by Paul Buress

Those familiar with the history of the game know that violence is nothing new, and that in the early days death was a not-uncommon visitor to the gridiron. In fact, over a century before President Obama voiced his worry over college players facing “concussions and so forth,” President Teddy Roosevelt called a meeting of several university football team representatives to push for safety measures after 19 boys were killed during regulation time in 1905. Four years later, the five-year tally was 113 dead, and finally changes began to take shape. Read more at: http://www.thebestcolleges.org/hard-knocks-college-footballs-wake-up-call/

Sport Injuries

We are all urged to exercise in order to keep fit and to avoid getting fat. Sports seem like a fun way of burning extra calories to lose weight, but according to a U.S. Consumer Product Safety Commission report, sports injuries among baby boomers increased by 33 percent from 1991 to 1998.[1]  There were about 276,000 hospital emergency room-treated injuries to persons 35 to 54 in 1991 compared to more than 365,000 sports injuries to persons of these ages in 1998. The number of injuries keeps increasing every year. In 2006, the National Electronic Injury Surveillance System (NEISS) reported over half a million injuries just for basketball. Another two million injuries were associated with bicycling, football, other sports.[2] The increase in injuries has also made doctors and RN's much busier which has sparked an increase in the need for CNA training across the country.

Boxer 
Is boxing really a sport
when the goal is to
knock each other senseless? 

Baby boomers suffered more that 1 million sports injuries which cost over $18.7 billion Dollars in medical expenses in 1998. The highest numbers of sports-related injuries came from bicycling, basketball, baseball, and running.

The largest number of deaths were associated with head injuries while riding a bicycle. Most of these injuries resulted from accidents with motor vehicles due to heavy traffic, poor visibility, or failure to obey traffic regulations. Drowning while swimming was the next most common cause of death, followed by skiing accidents. Swimming where there is no lifeguard increases the risk of drowning if a person should get a cramp, or have some other serious problem. Deaths from skiing accidents occur because of the high speeds involved and the inability to maneuver to avoid obstacles like trees or rocks. Sonny Bono, of Sonny and Cher fame, died of injuries after hitting a tree while skiing near Lake Tahoe, California. His death came just days after Michael Kennedy, son of Robert F. Kennedy, died in a similar accident.

Injured Football Player 
The effect of an injury
may be felt many years later.
 

The prevalence of sport injuries in professional sports can be seen by just reading the sports pages of any newspaper, especially after the weekend games. Here is a sampling of the Washington Post for Tuesday, March 13, 2007:

Basketball:

Caron Butler's value to the Washington Wizards was made obvious late last season when the team lost five straight games while he was out with a thumb injury on his right (shooting) hand and again after this season's all-star break when the team went 0-3 while he was out with lower back spasms.
  Butler said persistent stiffness in the left knee -- the same knee that required arthroscopic surgery in October 2003 and forced him to miss 13 games as a member of the Miami Heat season -- has robbed him of quickness and explosiveness and led him to play with uncharacteristic hesitancy.

Hockey:

Washington Capitals' goaltender Brent Johnson left after the second period with a right knee injury. Johnson hurt himself while sprawling to stop Tkachuk's shot and was replaced by Frederic Cassivi at the start of the third period. Johnson will be reevaluated Tuesday. The Capitals don't play again until Thursday in Boston, where Olie Kolzig hopes to return from a sprained left knee.

Baseball:

Texas Rangers outfielder Nelson Cruz was hit in the head by a pitch and taken to a hospital during the Rangers' 11-7 victory over the Milwaukee Brewers yesterday in Phoenix.
  Cruz was batting with the bases loaded in the sixth inning when he was hit on the helmet near an ear by a fastball from Yovani Gallardo.
  Cruz stayed on the ground for several minutes, then walked off on his own power. He had an indentation on the side of his face where his helmet had been and looked dazed as he walked to the visitor's clubhouse. He was coherent when he got in a car and was taken to the hospital.

- Yankees: Carl Pavano last pitched in the majors on June 27, 2005, before being sidelined by shoulder, back, buttocks, elbow, and rib injuries.
- Cardinals: Jason Isringhausen is set to make his spring training debut Thursday, right on schedule. The right-handed closer missed the World Series after hip surgery in September.
- Padres: Greg Maddux was scratched from a scheduled start against the White Sox because of a mild lower abdominal strain.

Basketball fall    Basketball block    Basketball foul

As far as injuries are concerned, basketball is near the top of the list. The large number of injuries is due in part to the popularity of basketball, but the jumping and competitive aspects of the game cause the most damage. Players collide, hit (foul) each other, or fall and land improperly after jumping and they get hurt. Attempts to block the ball under the basket put the players in direct conflict without any protective equipment. Experienced players like Kareem Abdul-Jabbar used goggles to avoid eye injuries.

Greg Oden
Greg Oden after breaking his kneecap
 
 
    President Obama needed 12 stitches
President Obama needed twelve
stitches after getting elbowed
during a basketball game in 2010

The 2009 season was particularly disastrous for the Portland Trail Blazers who had many players sidelined with serious injuries. Greg Oden broke his left kneecap after jumping to block a play. The rookie Patrick Mills injured a foot during training right after he was drafted. Nicolas Batum suffered a shoulder injury the previous year, and then re-injured it during the summer. When he started playing again, the cartilage in his shoulder tore and he had to have surgery. Travis Outlaw was lost for the year while recovering from a stress fracture in his foot. Martell Webster had a similar injury the previous year, and he re-broke the foot when he returned to play. Even the head coach, Nate McMillan, ruptured his Achilles' tendon during practice when he stepped in to fill gaps due to the shortage of players.

Sport Injury Statistics for gymnastics, ice hockey, snowboarding, tennis, volleyball, swimming, soccer, skating, golf, football, weightlifting, skiing, running, baseball, basketball, and bicycling

The following table of injuries is based on 2006 data compiled by the U.S. Consumer Product Safety Commission's National Electronic Injury Surveillance System (NEISS).

Estimated Number
of Injuries
Sport and Type of Injury
529,837  Basketball - Cut hands, sprained ankles, broken legs, eye and forehead injuries.
490,434  Bicycling - Feet caught in spokes, head injuries from falls, slipping while carrying bicycles, collisions with cars.
460,210  Football - Fractured wrists, chipped teeth, neck strains, head lacerations, dislocated hips and jammed fingers.
275,123  ATVs, Mopeds, Minibikes - Riders of ATVs were frequently injured when they were thrown from vehicles. There were also fractured wrists, dislocated hands, shoulder sprains, head cuts and lumbar strains.
274,867  Baseball, Softball - Head injuries from bats and balls. Ankle injuries from running bases or sliding into them.
269,249  Exercise, Exercise Equipment - Twisted ankles and cut chins from tripping on treadmills. Head injuries from falling backward from exercise balls, ankle sprains from jumping rope.
186,544  Soccer - Twisted ankles or knees after falls, fractured arms during games.
164,607  Swimming - Head injuries from hitting the bottom of pools, and leg injuries from accidentally falling into pools.
96,119  Skiing, Snowboarding - Head injuries from falling, cut legs and faces, sprained knees or shoulders.
85,580  Lacrosse, Rugby, & other Ball Games - Head and facial cuts from getting hit by balls and sticks, injured ankles from falls.

Head Injuries can have long-term effects. Brain damage caused by concussions may result in strokes, paralysis, headaches or reduced concentration and mental clarity. A 2009 study commissioned by the National Football League reported that Alzheimer's disease or other similar memory-related diseases appear in the league's former players at 19 times the normal rate for men ages 30 through 49. Other studies have found that football players who suffered concussions were more likely to suffer from depression. In general, it is a good idea to avoid sports that expose the head to repeated impacts, such as boxing, soccer, and football.

Boxing Head Punch

Soccer head hit   Football block

References:
  1. Baby Boomer Sports Injuries, U.S. Consumer Product Safety Commission, April 2000. [PDF]
  2. National Electronic Injury Surveillance System (NEISS) On-line


 

Brain injuries pose risk to athletes Efforts to safeguard children on Oregon’s sports fields ramp up as our knowledge about concussions grows

Posted to Web: Sunday, Mar 8, 2009 04:31PM
Appeared in print:
Sunday, Mar 8, 2009, page G4


March is Brain Injury Awareness Month, and this year’s focus is on concussion in sports. Concussion is often called the “silent injury,” because its effects cannot be seen. The casual observer cannot tell that a sullen, withdrawn teen was once a vibrant and smiling girl prior to her concussion while playing soccer. You don’t know that the young man next door now struggles with basic schoolwork after multiple concussions during last football season.

For many years concussions were described as “dings” or “bell-ringers” and usually thought to be minor injuries. In fact, a concussion is a traumatic brain injury that interferes with the brain’s normal function. Sadly, a small number of high school athletes die each year from catastrophic brain injuries. Thousands of additional athletes suffer nonfatal, but potentially disabling, brain injuries. These injuries garner very little attention, but may have dramatic long-term consequences.

The U.S. Centers for Disease Control and Prevention estimate that 300,000 sports concussions occur among children and adolescents each year in the United States. Using the most conservative estimates, approximately 1,000 high school athletes in Oregon suffer at least one concussion each school year. While most of these youngsters recover within a few weeks, many suffer from memory problems, chronic headaches, difficulty concentrating and depression for months or even years.

The past decade has seen a revolution in the management of sports-related concussion. What was once considered a relatively benign condition is now recognized as a critical medical issue with distressing and potentially permanent consequences.

We have learned that adolescents recover more slowly and are more prone to further injury than college and professional athletes. We now know that an athlete doesn’t have to be rendered unconscious to have suffered a concussion. In fact, only about 5 percent of all concussed athletes are “knocked out” at the time of injury. Research also indicates that young athletes who have a history of a previous concussion take longer to get better and may be three to six times more likely to sustain an additional concussion.

Perhaps even more surprisingly, recent studies confirm that concussions are not just “football injuries.” New evidence suggests that girls playing soccer are not only more susceptible to concussions than their male counterparts, they also take longer to recover normal brain function after the injury. High school girls playing soccer sustain concussions at a rate 60 percent higher than boys. In basketball, the concussion rate for girls is 300 percent that of the boys.

As our knowledge of concussions has evolved, so has our approach to diagnosing and managing injured athletes. Key to this understanding is that athletes who are still having symptoms from a concussion (headache, confusion, difficulty concentrating, etc.) should never return to physical activity until those symptoms have resolved and they have been cleared by a physician. If they do return to sports while still experiencing concussion symptoms, they are at risk for a more severe concussion, or even a potentially fatal condition called Second Impact Syndrome.

To safeguard high school athletes, the Oregon School Activities Association became the nation’s first state athletic governing body to mandate a “no same day return to play” policy for concussed athletes. The OSAA has also supplied coaches and athletic directors with educational materials on the signs and symptoms of concussion. Unfortunately, our ability to protect high school athletes does not extend to the thousands of athletes in youth and club sports. Parents and coaches in youth and club leagues must be aware of the signs and symptoms of concussion and insist that educational programs, rules and proto­cols regarding proper concussion management are instituted.

In response to these concerns, we have formed the Oregon Concussion Awareness and Management Program. This program has focused upon educating physicians, coaches, administrators, athletes, parents and others on the signs and symptoms of concussion, as well as management strategies, safe return to play, and prevention. The program also has helped make computerized neurocognitive testing available at a discounted rate to all high schools across the state. While the program was created to address concussions in high school athletes, we stand ready to expand our efforts to encompass all young athletes within our state.

The goals that program has set can be reached only through the cooperation of all the parties involved: parents, athletes, coaches, athletic trainers, physicians, teachers and others. Unfortunately, educating this broad group of participants across our large state brings many logistical and financial barriers. While the dedicated efforts of a handful of individuals have already shown tangible results, we will require the help of many more. Only through grants, state funding, private contributions and sponsorship will we be able to make youth, club and high school sports safer throughout Oregon.

 

Head Injuries Sustained during Sports and Recreation  pdf: Hbn2-2.pdf

 

Sports and Recreation 

Sports are a valued pastime, but playing them safely is part of the game.

Scope

  • The most common brain injury in sports is a concussion. According to a study released by the Centers for Disease Control and Prevention, there are an estimated 300,000 sports-related concussions in the United States each year. ( 1 )
  • Brain injuries cause more deaths than any other sports injury. In football for instance, brain injury accounts for 65 to 85% of all fatalities. ( 1 )

Boxing

  • Nearly 90 percent of professional boxers have sustained a brain injury. ( 2 )
  • Because the objective of boxing is to make one's opponent unable to fight, it is not surprising that acute traumatic brain injury (ATBI) occurs in boxing matches and sparring sessions. Jabs and angled blows to the head may result in ATBI. In addition to ATBI, chronic traumatic brain injury (CTBI) is of concern in boxing. ( 3 )

Soccer

  • Approximately 5 percent of soccer players sustain brain injury as a result of head-to-head contact, falls, or being struck on the head by the ball. ( 2 )
  • Heading or hitting the ball with the head is the riskiest activity; when done repeatedly, it can cause a concussion. ( 2 )

Football

  • Football injuries associated with the brain occur at a rate of one in every 3.5 games. ( 4 )
  • Football is responsible for more than 250,000 head injuries in the United States. In any given season 10 percent of all college players and 20 percent of all high school players sustain brain injuries. ( 5 )
  • Football players with brain injuries are six times more likely to sustain new injuries. ( 5 )
  • A helmet helps prevent a brain injury from occurring.


Skiing

  • The Consumer Product Safety Commission (CPSC) estimates that in 1997, there were 84,200 skiing injuries (including 17,500 head injuries) treated in U.S. emergency rooms. The CPSC also estimated that 7,700 of those head injuries, including 2,600 head injuries to children, could be prevented or reduced in severity each year by using helmets. About 11 skiing and snowboarding-related deaths would be prevented annually with helmets. ( 6 )
  • Always wear a helmet when skiing for protection during falls and collisions.


Baseball

  • The head is involved in more baseball injuries than any other body part. Almost half of the injuries involve a child’s head, face, mouth or eyes. ( 2 )
  • The leading cause of injury and death is being hit by the ball, the second leading cause is collision. ( 2 )
  • Always wear a helmet when batting.


In-Line Skating, Rollerskating and Skateboarding

  • Brain injuries occur most often when skaters fall and hit their heads on the pavement.
  • Skating on roads causes a risk of colliding with cars, bicyclists, pedestrians and pets.
  • Always wear a helmet for protection from falling.


Horseback Riding

  • Brain injuries account for 60 percent of equestrian related fatalities, and 17 percent of all equestrian injuries are brain injuries. ( 7 )
  • Always wear a helmet when riding a horse.
  • In 90% of the cases, injuries to equestrians that require hospitalization are caused from the rider being separated from the horse while riding or the rider falling with the horse. ( 8)
  • In 1999, there were an estimated 6,000 horseback riding brain injuries. ( 9 )

Sources:

1. Concussion in Sports and Return to School Issues Following Concussion, James P. Kelly, MD and Ronald C. Savage, Brain Injury Source Pediatric Issue, Volume 3, No. 3, Summer 1999
2. American Association of Neurological Surgeons/Congress on Neurological Surgeons, 1998. http://www.neurosurgery.org/pubpages/patres/faq_sports.html ((February 5, 2001)
3. The Physician and Sportsmedicine - Vol 28 - No. 1 - January 2000, "Acute Traumatic Brain Injury in Amateur Boxing." http://www.physsportsmed.com/issues/2000/01_00/matser.htm (February 5, 2001)
4. Kelly JP. Concussion. LN Torg JS, Shepard RJ (eds.) Current Therapy in Sports Medicine, Philadelphia: Mosby, 1995.
5. Diagnosis and Management of Concussion in Sports, James P. Kelly, MD and Jay H. Rosenberg, MD
6. Centers for Disease Control, SafeUSA: Winter Sports Injury Prevention - Safety on the Slopes. http://www.cdc.gov/safeusa/slopes.htm (January 26, 2001)
7. National Electronic Injury Surveillance System, 1991-1992
8. American Medial Equestrian Association, Sept. 2000
9. National Electronic Injury Surveillance System, 1999.

This fact sheet was developed by the Brain Injury Association of America (April 2001)

 

 High School Sports and Brain Injury

 

Do you play sports? Perhaps you are on a basketball team? Do you play soccer or football? Volleyball? Baseball or Softball? A study published on September 8, 1999 (Journal of the American Medical Association, Vol. 282, pp. 958-963, 1999) has documented the incidence of traumatic brain injury in high school athletes who play these and other sports. The results may surprise you.

 

            246 athletic trainers in 235 high schools in the United States were asked to keep track of the injuries associated with 10 different sports teams (5 boys' teams and 5 girls' teams). Of the 23,566 injuries reported over the 1995-1997 seasons, 1,219 were classified as mild traumatic brain injuries (MTBIs). From these data, it was estimated that in the US there are 62,816 MTBIs each year in these ten sports. Most people will think of an MTBI as a "concussion": a change in mental status, such as confusion or disorientation, caused by an impact to the head. Such a head injury does NOT have to cause a person to lose consciousness.

 

The sports included in the study were:

BOYS GIRLS 
* Baseball * Basketball
* Basketball * Field Hockey
* Football * Softball
* Soccer * Soccer
* Wrestling * Volleyball
   

Below are the sports had the most (#1) and fewest (#5) MTBIs? Make your predictions then move your mouse over the two boxes below to see which of these sports had the most (#1) and the fewest (#5) MTBIs.

Boys

1-Football

2-Wrestling

3-Soccer

4-Basketball

5-Baseball     

 

Girls

1-Soccer

2-Basketball

3-Softball

4-Field Hockey

5-Volleyball

 

 Here are some details about the injuries associated with each of the sports.

Football

    * 63.4% of all reported MTBIs were related to football.

    * Players did not return to play for an average of three days.

    * The number of MTBIs during games was 11 times higher than during practices.

    * Most injuries were associated with tackling or being tackled.

    * 14.3% of the MTBIs occurred in linebackers; 14.0% in running backs; 13.4% in offensive linemen.

    * Of the 693 different players who suffered an MTBI, 621 players (89.6%) had only 1 MTBI; 65 players (9.4%) had 2 MTBIs; 6 players (0.9%) had 3 MTBIs and 1 player (0.2%) had 4 MTBIs.

    * No deaths were reported.

 Wrestling

     * 10.5% of all reported MTBIs were related to wrestling.

    * The number of MTBIs during matches was 3.1 times higher than during practice.

    * Most MTBIs were suffered during takedowns or attempted takedowns.

    * Wrestlers did not return to the sport for an average of 2 days after an MTBI.

Basketball

   * 4.2% of all reported MTBIs were related to boys' basketball and 5.2% were related to girls' basketball.

    * MTBIs occurred more often during games than practice: 4.9 times more often in boys' games compared to practice; 6.1 times more often in girls' games compared to practice.

    * Collisions between players accounted for most MTBIs. MTBIs were also suffered by many girls during rebounding.

    * Most game-related MTBIs in boys and girls were suffered by guards. In practice, most MTBIs occurred in forwards.

    * Players did not return to play for an average of 2 days.

Soccer

    * 5.7% of all reported MTBIs were related to boys' soccer and 6.2% were related to girls' soccer.

    * In boys' soccer, the injury rate was 16.2 times higher during games than during practices; in girls' soccer, it was 14.4 times higher during games than during practices.

    * Forwards and halfbacks suffered most of the MTBIs.

    * Most MTBIs occurred while heading the ball. However, it is unclear if player-to-player, player-to-ball or player-to-ground collisions caused the MTBIs.

    * Players did not return to play for an average of 3 days.

 Baseball and Softball

   * 1.2% of all reported MTBIs were related to boys' baseball; 2.1% were related to girls' softball.

    * Most baseball and softball related MTBIs occurred when players collided with other players, although MTBIs were also sustained by players from collisions with a bat, during sliding and from being hit by a pitch.

    * Baseball players did not return to play for an average of 3 days; softball players did not return to play for an average of 2 days.

 Field Hockey

    * 1.1% of all reported MTBIs were related to girls' field hockey.

    * Games had MTBI rates 14.4 times higher than practices.

    * MTBIs occurred from being hit with a hockey stick, hit with a ball and collsions with other players.

    * Players did not return to play for an average of 3 days.

 Volleyball

     * 0.5% of all reported MTBIs were related to girls' volleyball.

    * MTBIs occurred from being hit with a ball, collisions with other players, and during digging.

    * Players did not return to play for an average of 1 day.

 These data show that many high school sports have a significant risk for brain injury. It is especially important to monitor and treat people who suffer MTBIs because injuries to the head may have lasting effects on memory and learning.

 To prevent injuries:

    * Know the rules of the game.

    * Know the proper technique to play the game.

    * Wear protective safety equipment.

    * Seek immediate medical help if you are injured.

 JUST DO IT!

(but do it safely)

Did you know?

             In 1904, US President Theodore Roosevelt threatened to outlaw football after 19 college football players were killed or paralyzed from brain or spinal cord injuries. (Statistic from Maroon et al., Neurosurgery, 47:659-672, 2000.)

 References and further information:

    1. Powell, J.W. and Barber-Foss, K.M. Traumatic brain injury in high school athletes, J. American Medical Association, 282:958-963, 1999.

   2. Soccer and the Brain

 Source: http://faculty.washington.edu/chudler/sports.html; September 20, 1999

 



Sports-Related Head Injury

July, 2006  http://www.neurosurgerytoday.org/what/patient_e/sports.asp

Although sports injuries contribute to fatalities infrequently, the leading cause of death from sports-related injuries is traumatic brain injury. Sports and recreational activities contribute to about 21 percent of all traumatic brain injuries among American children and adolescents.

Traumatic Brain Injury

A traumatic brain injury (TBI) is defined as a blow or jolt to the head or a penetrating head injury that disrupts the normal function of the brain. TBI can result when the head suddenly and violently hits an object, or when an object pierces the skull and enters brain tissue. Symptoms of a TBI can be mild, moderate, or severe, depending on the extent of damage to the brain. Mild cases may result in a brief change in mental state or consciousness, while severe cases may result in extended periods of unconsciousness, coma, or even death.

Incidence

The U.S. Consumer Product Safety Commission (CPSC) tracks product-related injuries through its National Electronic Injury Surveillance System (NEISS). According to the CPSC, there were an estimated 313,726 sports-related head injuries treated at U.S. hospital emergency rooms in 2007. The actual incidence of head injuries may potentially be much higher for two primary reasons. 1). In the 2007 report, the CPSC excluded estimates for product categories that yielded 1,200 injuries or less, those that had very small sample counts, or those that were limited to a small geographic area of the country; 2). Many less severe head injuries are treated at physician’s offices, immediate care centers, or self-treated.

Included in these statistics are not only the sports/recreational activities, but the equipment and apparel used in these activities. For example, swimming-related injuries include the activity as well as diving boards, equipment, flotation devices, pools, and water slides.

The following 20 sports/recreational activities represent the categories contributing to the highest number of estimated head injuries treated in U.S. hospital emergency rooms in 2007.

Cycling: 64,993
Football: 36,412
Baseball and Softball: 25,079
Basketball: 24,701
Powered Recreational Vehicles (ATVs, Dune Buggies, Go-Carts, Mini bikes, Off-road): 24,090
Skateboards/Scooters (Powered): 18,542
Soccer: 17,108
Skateboards/Scooters: 16,477
Winter Sports (Skiing, Sledding, Snowboarding, Snowmobiling): 16,120
Water Sports (Diving, Scuba Diving, Surfing, Swimming, Water Polo, Water Skiing): 12,096
Horseback Riding: 11,759
Health Club (Exercise, Weightlifting): 11,550
Golf: 8,417
Trampolines: 7,075
Hockey: 5,483
Gymnastics/Dance/Cheerleading: 5,459
Ice Skating: 3,703
Fishing: 3,560
Rugby/Lacrosse: 3,281
Wrestling: 2,640

The top 10 head injury categories among children ages 14 and younger:

Cycling: 32,899
Football: 17,441
Baseball and Softball: 13,508
Skateboards/Scooters (Powered): 11,848
Basketball: 10,844
Skateboards/Scooters: 10,256
Winter Sports: 7.546
Powered Recreational Vehicles: 7,460
Water Sports: 6,498
Trampolines: 6,360
Winter Sports: 4,874

Additional Sports Facts

Boxing
Over time, professional boxers can suffer permanent brain damage. The force of a professional boxer's fist is equivalent to being hit with a 13 pound bowling ball traveling 20 miles per hour, or about 52 g's.

There are boxers with minimal involvement and those that are so severely affected that they require institutional care. There are some boxers with varying degrees of speech difficulty, stiffness, unsteadiness, memory loss, and inappropriate behavior. In several studies, 15-40 percent of ex-boxers have been found to have symptoms of chronic brain injury. Most of these boxers have mild symptoms. Recent studies have shown that most professional boxers (even those without symptoms) have some degree of brain damage.

Cycling
Every year, more than 500,000 people visit emergency rooms in the United States with bicycle-related injuries. Of those, nearly 65,000 were head injuries in 2007. There are about 600 deaths a year, with two-thirds being attributed to TBI. It is estimated that up to 85 percent of head injuries can be prevented through proper usage of SNELL, American National Standards Institute (ANSI) or American Society for Testing and Materials (ASTM)-approved helmets. It is essential that the helmet fit properly so that it doesn’t fall off while riding or if you take a fall.

The following facts/statistics are from Safe Kids USA:

  • Head injury is the leading cause of wheeled sports-related death and the most important determinant of permanent disability after a crash.
  • Without proper protection, a fall of as little as two feet can result in a skull fracture or other TBI.
  • About 52 percent of children ages 5-14 do not use a bicycle helmet, while 41 percent do, and 7 percent had one but were not wearing it.
  • Children whose helmets fit poorly are twice as likely to sustain a head injury in a bicycle crash as children whose helmets fit properly.
  • A helmet that is worn too far back on the head is 52 percent less effective.

Football
The National Center for Catastrophic Sport Injury Research tracks a number of head injury statistics related to football annually:

  • There were 44 head injury-related deaths from 1995-2004.
  • High school players sustained 43 head injuries from 1995-2004 in which there was incomplete recovery.
  • College players sustained five head injuries from 1995-2004 in which there was incomplete recovery.
  • According to league officials there are about 160 concussions in the National Football League every year.

Horseback Riding
Head injuries comprise about 18 percent of all horseback riding injuries, although they are the number one reason for hospital admissions and the leading cause of death. Three of every five equestrian accident deaths are due to head injuries.

Soccer
Protection against head injuries in soccer is complicated by the fact that heading is an established part of the game, and any attempt to protect against head injuries must allow the game to be played without modification. Several head guards have been developed to reduce the risk of head injuries in soccer. One independent research study found that none of the products on the market provided substantial benefits against minor impacts, such as heading with a soccer ball.

A McGill University study found that more than 60 percent of college-level soccer players reported symptoms of concussion during a single season. Although the percentage at other levels of play may be different, these data indicate that head injuries in soccer are more frequent than most presume.

According to CPSC statistics, 40 percent of soccer concussions are attributed to head to player contact; 10.3 percent are head to ground, goal post, wall, etc.; 12.6 percent are head to soccer ball, including accidents; and 37 percent are not specified.

Types of Head Injuries

Concussions

Cerebral concussions frequently affect athletes in both contact and non-contact sports. Cerebral concussions are considered diffuse brain injuries and can be defined as traumatically induced alterations of mental status. A concussion results from shaking the brain within the skull and, if severe can cause shearing injuries to nerve fibers and neurons.

Grading the concussion is a helpful tool in the management of the injury (see Cantu below) and depends on: 1) Presence or absence of loss of consciousness, 2) Duration of loss of consciousness, 3) Duration of posttraumatic memory loss, and 4) Persistence of symptoms, including headache, dizziness, lack of concentration, etc.

Some team physicians and trainers evaluate an athlete’s mental status by using a five-minute series of questions and physical exercises known as the Standardized Assessment of Concussion (SAC). This method, however, may not be comprehensive enough to pick up subtle changes.

According to the Cantu Guidelines, Grade I concussions are not associated with loss of consciousness, and posttraumatic amnesia is absent or is less than 30 minutes in duration. Athletes may return to play if no symptoms are present for one week.

Players who sustain a Grade II concussion lose consciousness for less than five minutes or exhibit posttraumatic amnesia between 30 minutes and 24 hours in duration. They may also return to play after one week of being asymptomatic.

Grade III concussions involve posttraumatic amnesia for more than 24 hours or unconsciousness for more than five minutes. Players who sustain this grade of brain injury should be sidelined for at least one month, after which they can return to play if they are asymptomatic for one week.

Following repeated concussions, a player should be sidelined for longer periods of time and possibly not allowed to play for the remainder of the season.

Second Impact Syndrome results from acute, sometimes fatal brain swelling that occurs when a second concussion is sustained before complete recovery from a previous concussion. This causes vascular congestion and increased intracranial pressure, which may be difficult or impossible to control. The risk for second impact syndrome is higher for sports such as boxing, football, ice or roller hockey, soccer, baseball, basketball, and snow skiing.

Coma

The word coma refers to a state of unconsciousness. The unconscious state has variability and may be very deep, where no amount of stimulation will cause the person to respond or, in other cases, a person who is in a coma may move, make noise, or respond to pain but is unable to obey simple, one-step commands, such as "hold up two fingers," or "stick out your tongue." The process of recovery from coma is a continuum along which a person gradually regains consciousness.

For people who sustain severe injury to the brain and are comatose, recovery is variable. The more severe the injury, the more likely the result will include permanent impairment.

The Glasgow Coma Scale is usually administered upon admission to establish a base line of level of consciousness, motor function and eye findings. Frequent evaluations of the patient are imperative to help assess neurologic improvement or deterioration.

Brain imaging technologies, particularly computerized axial tomography (CT or CAT scan) can offer important immediate information about a person's status. The purpose of performing an emergency CT scan is to rule out a large mass lesion (hematoma) compressing the brain that requires immediate surgical removal. Magnetic Resonance Imaging (MRI) is used in a more elective setting to image subtle changes that are not picked up by CT.

Brain Injury Symptoms

  • Pain: Constant or recurring headache
  • Motor Dysfunction: Inability to control or coordinate motor functions, or disturbance with balance
  • Sensory: Changes in ability to hear, taste or see; dizziness; hypersensitivity to light or sound
  • Cognitive: Shortened attention span; easily distracted; overstimulated by environment; difficulty staying focused on a task, following directions or understanding information; feeling of disorientation and confusion and other neuropsychological deficiencies.
  • Speech: Difficulty finding the "right" word; difficulty expressing words or thoughts; dysarthric speech.

Head Injury Prevention Tips

Buy and use helmets or protective head gear approved by the ASTM for specific sports 100 percent of the time. The ASTM has vigorous standards for testing helmets for many sports; helmets approved by the ASTM bear a sticker stating this. Helmets and head gear come in many sizes and styles for many sports and must properly fit to provide maximum protection against head injuries. In addition to other safety apparel or gear, helmets or head gear should be worn at all times for:

  • Baseball and Softball (when batting)
  • Cycling
  • Football
  • Hockey
  • Horseback Riding
  • Powered Recreational Vehicles
  • Skateboards/Scooters
  • Skiing
  • Wrestling

Head gear is recommended by many sports safety experts for:

  • Bull riding
  • Martial Arts
  • Pole Vaulting
  • Soccer
  • Vintage Motor Sports

General Tips

  • Supervise younger children at all times, and do not let them use sporting equipment or play sports unsuitable for their age.
  • Do not dive in water less than 12 feet deep or in above-ground pools.
  • Follow all rules at water parks and swimming pools.
  • Wear appropriate clothing for the sport.
  • Do not wear any clothing that can interfere with your vision.
  • Do not participate in sports when you are ill or very tired.
  • Obey all traffic signals, and be aware of drivers when cycling or skateboarding.
  • Avoid uneven or unpaved surfaces when cycling or skateboarding.
  • Perform regular safety checks of sports fields, playgrounds and equipment.
  • Discard and replace sporting equipment or protective gear that is damaged.

Rule Changes in Contact Sports to Prevent Head and Neck Injuries

The National Athletic Trainers’ Association and the American Football Coaches Association (NATA/AFCA) Task Force, headed by Ron Courson, director of sports medicine for the University of Georgia, focused on two primary problems this year with head contact.

  • Head-down contact still occurs frequently in intercollegiate football
  • Helmet-contact penalties are not adequately enforced.

    Rule changes implemented by the NCAA related to head-down contact and spearing in collegiate football have been distributed to all coaches and officials throughout the country. The objective is to eliminate injuries resulting from a player using his helmet in an attempt to punish an opponent.

    With the rule changes and more diligent enforcement of the rules, there is hope that a significant reduction in head and neck injuries will result.



  •  Genetic Susceptibility to Brain Injury in Sports:

     A Role for Genetic Testing in Athletes

    Barry D. Jordan MD, MPH

    THE PHYSICIAN AND SPORTSMEDICINE - VOL 26 - NO. 2 - FEBRUARY 98


    Technological advances in molecular biology during the next millennium may cause an explosion of genetic information about athletes' predisposition to illness and injury. Recent discoveries about a possible genetic predisposition to brain injury in boxers may be the tip of the iceberg, with far-reaching implications for members of the sports medicine community.

    Evidence for Inherited Susceptibility

    Chronic traumatic brain injury (CTBI), which occurs primarily among retired boxers after long exposure to the sport, is also known as dementia pugilistica, chronic traumatic encephalopathy, or "punch-drunk" syndrome. The condition represents the cumulative long-term neurologic consequence of repetitive concussive and subconcussive blows to the head. A milder form of CTBI can occur in American football, ice hockey, rugby, soccer, or any sport associated with traumatic brain injury. Clinically, CTBI is characterized by slurred speech, gait ataxia, memory impairment, behavior and/or personality changes, parkinsonism, and/or incoordination (1-6). On postmortem examination, CTBI shares several neuropathologic features with Alzheimer's disease (7-11).

    Recent evidence suggests that apolipoprotein E epsilon-4 (apo E-e4), a susceptibility gene for late-onset familial and sporadic Alzheimer's disease (12,13), may also be associated with an increased risk of CTBI in boxers (14). In a survey of 30 boxers, those who harbored an apolipoprotein E epsilon-4 allele and had high exposure to the sport (more than 12 professional bouts) exhibited greater neurologic dysfunction than those without an apolipoprotein E epsilon-4 allele. In addition, all the boxers who were severely impaired possessed an apolipoprotein E epsilon-4 allele.

    Also supporting the hypothesis of a genetic predisposition to the neurologic effects of boxing, Teasdale et al (15) have since reported a significant association between apolipoprotein E epsilon-4 polymorphism and outcomes following acute traumatic brain injury in a nonboxing population. In a prospective evaluation of 89 patients admitted to a neurosurgical unit, 17 (57%) of 30 patients who had the apolipoprotein E epsilon-4 allele experienced an unfavorable outcome (death, a vegetative state, or severe disability). The same was true of only 16 (27%) of 59 patients who did not have an apolipoprotein E epsilon-4 allele.

    Weighty Decisions Ahead

    Our recent finding of this genetic predisposition to brain injury has implications not only for the medical regulation of boxing and other contact sports but also for our awareness of a need to better understand the interaction between genetic susceptibility and environmental triggers. With future advances we may be able to identify genes that predispose athletes to other sports-related injuries. For example, we may be able to identify those who are at increased risk of rupture of the anterior cruciate ligament. With such possibilities in mind, the medical community is confronted with new possibilities for helping patients as well as with serious ethical and moral concerns about the role of genetic testing.

    There are certain advantages to knowing of a genetic susceptibility to injury. Identifying athletes who are susceptible to a specific injury would give physicians the opportunity to advise them of the potential risk. Such an athlete could elect to participate in a different sport. Other options might include modification of training or playing techniques, use of specialized safety equipment, rule changes, or more rigorous medical surveillance and health status monitoring. Furthermore, the identification of genes for sports injury susceptibility may also provide a basis for novel treatment strategies, such as gene therapy.

    Despite these potential benefits, identifying athletes who have a genetic predisposition to injury in sports raises important ethical and legal issues. First, the knowledge must be kept confidential. Public knowledge of an athlete's genetic risk could compromise his or her well-being and livelihood. For example, knowledge of a predisposition to disease could limit an athlete's negotiating power and/or limit the ability to obtain medical or disability insurance. Furthermore, an athlete's own knowledge of this predisposition could impose a significant psychological and emotional burden. Complicating all of this is uncertainty about the reliability of genetic testing in sports: It may be very difficult to determine the positive predictive value of a genetic test and to quantify the amount of athletic exposure that will trigger a pathobiologic response.

    A Future for Genetic Testing?

    Advances in molecular biology will undoubtedly expand our understanding of the interactions between inherited disease susceptibility and environmental precipitants. Any future application of such scientific knowledge in the domain of sports medicine must be accompanied by scientific validation, ethical responsibility, moral integrity, and appropriate regulatory policies. Genetic testing may be the wave of the future, but because of uncertainty about genetic and environmental interactions, its role remains to be delineated.

    References

    1. Jordan BD: Chronic neurologic injuries in boxing, in Jordan BD (ed): Medical Aspects of Boxing. Boca Raton, Fla, CRC Press, 1993, pp 177-185
    2. Mendez MF: The neuropsychiatric aspects of boxing. Int J Psychiatry Med 1995;25(3):249-262
    3. Roberts AH: Brain Damage in Boxers: A Study of the Prevalence of Traumatic Encephalopathy Among Ex-professional Boxers. London, Pittman, 1969
    4. Jordan BD: Neurologic injuries in boxing, in Jordan BD, Tsairis P, Warren RE (eds): Sports Neurology, ed 2. Philadelphia, Lippincott-Raven, to be published
    5. Jordan BD: Dementia pulgilistica, in Folstein MF (ed): Neurobiology of Primary Dementia. Washington, DC, Association for Research in Nervous and Mental Disease: American Psychiatric Press, to be published
    6. Critchley M: Medical aspects of boxing, particularly from a neurological standpoint. BMJ 1957;(February 16):357-362
    7. Corsellis JA, Bruton CJ, Freeman-Browne D: The aftermath of boxing. Psychol Med 1973;3(3):270-303
    8. Roberts GW, Allsop D, Bruton C: The occult aftermath of boxing. J Neurol Neurosurg Psychiatry 1990;53(5):373-378
    9. Uhl GR, McKinney M, Hedreen JC, et al: Dementia pugilistica: loss of basal forebrain cholinergic neurons and cortical cholinergic markers, abstracted. Ann Neurol 1982;12(1):99
    10. Tokuda T, Ikeda S, Yanagesawa N, et al: Re-examination of ex-boxers' brains using immunohistochemistry with antibodies to amyloid beta-protein and tau protein. Acta Neuropathol (Berl) 1991;82(4):280-285
    11. Dale GE, Leigh PN, Luthert P, et al: Neurofibrillary tangles in dementia pugilistica are ubiquitinated. J Neurol Neurosurg Psychiatry 1991;54(2):116-118
    12. Saunders AM, Strittmatter WJ, Schmechel D, et al: Association of apolipoprotein E allele epsilon 4 with late-onset familial and sporadic Alzheimer's disease. Neurology 1993;43(8):1467-1472
    13. Corder EH, Saunders AM, Strittmatter WJ, et al: Gene dose of apolipoprotein E type 4 allele and the risk of Alzheimer's disease in late onset families. Science 1993; 261(5123):921-923
    14. Jordan BD, Relkin NR, Ravdin LD, et al: Apolipoprotein E epsilon4 associated with chronic traumatic brain injury in boxing. JAMA 1997;278(2):136-140
    15. Teasdale GM, Nicoll JAR, Murray G, et al: Association of apolipoprotein E polymorphism with outcome after head injury. Lancet 1997:350(9084):1069-1071

    Dr. Jordan is adjunct associate professor of psychistry at the Charles R. Drew University of Medicine and an instructor of neurology at the Uersity of California at Los Angeles (UCLA) School of Medicine. Address correspondence to Barry D. Jordan, MD, Charles R. Drew University of Medicine, 1621 E 120th St, MP-19B, Los Angeles, CA 90059, e-mail to Bjordan@UCLA.edu.

     

    Sports-Related Recurrent Brain Injuries -- United States

    Source:  MMWR Weekly; March 14, 1997 / 46(10);224-227

    An estimated 300,000 sports-related traumatic brain injuries (TBIs) of mild to moderate severity (1), most of which can be classified as concussions (i.e., conditions of temporarily altered mental status as a result of head trauma), occur in the United States each year. The proportion of these concussions that are repeat injuries is unknown; however, there is an increased risk for subsequent TBI among persons who have had at least one previous TBI (2,3). Repeated mild brain injuries occurring over an extended period (i.e., months or years) can result in cumulative neurologic and cognitive deficits (4,5), but repeated mild brain injuries occurring within a short period (i.e., hours, days, or weeks) can be catastrophic or fatal. The latter phenomenon, termed "second impact syndrome," has been reported more frequently since it was first characterized in 1984 (6-8). This report describes two cases of second impact syndrome and presents recommendations developed by the American Academy of Neurology to prevent recurrent brain injuries in sports and their adverse consequences (9). Case Reports

    Case 1. During October 1991, a 17-year-old high school football player was tackled on the last play of the first half of a varsity game and struck his head on the ground. During halftime intermission, he told a teammate that he felt ill and had a headache; he did not tell his coach. He played again during the third quarter and received several routine blows to his helmet during blocks and tackles. He then collapsed on the field and was taken to a local hospital in a coma. A computed tomography (CT) brain scan revealed diffuse swelling of the brain and a small subdural hematoma. He was transferred to a regional trauma center, where attempts to reduce elevated intracranial pressure were unsuccessful, and he was pronounced brain dead 4 days later. Autopsy revealed diffuse brain swelling, focal areas of subcortical ischemia, and a small subdural hematoma.

    Case 2. During August 1993, a 19-year-old college football player reported headache to family members after a full-contact practice during summer training. During practice the following day, he collapsed on the field approximately 2 minutes after engaging in a tackle. He was transported to a nearby trauma center, where a CT scan of the head showed diffuse brain swelling and a thin subdural hematoma. Attempts to control the elevated intracranial pressure failed, and he was pronounced brain dead 3 days later. Autopsy revealed the brain to be diffusely swollen with evidence of cerebrovascular congestion and features of temporal lobe herniation.

    Summary of Related Data

    The true incidence of second impact syndrome is unknown. During 1984-1991, four cases were described, and during 1992-1995, a total of 17 cases were described; most cases have involved male adolescents or young adults and involved participation in boxing, football, ice hockey, and snow skiing (8). Combined data from four states (Colorado, Missouri, Oklahoma, and Utah) during 1990-1993 indicated an annual rate of 2.6 cases per 100,000 population of sports-related TBI that resulted in hospitalization or death; the proportion attributable to second impact syndrome is unknown.

    Reported by: J Kelly, MD, Brain Injury Program, Rehabilitation Institute of Chicago, Illinois. Quality Standards Subcommittee and Task Force on Preventive Neurology, American Academy of Neurology, Minneapolis, Minnesota. Div of Acute Care, Rehabilitation Research, and Disability Prevention, and Div of Unintentional Injury Prevention, National Center for Injury Prevention and Control, CDC.

    Editorial Note

    Editorial Note: The two cases described in this report involved repeated head trauma with probable concussions that separately might be considered mild but in additive effect were fatal. The risk for catastrophic effects from successive, seemingly mild concussions sustained within a short period is not yet widely recognized. Second impact syndrome results from acute, usually fatal, brain swelling that occurs when a second concussion is sustained before complete recovery from a previous concussion. Brain swelling apparently results from a failure of autoregulation of cerebral circulation that causes vascular congestion and increased intracranial pressure, which may be difficult or impossible to control (7).

    Population-based data are needed to define the incidence of this condition, describe causes, and identify populations at highest risk. CDC is developing a multi-state system for TBI surveillance (10). Based on this surveillance system, CDC, in collaboration with participating states, is developing methods to conduct surveillance for sports-related second impact syndrome.

    The risk for second impact syndrome should be considered in a variety of sports associated with likelihood of blows to the head, including boxing, football, ice or roller hockey, soccer, baseball, basketball, and snow skiing. The American Academy of Neurology has proposed recommendations for the management of concussion in sports that are designed to prevent second impact syndrome and to reduce the frequency of other cumulative brain injuries related to sports (9) (see box (Table_1)). These recommendations define symptoms and signs of concussion of varying severity and indicate intervals during which athletes should refrain from sports activity following a concussion. Following head impact, athletes with any alteration of mental status, including transient confusion or amnesia with or without loss of consciousness, should not return to activity until examined by a health-care provider familiar with these guidelines.

    The popularity of contact sports in the United States exposes a large number of participants to risk for brain injury. Recurrent brain injuries can be serious or fatal and may not respond to medical treatment. However, recurrent brain injuries and second impact syndrome are highly preventable. Physicians, health and physical education instructors, athletic coaches and trainers, parents of children participating in contact sports, and the general public should become familiar with these recommendations.

    References

    1.      Sosin DM, Sniezek JE, Thurman DJ. Incidence of mild and moderate brain injury in the United States, 1991. Brain Inj 1996;10:47-54.

    2.      Salcido R, Costich JF. Recurrent traumatic brain injury. Brain Inj 1992;6:293-8.

    3.      Annegers JF, Grabow JD, Kurland LT, Laws ER Jr. The incidence, causes, and secular trends of head trauma in Olmsted County, Minnesota, 1935-1974. Neurology 1980;30:912-9.

    4.      Jordan BD, Zimmerman RD. Computed tomography and magnetic resonance imaging comparisons in boxers. JAMA 1990;263:1670-4.

    5.      Gronwall D, Wrightson P. Cumulative effect of concussion. Lancet 1975;2:995-7.

    6.      Saunders RL, Harbaugh RE. The second impact in catastrophic contact-sports head trauma. JAMA 1984;252:538-9.

    7.      Kelly JP, Nichols JS, Filley CM, Lillehei KO, Rubinstein D, Kleinschmidt-DeMasters BK. Concussion in sports: guidelines for the prevention of catastrophic outcome. JAMA 1991;266: 2867-9.

    8.      Cantu RC, Voy R. Second impact syndrome: a risk in any contact sport. Physician and Medicine 1995;23:27-34.

    9.      Quality Standards Subcommittee, American Academy of Neurology. Practice parameter: the management of concussion in sports. Neurology 1997;48:581-5.

    10.  CDC. Traumatic brain injuries -- Colorado, Missouri, Oklahoma, and Utah, 1990-1993. MMWR 1997;46:8-11.


    Table_1
    Summary of Recommendations for Management of Concussion in Sports

     
         A concussion is defined as head-trauma-induced alteration in
    mental status that may or may not involve loss of consciousness.
    Concussions are graded in three categories. Definitions and
    treatment recommendations for each category are presented below.
     
    Grade 1 Concussion
    --  Definition: Transient confusion, no loss of consciousness, and
        a duration of mental status abnormalities of less than 15
        minutes.
     
    --  Management: The athlete should be removed from sports
        activity, examined immediately and at 5-minute intervals, and
        allowed to return that day to the sports activity only if
        postconcussive symptoms resolve within 15 minutes. Any athlete
        who incurs a second Grade 1 concussion on the same day should be
        removed from sports activity until asymptomatic for 1 week.
     
    Grade 2 Concussion
    --  Definition: Transient confusion, no loss of consciousness, and
        a duration of mental status abnormalities of greater than or
        equal to 15 minutes.
     
    --  Management: The athlete should be removed from sports activity
        and examined frequently to assess the evolution of symptoms, with
        more extensive diagnostic evaluation if the symptoms worsen or
        persist for greater than 1 week. The athlete should return to
        sports activity only after asymptompatic for 1 full week. Any
        athlete who incurs a Grade 2 concussion subsequent to a Grade 1
        concussion on the same day should be removed from sports activity
        until asymptomatic for 2 weeks.
     
    Grade 3 Concussion
    --  Definition: Loss of consciousness, either brief (seconds) or
        prolonged (minutes or longer).
    --  Management: The athlete should be removed from sports activity
        for 1 full week without symptoms if the loss of consciousness is
        brief or 2 full weeks without symptoms if the loss of
        consciousness is prolonged. If still unconscious or if abnormal
        neurologic signs are present at the time of initial evaluation,
        the athlete should be transported by ambulance to the nearest
        hospital emergency department. An athlete who suffers a second
        Grade 3 concussion should be removed from sports activity until
        asymptomatic for 1 month. Any athlete with an abnormality on
        computed tomography or magnetic resonance imaging brain scan
        consistent with brain swelling, contusion, or other intracranial
        pathology should be removed from sports activities for the season
        and discouraged from future return to participation in contact
        sports.
     

    Source: Quality Standards Subcommittee, American Academy of Neurology

     

    Additional information-Prevention Sports in PDF

     

    Additional Statistics and Information

    Most Hazardous Sports - Forbes.com
    But given the statistics on sports-related injuries sending Americans to emergency rooms each year, experts say it's a topic that deserves more attention. ...
    www.forbes.com/2008/05/29/health-hazardous-sports-forbeslife-cx_avd_0529health.html
     

    Sports Injury Statistics
    Detailed information on sports injuries in children.
    www.healthsystem.virginia.edu/UVAHealth/peds_orthopaedics/stats.cfm


    NCHS - NAMCS / NHAMCS Sports Injury Table
    National Center for Health Statistics 3311 Toledo Road Hyattsville, Maryland 20782 ... Emergency visits for sports-related injuries. Ann Emerg Med. ...
    www.cdc.gov/nchs/about/major/ahcd/injurytable.htm


    Sports Injury Statistics
    Other national surveys have highlighted the problem of sports injuries among children and adolescents. During the years 1997-1998, an estimated 2.6 million ...
    www.iprc.unc.edu/pages/stats/sports.html


    Sports Injury Statistics - Lucile Packard Children's Hospital
    In the United States, about 30 million children and teens participate in some form of organized sports, and more than 3.5 million injuries each year, ...
    www.lpch.org/DiseaseHealthInfo/HealthLibrary/orthopaedics/stats.html


    Sports Injury Statistics - My Child Has - Children's Hospital Boston
    Flower Sports Injury Statistics ... Although death from a sports injury is rare, the leading cause of death from a sports-related injury is a brain injury. ...
    www.childrenshospital.org/az/Site1112/mainpageS1112P0.html
     

    sports related injuries
    Common sport injuries - prevention, statistics, stretching exercises and ... common sport injuries, sport related injuries, sport injury statistics, ...
    www.sportsinjurybulletin.com/archive/0123a-sport-injuries.htm


    Sports injury rates: U.S. statistics on all sports injuries.
    As the definitive U.S. study on the subject, the Comprehensive Study of Sports Injuries in the U.S. reveals injury statistics and sports injury rates as ...
    www.americansportsdata.com/sports-injury-rates-statistics.asp


    Sports injury experiences from the Western Australian sports ...
    injury statistics for. professional sport may not necessarily be translatable to community-level sports. ...
    www.blackwell-synergy.com/doi/pdf/10.1111/j.1467-842X.2002.tb00348.x


    Sports Injury Statistics
    National Injury Information Clearinghouse. Estimates for Sports Injuries 1998 (1998 Statistics should be released from the CPSC in July of 2000) ...
    www.nyssf.org/statistics1998.html
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