In my diving into the world of concussion I found early on, we don’t know what we think we know. It is obvious that there are many causes of concussions that do not involve playing sports. The following statement might shock you but childhood concussions also occur outside of contact sports. The takeaway from a new study is we need to think beyond contact sports in regards to concussions in childhood.
This study was published April 4 2018 and examined data from Children’s Hospital of Philadelphia health system between July 1 2012 to June 30 2014. The authors looked into visits children between 0-17 made to the hospital in regards to a diagnosis of concussion. They found 8233 records and randomly selected 20% of them for the study. In the 0-4 age range 18% were due to sports, 5-11 67% were due to sports, 77% from 12-14, and 73% in the 15-17 age range. The most common non sports related cause of concussion were struck by an object or from a fall. The authors not that, for children older than 6, about 1/3 of concussions occur outside of playing a sport. They find this important because we have placed a lot of focus on sports related concussions and concussions from other causes have been almost entirely ignored.
In diving into their data I found a lot of fascinating details. 46.9% of concussed children where girls. A total of 94 children suffered a concussion due to a motor vehicle crash. We can assume that the vast majority of the athletes who play football are boys, based on the data more boys suffered a concussion due suffering a fall (269) than playing football (169). Most of the injured children (58%) were seen two or more days after their injury. The top six sports related causes of concussion were, ranked in order of 1-6, Football (169 children), Soccer (156), Basketball (103), Ice Hockey (57), Cheerleading (47), and Lacrosse (45). Girls suffered more concussions due to being struck by an object than boys but boys suffered more concussions due to falls than girls by rather large margins in both cases.
A concussion can be a serious matter, if treated poorly it may result in poor performance both academically and athletically in our children. Second and third concussions, too soon after a first, have been know to be fatal in some rare cases and is actually called Second Impact Syndrome. It is very important to identify when a child has had a concussion and allow sufficient healing time. I find this study important for a number of reasons, first is that 30% of concussion occur outside of sports and second is football is not the only sport to be concerned about in regards to concussion. There are a number of different ways a child can suffer a concussion and practically all sports carry some sort of risk of concussion. In the data 2 children had a concussion while hunting, 3 from tennis, and 4 from participating in track. There is definitely a lower risk for concussion while playing tennis than football but tennis still carries a risk. Please understand that there is a risk for concussion in many activities outside of the sports which carry the biggest risk.
As I write this I was informed that my 5 year old daughter fell and hit her head during kindergarten today. How she presents sounds like a concussion, my plan is to keep her from school for the rest of the week and out of dance class to give her brain time to heal. Is two days plus a weekend enough time to heal? I don’t know but no one knows how much time is the minimum, our understanding on this topic is too new. Each case is different, each child is different so an individualized approach is necessary. When I see her later tonight I will evaluate her and know more.
I value sport for many reasons so I do not want to see a world in which we ban sport because it carries a risk for injury. Instead we need to understand how best to mitigate the risks and treat injured children better. Some sports are already policing themselves through rule changes to reduce the risk for concussion. When we have an injured athlete we need to identify him or her and treat them appropriately. There are no drugs to take, and none should even be taken to treat for aches or pains because masking symptoms with pain medication might mask symptoms of a deteriorating condition leading to serious complications. The best thing is for the child to rest, brain rest, which means not only discontinuing their sport but also regular schoolwork too. If a child has suffered multiple concussions it might be prudent for them to discontinue their participation in sports altogether. Multiple concussions result in things like an increased risk for ankle sprains, ACL tears, and poor academic performance. Your kid can be a great athlete but if he/she can’t pass the SAT they aren’t getting that athletic scholarship.
If your child participates in sports it is best to get some sort of baseline testing done. There is no imaging we can do to measure the injury and then determine when a patient is better. The best thing is to re-test an injured athlete against their baseline. An indication that the patient is healed or healing is a return to their baseline score. We utilize two different methods to do baseline testing of balance and reaction time. This is a serious issue today and this blog post does not do it justice. If you want more information let me know. I actually give a talk on concussion injuries and discuss the complex issue in its entirety, not just signs and symptoms.