Emergency department visits for concussions sustained during organized
team sports doubled among 8-13 year olds between 1997 and 2007 and nearly
tripled among older youth, according to recent reports. Additionally,
more than 248,000 children visited hospital emergency departments in 2009
alone for concussions and other traumatic brain injuries related to sports
David W. Kruse, M.D., a sports medicine physician with Hoag Orthopedic Institute, gives a
closer look into the rise of concussions and how they should be treated.
Q. Why does there seem to be a sudden influx in head injuries?
A. The increased prevalence is multifactorial. Partly due to increased recognition
and education regarding head injuries. Thankfully, many more cases are
being identified that went previously undiagnosed. We also know that athletes
are bigger and stronger and are being hit with increased forces at younger
ages – at a time in which time their brains are more vulnerable.
Q. Are children of a certain age more susceptible to brain injuries while
A. We know that pediatric brains are more vulnerable and potentially can take
longer to recover.
Q. I’ve read that doctors recommend wearing “protective headgear”.
In soccer, players don’t normally wear headgear—what do you suggest?
A. It should be clearly stated that "protective headgear" is very
sport specific. Certainly in football or hockey, headgear should be worn
and is part of the sports regulations for multiple reasons (i.e. protection
against lacerations, eye injuries, facial and skull fractures, etc.).
In soccer, headgear is not part of the regulated equipment. It is also
important to note that no study has yet shown that headgear or a helmet
can prevent a concussion injury. Soccer has commercially available "headgear"
which can be helpful to prevent lacerations or abrasions, but DOES NOT
prevent concussion. Therefore, doctors trained in the care of sports concussion
do not recommend the use of soccer headgear to prevent concussion. We
unfortunately do not have that technology yet.
Q. What are some instant signs that a head injury has happened? How do we
know that our child shouldn’t go back into the game? What should
we do if a head injury took place?
A. Because concussion can affect any part of the brain, symptoms can be diverse
and can include headache, dizziness, light and sound sensitivity, confusion,
feeling slowed down, nausea, and fatigue, among others. Concussions may
or may not involve loss of consciousness. If an impact was witnessed and
symptoms are present, then a concussion injury should be suspected. The
athlete should then be pulled from participation, whether practice or
game, and should not return until further evaluation by a physician trained
in the care of sports concussion. it is important to keep in mind that
concussion is part of a spectrum of head and neck injuries. If a neck
injury is suspected, the athlete should not be moved and 911 should be
called. If the athlete has sustained loss of consciousness, worsening
symptoms, vomiting, numbness or weakness in the extremities, or increasing
confusion, the athlete should be taken to the emergency room or 911 called.
For more information, please see the following pocket guides published
by an international consortium of experts:
Concussion Recognition Tool:
Concussion Overview of Actions & Red Flags:
Q. Once home, what signs should we look for? When is it serious enough to
go to the hospital?
A. The athlete should be monitored for a few hours following the injury.
A parent, guardian, or roommate should watch out for the red flags or
worsening signs discussed above. If the athlete meets some of the red
flags they should be taken to a hospital immediately.
Q. Anything you’d like to add?
A. It is common for an athlete with a concussion to require time away from
school or at least have some initial restrictions placed on academic participation.
This is often missed and can be a common reason for persistent symptoms
following a concussion. Academic accommodations should be put in place,
facilitated by the caring physician.
Final clearance back to full soccer or sport participation should be based
on the following: complete symptom resolution, tolerating all academic
work, has successfully completed a graded exertional protocol, and has
been cleared by their treating physician. All of the above can be monitored
by a physician trained in the care of sports concussion.
Dr. Kruse holds two board certifications, sports medicine and family medicine,
and practices as a Primary Care
Sports Medicine specialist. Dr. Kruse’s clinical expertise includes non-operative
orthopedics and sports medicine, general musculoskeletal care, sports
concussion, general medical needs of the athlete, and musculoskeletal
procedures including joint and tissue injections. Dr. Kruse also has special
insight into the care of the injured gymnast or dancer.