New developments in the management of sports concussion:

Second-Impact Syndrome

Sports-related injuries are among the more common causes of injury in adolescents that can result in concussion and its sequelae, postconcussion syndrome and second-impact syndrome (SIS). Students who experience multiple brain injuries within a short period of time (hours, days, or weeks) may suffer catastrophic or fatal reactions related to SIS. Adolescents are particularly susceptible to the dangers of SIS, and current return-to-play guidelines may be too lenient to protect a student from SIS. Any student with signs of a concussion should receive medical evaluation and not be allowed to return to play in the current game or practice. The role of the school nurse includes being knowledgeable about management of head injuries and return-to-play guidelines, providing follow-up for athletes who have concussions, and providing education on prevention and management of head injuries.

Exploration of awareness, knowledge, and perceptions of traumatic brain injury among American youth athletes and their parents

PURPOSE

Although much effort is underway by the Centers for Disease Control and Prevention (CDC) and other organizations to highlight the seriousness of traumatic brain injury, including concussions, among young athletes, little is known about how these athletes and their parents view this injury and how much they know about it.

METHODS

Online surveys were conducted with youth who participate in sports (n = 252) and with the parents of youth who participate in sports (n = 300) to explore the ways in which these audiences view concussion and messaging related to concussion.

RESULTS

More than four out of five youth and parents reported that they had heard about concussions, although awareness was significantly higher for some subgroups, including parents of children 10-13 years old, and parents who reported using the Internet several times daily. Youth ages 13-15 years were significantly more likely to strongly agree that concussions are a "critical issue," as compared with youth ages 16-18 years. Among parents, significantly more mothers than fathers agreed that concussions are a critical issue. More than half of youth participants strongly disagreed that their friends would think they were "dumb for caring about concussions," with girls significantly more likely to strongly disagree than boys. When parents were asked to identify organizations they would trust as a reliable source of information for concussions, the most frequently cited organization was the CDC.

CONCLUSIONS

Results of this study demonstrate a high level of awareness about concussion among youth athletes and parents of youth athletes. However, important distinctions among subgroups of both youth and parents-such as by race/ethnicity, age, sex, and Internet use-suggest directions for future communication and research efforts.

The pediatric athlete: younger athletes with sport-related concussion

Although much of the lay media attention surrounding sport-related concussion (SRC) focuses on professional athletes, SRC is a common injury in pediatric sports. The anatomy, biomechanics, and response to injury of the developing pediatric brain differ from those of the adult. Similarly, the neurocognitive abilities of the child are developing more rapidly than in an adult. The effects of concussive brain injury on the life of a child are different from those of an adult. This article focuses on the aspects of SRC that are specific to the younger athletes.

Sport-related concussion

Sport-related concussion is a common injury in children and adolescents. Athletes seldom report concussive symptoms, which makes the diagnosis a challenge. The management of sport-related concussion has changed significantly over the last several years. The previously used grading systems and return-to-play guidelines have been abandoned in favor of more individualized assessment and management. Neuropsychological testing is being used more frequently to assist in management. After recovery, it is recommended that an athlete's return-to-play progress in a gradual, stepwise fashion while being monitored by a health care provider. Proper assessment and management of a sport-related concussion is crucial, because repeat concussions can result in decreased neurocognitive functioning, increased symptomatology, and, at times, catastrophic outcomes.

[The undetected brain lesion in sports. Minor traumatic brain injury and its sequelae]

The minor traumatic brain injury (mTBI) in sports is often looked at as a bagatelle. The treating physician underestimates the severity of the injury suspecting that a mTBI is a nonstructural lesion with an overall excellent prognosis in the majority of the cases. This paper shows that the minor traumatic brain injury may be a structural brain lesion with potentially life-threatening dangers. The therapy should follow exactly defined guidelines, e.g., stepwise protocol of the Concussion in Sports (CIS-) Group. Return to sports activities should happen only when all physical but also cognitive symptoms have subsided. All mTBIs that have been sustained prior to the actual injury have to be recorded properly because repeated mTBIs may cause chronic degenerative brain damage. Neuropsychological testing will aid in the correct diagnosis of a mTBI and is a useful parameter in the course of the injury. In the future biochemical markers may serve as indicators of the severity of the brain injury and may also aid in predicting the outcome after TBI. Today biochemical markers do not serve as a substitute for neuroimaging.

Dental Injuries in Sports

The expanding arena of sports and vigorous recreational activities is associated with an increased risk for sports-related injuries, including trauma to the teeth. Because dental professionals may not be present on site, in the best interest of athletes, it is suggested that sports medicine professionals who are present be provided with current evaluative, emergent, and referral protocols for proper management of sports-related dental injuries to address the immediate needs of the athlete and to enhance the long-term prognosis of the traumatized tooth. This article provides information related to some of the more common dental injuries encountered in sports, including crown fractures, root fractures, and traumatic tooth displacements. Use of properly fitted, custom-fabricated athletic mouth guards for the prevention of dental injuries is recommended strongly, as is the inclusion of a dentist on the sports medicine team roster.