October 7, 2011
CDC Report Details Increase In Childhood Concussions
The number of children and adolescents going to the hospital with concussions has jumped more than 60 percent in the past decade, according to a report released Thursday by the Centers for Disease Control and Prevention (CDC).
The CDC said the increase in emergency room visits for concussion was likely due to parents and coaches being more aware of concussions and other head injuries.
The study is based on a survey of 66 hospital emergency departments. The CDC looked at non-fatal data for the years 2001 through 2009 for children and adolescents under the age of 20. The agency looked at traumatic brain injuries, a category of injuries that mostly counts concussions but also includes skull fractures and bleeding in the brain.
The study report said ERs recorded an increase of visits from 153,375 in 2001 to 248,418 in 2009 among children and adolescents due to traumatic brain injuries sustained in recreational activities.
“It´s a good increase, if that makes any sense,” Steven Marshall, interim director of the University of North Carolina´s Injury Prevention and Research Center, told USA Today. “These injuries were always there. It´s not that there are more injuries now. It´s just that now people are getting treatment that they weren´t getting before.”
The CDC study reported that the most common sports related to likelihood of brain injury were bicycling, football, basketball and soccer, as well as playground activities.
“We believe that one reason for the increase in emergency department visits among children and adolescents may be a result of the growing awareness among parents and coaches, and the public as a whole, about the need for individuals with a suspected TBI [traumatic brain injury] to be seen by a health care professional,” Dr. Linda C. Degutis, director of the CDC´s National Center for Injury Prevention and Control, told New York Times reporter Lynn Zinser.
The authors report, however, there was no significant increase in the rate of kids being admitted into the main hospital for further treatment. That finding suggests that more coaches and parents have been bringing kids in with mild concussions and blows to the head, said Dr Julie Gilchrist, a CDC epidemiologist who led the study.
That probably relates to more awareness of the formerly under-appreciated hazards associated with concussions, she added.
The CDC started a “Heads Up” youth awareness campaign in 2003 that targeted doctors. Since then, the agency has expanded the campaign to include coaches and school officials. And the measure was reinforced by a series of studies that began to appear around 2005 that showed brain damage in former NFL players.
The NFL has taken steps to reduce the number of head injuries to its players after years of distancing itself from research on the lasting impact of such injuries. The NHL was also slow to adjust its rules. It will start this season on Thursday with one its best players, Sidney Crosby of Pittsburgh, sidelined due to the lasting effects of a concussion.
And a recent report by the National Center for Catastrophic Sport Injury Research, showed that more than 500,000 concussions are sustained by the 4.4 million children who play tackle football.
According to Gilchrist, the ER data is the first to calculate that the effort to educate coaches, parents and children about brain injury is working.
“We would like to see the numbers go down because we hope we have gotten better at preventing them, but we knew the numbers would have to go up before they start to come down because awareness has to go up first,” Gilchrist told the new York Times.
Dr. Robert Cantu, co-director of Boston University´s Center for the Study of Traumatic Encephalopathy, told Zinser that the publicity surrounding concussions is having a significant impact. “I view the numbers as encouraging,” he said. “Some people will say that the numbers go up because the number of concussions is going up, but I don´t believe it is.”
Cantu said the biggest danger area is the amount of concussions that go undiagnosed, leading to potentially more severe and even fatal second-impact injuries. In football and hockey the number of actual concussions is six or seven times greater than the number diagnosed. The numbers in hockey stem from Canadian research in which physicians watched and counted the number of likely concussions sustained in games and practices in youth leagues.
Cantu argues that children under 14 should not be allowed to play collision sports until they can be made safer. “Listen, I love sports. I´m not trying to get rid of sports. I´m trying to get rid of head trauma in sports, particularly at the youth level,” he noted.
The CDC study said that collision sports were not at the root of all head injuries in the report. It said that children under ten are most likely to visit the ER for head injuries sustained on a playground or while riding a bike. Injuries sustained by males 10 to 19 are most likely from football, followed by bicycling. Football causes the most concussions in adolescents aged 15 to 19, over 30 percent. Soccer, basketball and bicycling are the most likely culprits for females between 10 and 19.
Gilchrist said she hopes future research can pin down head injuries that are treated by primary care physicians and other doctors, not just ones that appear in the ER, to get a better handle on just how many concussions are being sustained and how they are being treated.
“We are never going to get all of them, but we have to get a lot better,” Cantu said. “Not all the fault lies with the people on the sidelines. The kids have been to blame, too, playing through symptoms and not reporting. That´s why we have to educate them about the dangers of playing through them.”
Thirty-two states have passed legislation mandating concussion education for young athletes, parents and coaches, Cantu noted.
You can read the full CDC report here.