When high school athletes suffer concussions, as many as 40.5% return to action prematurely and set themselves up for more severe injuries, new research shows.
The study from the Center for Injury Research and Policy at Nationwide Children's Hospital in Columbus, Ohio, adds fuel to growing concerns about the long-term side effects of concussions. It also shines new light on inadequately trained personnel on the sidelines unprepared to make accurate diagnoses and informed decisions about sending players back on the field.
"We find these numbers about athletes returning to play tremendously alarming," says Dawn Comstock, the study's director of research.
Concussions account for almost one in 10 sports injuries, according to the Centers for Disease Control and Prevention, and for young people ages 15-24, sports are second only to motor vehicle accidents as the leading cause of brain injury. Comstock estimated that more than 130,000 concussions occurred in nine sports last year, adding that those are "conservative estimates" that will grow when she adds nine additional sports to her research this year.
About 3.8 million students competed in those sports. The most concussions occurred in football and boys' and girls' soccer.
The statistic most troubling to Comstock: 16% of football players reported returning to play the same day they lost consciousness. An athlete is advised not to return to play the same day after losing consciousness in guidelines created by an international panel of experts in 2004.
Young athletes, whose brains and skulls are immature, risk death or additional concussions by going back too soon. Recurrent concussions also have led to depression and early dementia, according to studies on retired NFL players. All concussions require evaluation by a medical doctor.
In rare instances, the danger of playing with a concussion can lead to death from second impact syndrome (SIS), a condition in which the brain swells, shutting down the brain stem and resulting in respiratory failure. In North Carolina last year, two high school football players died from SIS. Both returned to play within two days of getting a concussion. Three other football players died from brain injuries, and 14 high school football players died overall, says the Annual Survey of Football Injury Research.
The National Federation of State High School Associations has reviewed the new data from Comstock and is sending a revised concussion pamphlet to state federations before the end of the school year, says the federation's Bob Colgate.
"We're trying to keep this a front-burner issue," Colgate says. "Kids are still getting in and playing with head injuries."
The pamphlet is directed at coaches, the people most often responsible for the welfare of athletes, Colgate says.
Only 42% of high schools have athletic trainers. Kevin Guskiewicz, a former athletic trainer for the Pittsburgh Steelers, belongs to the National Athletic Trainers Association and is chair of the sports science department at the University of North Carolina.
"If we cannot put the appropriate medical personnel on the sidelines, such as certified athletic trainers, schools should consider dropping contact or high-risk sports," he says. "People have said we're overreacting, but if you're involved in mismanagement of these kids and listen to their families, you quickly realize the importance of quality care."
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