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Canseco JA, Franks RR, Karamian BA, Divi SN, Reyes AA, Mao JZ, Al Saiegh F, Donnally CJ, Schroeder GD, Harrop JS, Pepe MD, Vaccaro AR. Overview of Traumatic Brain Injury in American Football Athletes. Clin J Sport Med 2022; 32:236-247. [PMID: 33797476 DOI: 10.1097/jsm.0000000000000918] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/17/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this review is to provide a summary of the epidemiology, clinical presentation, pathophysiology, and treatment of traumatic brain injury in collision athletes, particularly those participating in American football. DATA SOURCES A literature search was conducted using the PubMed/MEDLINE and Google Scholar databases for publications between 1990 and 2019. The following search phrases were used: "concussion," "professional athletes," "collision athletes," "mild traumatic brain injury," "severe traumatic brain injury," "management of concussion," "management of severe traumatic brain injury," and "chronic traumatic encephalopathy." Publications that did not present epidemiology, clinical presentation, pathophysiology, radiological evaluation, or management were omitted. Classic articles as per senior author recommendations were retrieved through reference review. RESULTS The results of the literature review yielded 147 references: 21 articles discussing epidemiology, 16 discussing clinical presentation, 34 discussing etiology and pathophysiology, 10 discussing radiological evaluation, 34 articles for on-field management, and 32 articles for medical and surgical management. CONCLUSION Traumatic brain injuries are frequent in professional collision athletes, and more severe injuries can have devastating and lasting consequences. Although sport-related concussions are well studied in professional American football, there is limited literature on the epidemiology and management of severe traumatic brain injuries. This article reviews the epidemiology, as well as the current practices in sideline evaluation, acute management, and surgical treatment of concussions and severe traumatic brain injury in professional collision athletes. Return-to-play decisions should be based on individual patient symptoms and recovery.
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Affiliation(s)
- Jose A Canseco
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - R Robert Franks
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
- Rothman Sports Concussion Institute, Rothman Institute, Philadelphia, Pennsylvania; and
| | - Brian A Karamian
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Srikanth N Divi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ariana A Reyes
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jennifer Z Mao
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Fadi Al Saiegh
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Chester J Donnally
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Gregory D Schroeder
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - James S Harrop
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Matthew D Pepe
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Alexander R Vaccaro
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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McDermott ER, Tennent DJ, Patzkowski JC. On-field Emergencies and Emergency Action Plans. Sports Med Arthrosc Rev 2021; 29:e51-e56. [PMID: 34730115 DOI: 10.1097/jsa.0000000000000319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Sideline coverage can be an enjoyable experience and provide the opportunity to witness and evaluate an athlete's pathology at the time of injury. While the majority of on-field injury will likely be of low acuity, it is essential to develop an Emergency Action Plan (EAP) to deliver excellent medical care efficiently. The EAP should provide a written, standardized multidisciplinary approach involving key personnel. The EAP should be rehearsed on at least an annual basis and should highlight the initial assessment of the patient while also accounting for the various types of trauma that may occur on the field and appropriate field extrication procedures. As most players who have a true on-field emergency will not return to same-day play, a thorough understanding of how to deliver emergency care and transfer the player to a higher level of care is essential.
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Affiliation(s)
- Emily R McDermott
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, Fort Sam Houston, TX
| | - David J Tennent
- Orthopaedic Surgery Service, Evans Army Community Hospital, Fort Carson, CO
| | - Jeanne C Patzkowski
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, Fort Sam Houston, TX
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3
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De Stefano F, Fiani B, Mayo T. A Foundational “Survival Guide” Overview of Sports-Related Head Injuries. Cureus 2020; 12:e11636. [PMID: 33376648 PMCID: PMC7755598 DOI: 10.7759/cureus.11636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Dadabo J, Jayabalan P. Acute management of cervical spine trauma. HANDBOOK OF CLINICAL NEUROLOGY 2018; 158:353-362. [PMID: 30482363 DOI: 10.1016/b978-0-444-63954-7.00033-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Traumatic cervical spine injuries represent a significant cause of morbidity and mortality in sports. Appropriate management of such injuries is critical to minimizing harm and facilitating optimal long-term recovery and outcome. Management strategies begin with emergency preparedness amongst sideline providers and extends to paramedic services and medical teams in the acute care setting. This chapter outlines the principles of treatment across the care continuum, with a primary focus on hospital-based care. Diagnostic imaging and equipment considerations are reviewed, with discussion of corticosteroid administration, therapeutic hypothermia, and traction of the cervical spine. Approaches to cervical spine stabilization and return to play are also detailed, with an emphasis on patient-centered care and individualized treatment approaches to the athlete.
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Abstract
Cervical spine trauma in the athlete is not an insignificant occurrence with possibly catastrophic results. Football remains one of the most common and most well studied sporting activities associated with spine injuries. Transient spinal cord and peripheral nerve injuries may manifest as quadriparesis or burners/stingers with symptoms that resolve completely. More severe spinal cord injuries, typically from axial loading on the cervical spine, will cause bilateral symptoms with residual neurological deficit. Acute Trauma Life Support principles must always be applied to the player with a potential spine injury. Recent positional statements by National Athletic Trainers' Association advocate equipment removal on the field by 3 individuals with appropriate training, a shift from previous recommendations. This recommendation is still under debate, but equipment removal in the field is an option depending on staff training. The use of steroids in acute spinal cord injury remains controversial. Moderate systemic hypothermia has theoretical benefits for reducing spinal cord damage in the setting of an acute injury. Although it has been studied in the laboratory, only a few clinical trials have been performed and further research is necessary before routine implementation of hypothermia protocols.
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Stovitz SD, Weseman JD, Hooks MC, Schmidt RJ, Koffel JB, Patricios JS. What Definition Is Used to Describe Second Impact Syndrome in Sports? A Systematic and Critical Review. Curr Sports Med Rep 2017; 16:50-55. [PMID: 28067742 DOI: 10.1249/jsr.0000000000000326] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Concern about what has been termed, "second impact syndrome" (SIS) is a major factor determining return-to-play decisions after concussion. However, definitions of SIS vary. We used Scopus to conduct a systematic review and categorize the definitions used to describe SIS. Of the 91 sources identified, 79 (87%) clearly specified that SIS involved either cerebral edema or death after a concussion when a prior concussion had not resolved. Twelve articles (13%) could be interpreted as merely the events of two consecutive concussions. Among the articles that listed mortality rates, nearly all (33/35, 94%) said the rate of death was "high" (e.g., 50% to 100%). Our review found that most articles define SIS as a syndrome requiring catastrophic brain injury after consecutive concussive episodes. Given that it is unclear how common it is to have a second concussion while not fully recovered from a first concussion, the actual mortality rate of SIS is unknown.
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Affiliation(s)
- Steven D Stovitz
- 1Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN; 2University of Minnesota Medical School, Minneapolis, MN; 3Bio-Medical Library, University of Minnesota, Minneapolis, MN; 4Section of Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; and 5Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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8
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Morris SA, Jones WH, Proctor MR, Day AL. Emergent Treatment of Athletes With Brain Injury. Neurosurgery 2014; 75 Suppl 4:S96-S105. [DOI: 10.1227/neu.0000000000000465] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Bhamra J, Morar Y, Khan W, Deep K, Hammer A. Cervical spine immobilization in sports related injuries: review of current guidelines and a case study of an injured athlete. Open Orthop J 2012; 6:548-52. [PMID: 23248726 PMCID: PMC3522109 DOI: 10.2174/1874325001206010548] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 08/28/2012] [Accepted: 09/03/2012] [Indexed: 11/22/2022] Open
Abstract
Cervical spine immobilization is an essential component of the ATLS® system. Inadequate training in the management of trauma calls and failure of early recognition can have disastrous consequences. Pre-hospital personnel are routinely involved more in the assessment and stabilization of patients in comparison to other health care professionals. This case study and review highlights the importance of early recognition, assessment and correct stabilization of cervical spine injuries both in the field and during the initial assessment in hospital. Inadequate assessment, immobilization and lack of standard guidelines on the management of suspected cervical spine trauma can result in secondary injury. Regular assessment and training of pre-hospital and medical personnel is essential to the proper management of these potentially devastating injuries.
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Affiliation(s)
- Js Bhamra
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
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Finnoff JT, Willick S, Akau CK, Harrast MA, Storm SA. Sports and performing arts medicine: 4. Events coverage. PM R 2011; 1:S73-7. [PMID: 19627976 DOI: 10.1016/j.pmrj.2009.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This self-directed learning module highlights medical coverage of sports events and artistic performances. It is part of the study guide on sports and performing arts medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. Using a case vignette format, this article specifically focuses on performance anxiety, exercise-associated collapse, exercise-induced asthma, transient quadriparesis, stingers/burners and anterior glenohumeral joint dislocations. The goal of this article is to improve the learner's ability to formulate and implement an appropriate evaluation and treatment algorithm for certain conditions associated with sports and performing arts events.
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Affiliation(s)
- Jonathan T Finnoff
- Department of Physical Medicine and Rehabilitation, College of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55902, USA.
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Krabak BJ, Kanarek SL. Cervical spine pain in the competitive athlete. Phys Med Rehabil Clin N Am 2011; 22:459-71, viii. [PMID: 21824587 DOI: 10.1016/j.pmr.2011.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cervical pain is a common complaint in both the well-conditioned athlete and the weekend warrior. Some injuries are mild in nature, responding to conservative treatment, including rest, medication, physical therapy, and time. However, more serious injuries, especially those involving the cervical spine, can have devastating consequences. Having a comprehensive understanding of the evaluation and management of cervical pain and cervical spine emergencies is crucial for physicians providing coverage for organized athletic events or for those who serve as team physicians. This article reviews the common causes of cervical spine pain in the competitive athlete.
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Affiliation(s)
- Brian J Krabak
- Rehabilitation, Orthopaedics and Sports Medicine, University of Washington and Seattle Children's Sports Medicine, Seattle, WA, USA.
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13
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Baird LC, Newman CB, Volk H, Svinth JR, Conklin J, Levy ML. Mortality Resulting From Head Injury in Professional Boxing. Neurosurgery 2010; 67:1444-50; discussion 1450. [DOI: 10.1227/neu.0b013e3181e5e2cd] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Lissa C Baird
- Department of Neurosurgery, University of California, San Diego, California
| | - C Benjamin Newman
- Department of Neurosurgery, University of California, San Diego, California
| | - Hunter Volk
- Department of Neurosurgery, University of California, San Diego, California
| | - Joseph R Svinth
- Rady Children's Hospital of San Diego, San Diego, California
| | - Jordan Conklin
- Rady Children's Hospital of San Diego, San Diego, California
| | - Michael L Levy
- Department of Neurosurgery, University of California, San Diego, California
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Baird LC, Newman CB, Volk H, Svinth JR, Conklin J, Levy ML. Mortality resulting from head injury in professional boxing: case report. Neurosurgery 2010; 67:E519-20. [PMID: 20644386 DOI: 10.1227/01.neu.0000373207.04297.13] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The majority of boxing-related fatalities result from traumatic brain injury. Biomechanical forces in boxing result in rotational acceleration with resultant subdural hematoma and diffuse axonal injury. OBJECTIVE Given the inherent risk and the ongoing criticism boxing has received, we evaluated mortalities associated with professional boxing. METHODS We used the Velazquez Fatality Collection of boxing injuries and supplementary sources to analyze mortality from 1950 to 2007. Variables evaluated included age at time of death, association with knockout or other outcome of match, rounds fought, weight class, location of fight, and location of preterminal event. RESULTS There were 339 mortalities between 1950 and 2007 (mean age, 24 +/- 3.8 years); 64% were associated with knockout and 15% with technical knockout. A higher percentage occurred in the lower weight classes. The preterminal event occurred in the ring (61%), in the locker room (17%), and outside the arena (22%). We evaluated for significant changes after 1983 when championship bouts were reduced from 15 to 12 rounds. CONCLUSION There was a significant decline in mortality after 1983. We found no significant variables to support that this decline is related to a reduction in rounds. Rather, we hypothesize the decline to be the result of a reduction in exposure to repetitive head trauma (shorter careers and fewer fights), along with increased medical oversight and stricter safety regulations. Increased efforts should be made to improve medical supervision of boxers. Mandatory central nervous system imaging after a knockout could lead to a significant reduction in associated mortality.
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Affiliation(s)
- Lissa C Baird
- Department of Neurosurgery, University of California, San Diego, California, USA
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15
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Kane SM, White RA. Medical malpractice and the sports medicine clinician. Clin Orthop Relat Res 2009; 467:412-9. [PMID: 18989733 PMCID: PMC2628504 DOI: 10.1007/s11999-008-0589-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Accepted: 10/03/2008] [Indexed: 01/31/2023]
Abstract
More individuals are participating in athletics today than ever before. Physicians treating athletes confront unique diagnostic and treatment challenges and an increased risk of legal liability. The key areas regarding liability are preparticipation examinations, determination of eligibility, evaluation of significant on-field injuries, and information disclosure. The issues surrounding preparticipation physicals and determination of eligibility are closely linked. Physicians must be prepared to seek guidance from specialists, particularly when there are cardiac, spinal, or neurologic issues. Appropriate on-field evaluation of potential concussions, spinal injuries, and heat stroke are key areas of concern for the physician. Privacy issues have become more complex in the age of federal regulation. Physicians and all athletic staff should be aware of privacy laws and ensure proper consent documentation is obtained from all athletes or their parents. All athletic programs should develop a plan that details roles and procedures to be followed in a medical emergency. Sports caregivers must take affirmative steps that better protect their patients from harm and physicians from legal liability.
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Affiliation(s)
- Steven M Kane
- Department of Orthopaedic Surgery, Atlanta Medical Center, 303 Parkway Drive NE, Box 442, Atlanta, GA 30312, USA.
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Sawyer RJ, Hamdallah M, White D, Pruzan M, Mitchko J, Huitric M. High School Coaches’ Assessments, Intentions to Use, and Use of a Concussion Prevention Toolkit: Centers for Disease Control and Prevention’s Heads Up: Concussion in High School Sports. Health Promot Pract 2008; 11:34-43. [DOI: 10.1177/1524839907309377] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study evaluated school coaches’ perceptions, assessments, and use of a toolkit to prevent and manage concussions among school athletes. A computer-assisted telephone survey was conducted with a stratified, random sample of high school coaches (n = 497; response rate = 39.3%; cooperation rate = 81.5%) from five states. Most reported that they had used or planned to use kit materials. Most (81%) in schools with a written plan for preventing and managing concussions indicated that the toolkit could be used to improve it and 96% of coaches in schools without a plan indicated that the kit could be used to develop one. Most assessed the kit as visually appealing, easy to use, and containing appropriate content. There were no significant differences among coaches with differing professional experience or for sports with different injury rates. Among those with other concussion-prevention materials, most indicated greater satisfaction with the toolkit.
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Affiliation(s)
- Richard J. Sawyer
- Regional Educational Laboratory for the Southeast at
the Academy for Educational Development in Washington, DC,
| | - Myriam Hamdallah
- Center on AIDS & Community Health at the Academy for Educational Development in Washington, DC
| | - Debbie White
- John Tyler Community College in Chester, Virginia
| | - Marcia Pruzan
- Health communication and marketing consultant in Bethesda, Maryland
| | - Jane Mitchko
- Centers for Disease Control and Prevention in Atlanta, Georgia
| | - Michele Huitric
- Centers for Disease Control and Prevention in Atlanta,
Georgia
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Miele VJ, Norwig JA, Bailes JE. Sideline and ringside evaluation for brain and spinal injuries. Neurosurg Focus 2006. [DOI: 10.3171/foc.2006.21.4.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓Participation in contact and collision sports carries an inherent risk of injury to the athlete, with damage to the nervous system producing the most potential for significant morbidity and death. Neurological injuries suffered during athletic competition must be treated promptly and correctly to optimize outcome, and differentiation between minor and serious damage is the foundation of sideline/ringside management of the injury. In this article the authors present a guide to the sideline or ringside identification and management of head and spinal injuries.
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Abstract
Neurological conditions are common in athletes. Trauma can cause direct central (eg, concussion or hemorrhage) or peripheral (eg, stinger) injury. Also, as neurological conditions in athletes become better understood, more people who have pre-existing conditions are becoming involved in organized sports. This article reviews assessment and initial management of head injury, stingers, seizures, and headaches. Return-to-play criteria are also discussed.
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Affiliation(s)
- Elliot L Dimberg
- Department of Neurology, University of Virginia, Box 800394 Charlottesville, VA 22908, USA
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Abstract
This article reviews medicolegal issues in sports medicine. Nonmusculoskeletal medical conditions discussed include cardiac abnormalities, heat illness, and concussion in the athlete. Musculoskeletal injuries with the greatest potential for litigation, knee dislocation, and cervical spine trauma, are also reviewed. We provide legal case examples and discuss evaluation and treatment strategies to assist the medical team in the care of athletes.
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Affiliation(s)
- Alison K Sanders
- Duke Sports Medicine, 317 Finch-Yeager Building, Durham, NC 27708, USA
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Abstract
In summary, it is important for physicians dealing with neck pain in an athletic population to understand the differences between serious and mild cervical injuries. This is best facilitated by a thorough understanding of the signs and symptoms of serious cervical injury, familiarity with the basic anatomy of the neck and its structures, and a working knowledge of common causes of neck pain and mechanisms of injury. All unconscious athletes should be assumed to have a serious cervical injury until proven otherwise, and preventive measures should be taken to ensure the safety of the athlete. This includes airway management with a jaw thrust only, neck stabilization, and preventing helmet removal. In the conscious athlete who has neck pain, serious cervical injury can often be ruled out with an accurate history and physical examination. In all cases of neck pain, it is imperative that the athlete be protected. This may involve removing the athlete from competition, or transporting him or her to the local emergency room. Often, this decision falls on the shoulders of the doctor in the stands. Thus, a basic understanding of the evaluation and management of neck pain in athletes is an asset for all physicians who frequent athletic events or see athletes in the office. The physician responsible for patients who have Down syndrome or rheumatoid arthritis needs to consider the increased incidence of cervical instability in these patients when evaluating for athletic participation or neck pain.
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Affiliation(s)
- Gary W Dorshimer
- Internal Medicine/Sports Medicine, University of Pennsylvania Health System-Pennsylvania Hospital, 727 Delancy St, Philadelphia, PA 19106, USA.
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Abstract
Neck injuries can be some of the most serious and anxiety-producing injuries that occur during sporting events. It is important for the team physician to be prepared for the care of these injuries and be able to identify some of the more serious injuries. Proper care of these injuries can be life saving and prevent further injury and permanent disability. This article reviews the principles of management and latest evidence for acute neck injuries.
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Affiliation(s)
- Leslie Cooper
- Department of Family and Preventive Medicine, University of Utah, 555 Foothill Drive, Salt Lake City, UT 84112, USA
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Affiliation(s)
- Mark D Miller
- University of Virginia, McCue Center-3rd Floor, Emmet Street and Massie Road, Charlottesville, VA 22903. E-mail address:
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