RN

My Head Hurts: Understanding the Risk of Sports Related Concussions

By Suzan Miller-Hoover DNP, RN, CCNS, CCRN-K

Sports Related ConcussionsEach year, 1.6 to 3.8 million concussions result from sports/recreation injuries in the United States (American Academy of Neurology (AAN), 2018). Sports concussion can affect athletes of any age, gender, or type and level of sport played. While most concussions result in a full recovery, some can lead to more severe injuries if not identified early and treated properly (AAN, 2018).

  •   The risk of concussion is 19% per year of play
  •   More than 62,000 are sustained in high school
  annually by students involved in contact sports
  •   Among college football players: 34% have had one concussion, 20% have had multiple concussions
  •   Estimates show that between 4% to 20% of college and high school football players will sustain a
  concussion within one season
  •   The risk of having multiple concussions is 3-6 times greater in students who have suffered a previous
  concussion
  •   9% of athletes will die following concussion, the cause of death is related to:
       o   History of concussion within prior 4 weeks
       o   Second impact syndrome (catastrophic cerebral edema with second blow)
                Can occur even with a very mild concussion
  (American Association of Neurological Surgeons (AANS), 2018; (AAN, 2018. AANS, & Meegan &
  O’Brien, 2018)

A concussion is defined as a temporary loss of normal brain function, usually caused by a blow to the head. In many cases, there are no accompanying signs of head trauma. While it is thought that all concussions have a period of unconsciousness, many people do not lose consciousness (AANS, 2018).

The three main characteristics of concussion are:
  •   Inability to maintain a coherent stream of thought
  •   A disturbance of awareness with heightened distractibility
  •   Inability to carry out a sequence of goal-directed movements
Concussion symptoms:
  •   Prolonged headache
  •   Vision disturbances
  •   Dizziness
  •   Nausea or vomiting
  •   Impaired balance
  •   Confusion
  •   Memory loss
  •   Ringing ears
  •   Difficulty concentrating
  •   Sensitivity to light
  •   Loss of smell or taste
  (AAN, 2018. AANS, 2018, & Meegan & O’Brien, 2018)

If any of these symptoms or characteristics occur after a blow to the head, a healthcare professional should be consulted immediately. (AAN, 2018. AANS, 2018, & Meegan & O’Brien, 2018)

Initial Management:
  •   Manage airway and breathing before moving
  •   Ensure the player is out of danger of further injury
  •   If unconscious, apply C-spine precautions, immobilize

On-going Management
  •   Physical Rest
       o   24-48 hours of rest
       o   Gradual and progressive return to non-contact activity
                If symptoms reappear with increased activity, return to rest
  •   Cognitive Rest
       o   If cognitive symptoms appear (head ache, blurry vision) cessation of all cognitive activities including
       school attendance until symptom free
       o   If asymptomatic or low-level symptoms limit cognitive activities such as video games, loud music, or
       those requiring sustained focus, may attend school
  •   Headache
       o   Most mild headaches will be managed with acetaminophen or NSAIDs
                If headaches continue for several days, they may be rebound headaches which cannot be managed
             with acetaminophen or NSAIDS
       o   Migraines should be managed as previous migraines have been managed
       o   Prolonged headaches, cervicogenic, are secondary headaches involving the neck
       o   May attend school, but should not return to contact sports until headache resolves
  •   Persistent symptoms lasting more than four weeks should be managed by a sports medicine provider or
  other provider with similar expertise
  •   Return to learning
       o   When the person can tolerate and concentrate for 30-45 minutes, they may return to school
  •   Return to play (RTP)
       o   Successful return to school
       o   Symptom-free/off medications
       o   Normal neurologic exam
       o   Back to baseline gait/balance and cognitively
       o   Athlete should be symptom free for no less than 24 hours before progressing to next level of activity
       o   At least five days should pass between full recuperation and competition
       o   Full RTP exercise progression may take days, weeks, or months
                90% of athletes will be cleared to play within one month
       o   Final clearance to RTP should be completed by a sports medicine provider or other provider with similar
       expertise
  (AAN, 2018. AANS, 2018, & Meegan & O’Brien, 2018)

For a concussion checklist provided by the American Academy of Neurology click here.
Athletes of all ages and gender are at-risk for concussion. Prevention is the key; however, if a concussion occurs, cautious return to school and to sports should be the theme of treatment.



References
American Academy of Neurology. (2018). Sports concussion resources. Retrieved from: https://www.aan.com/tools-and-resources/practicing-neurologists-administrators/patient-resources/sports-concussion-resources/

American Association of Neurological Surgeons. (2018). Concussion. Retrieved from: http://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Concussion

Meehan, W. P., & O’Brien, M. J. (2018). Concussion in children and adolescents: Management. Retrieved from: https://www.uptodate.com/contents/concussion-in-children-and-adolescents-management

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