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Concussion Rates Are Rising in Younger Athletes Aged 8-13 Years

Publish date: September 1, 2010

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Awareness, Research Drive Increase

I'm not surprised by the increase in reports of concussions in young athletes. And because not every kid with a concussion goes to the emergency department, there are even more injuries occurring that are not being reported.

I think greater awareness and better diagnosis are the main reasons why the number of sports-related concussions is rising. Until 10 years ago, the medical literature focused only on concussions that involved loss of consciousness. But what we have learned in the past decade is that the subtleties of this injury are absolutely critical for diagnosis.

For example, loss of consciousness is actually less predictive than loss of memory. (I published a paper in 2003 showing that amnesia or memory loss around the time of the concussion is 10 times more predictive than a loss of consciousness.) Changes in the way we define the injury are driving the rise in reported concussions in young athletes.

As we continue to peel the onion on concussion, we realize that it is an extremely complex injury, and that there are more problems in those who are injured—particularly kids. Also, we now have animal models that help show what happens in the brain after a concussion. This knowledge base has accumulated at warp speed over the last 10 years, and with that has come better recognition, better management, and better understanding of the injury, as well as more concern.

Most importantly, neurocognitive testing is becoming more widely used as a way to assess sports-related concussion, and it is the key to why there is so much attention now being paid to the injury: We now have a way to measure it by collecting baseline data. The sensitivity and specificity of such tests are impressive.

One of the keys to improving the management of pediatric concussion is to get knowledge related to this injury, as well as its many assessment tools, into pediatric offices. Clinics are available around the United States to help pediatricians who want to incorporate neurocognitive testing into their practices. The American Academy of Pediatrics' report by Dr. Halstead and Dr. Walter lists several assessment tools, and it includes other valuable, relevant information about managing sports-related concussions in young athletes.

MICHAEL COLLINS, PH.D., is the assistant director of the sports medicine concussion program at the University of Pittsburgh Medical Center. He also coauthored the Centers for Disease Control and Prevention's “Heads Up: Brain Injury in Your Practice” tool kit for physicians.


 

"We felt there was a need to address specifically the [pediatric] athlete and address all the recent research that has been published on this topic," he said in an interview.

"The recommendations presented aren't significantly different from other recent documents published, but these were primarily published in sports medicine journals, which many pediatricians do not review.

"We wanted to bring these recommendations to the forefront to the pediatric community, and expand upon the details provided in previous documents published.

"We have highlighted some of the new research on neuroimaging, balance assessments, long-term complications, education, and neuropsychological testing," Dr. Halstead said.

Dr. Walter added, "I think it is also important to recognize that because we have learned more about concussion diagnosis, treatment, and complications, the treatment that coaches and parents received when they had a concussion themselves at a young age is likely different than today."

Many parents and coaches don't think concussion is a big deal because they had one when they were younger and they "toughed it out" and "are fine now," said Dr. Walter, program director of pediatric and adolescent sports medicine at Children's Hospital of Wisconsin in Milwaukee.

The authors acknowledged the lack of published baseline neuropsychological data on children younger than 12 years, and noted that assessment by a neuropsychologist might be helpful for children who have had more than one concussion, or whose postconcussive symptoms persist for several months.

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