Study finds revised concussion guidelines shorten duration of symptoms

Press release:

The adoption of recommended changes in concussion management led to a reduction in the length of symptoms among 11- to 18-year-old athletes with first-time, sports-related concussions, according to new research in the Journal of Osteopathic Medicine. These outcomes support the widespread adoption of the updated concussion guidelines.

Researchers conducted a retrospective review of the medical records of athletes who sustained a concussion between 2016 and 2018 and were treated by a physician who used the revised approach to concussion management. They then compared the data with a previously published data set from athletes who sustained a concussion between 2011 and 2013 and whose physicians followed older guidelines for concussion management. A total of 110 male and 72 female athletes met the study’s eligibility criteria.

The recommended changes in care include advocating for early activity, recognizing pre-existing conditions, and educating athletes about concussion recovery. Following implementation of the guidelines at the clinic, athletes of both genders experienced a significantly shorter median duration of concussion symptoms. Male athletes reported a duration of symptoms that dropped from 11 days to 5 days, while female athletes’ symptom duration dropped from 28 to 7 days.

Active rest

“The most significant change in care involved a shift from strict rest or cocoon therapy to a return to low-intensity physical or cognitive activity after 24 to 48 hours,” said the study’s lead researcher, John Neidecker, DO, a sports concussion specialist in Raleigh, North Carolina. “Our results show active rest dramatically improved recovery times among young athletes with first-time concussions.”

Active rest involves light movement that has no risk of head trauma. Patients should gradually increase their level of physical and mental activity under the guidance of a physician.

Pre-existing conditions

When comparing the 2011-2013 and 2016-2018 data sets, researchers found a higher incidence of pre-existing problems for patients in the newer data set, which suggests that better identification of these conditions led to improved patient outcomes.

“If diagnosis of a pre-existing condition has never been given, patients cannot be expected to report one during our concussion assessment,” said Dr. Neidecker. “This is especially true in the adolescent age group, as some may have a condition that they are not aware of yet. This makes screening for preexisting conditions more complex, yet even more essential for this age group.”

For example, motion sickness from car rides or intolerance to 3D movies could indicate a pre-existing vision disorder that was previously undiagnosed. Asking parents about preinjury personality and demeanor may uncover pre-existing anxiety, which can also impact recovery.

“This more individualized, osteopathic approach in screening the athletes’ past medical history helped us identify health issues that may have been overlooked in the past,” said Dr. Neidecker. “By focusing on the diagnosis and treatment of pre-existing health conditions, we can more effectively tailor treatment.”

Catastrophizing the injury

In the 2011-2013 data set, concussion knowledge was significantly less, and physician counseling often had a much more cautious or, at times, ominous tone, according to Dr. Neidecker. Following the revised guidelines, physicians in the clinic adopted a more optimistic outlook when speaking with patients. This adjustment in communication may have contributed to patients reporting fewer concussion symptoms at an earlier date.

“Simply put, making clinic visits more positive and less anxiety-provoking supports patient recovery,” said Dr. Neidecker. “Whereas catastrophizing an event, particularly with an adolescent population, may exacerbate symptoms.”

Early patient counseling and education about concussions and the typical course of symptom resolution may mitigate unnecessary worry. This counseling may be even more critical to patients with pre-existing anxiety.

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College Football Players Underestimate Risk of Injury and Concussion

College football players may underestimate their risk of injury and concussion, according to a new study published today in JAMA Network Open.

Christine Baugh, PhD, MPH, assistant professor of medicine at the University of Colorado School of Medicine and member of the CU Center for Bioethics and Humanities, is the corresponding author of the article, “Accuracy of US College Football Players’ Estimates of Their Risk of Concussion or Injury.”

Baugh and co-authors report on survey results of 296 college football players from four teams in the Power 5 Conferences of the National Collegiate Athletic Association. Athletes were surveyed in 2017. The researchers found that between 43 percent and 91 percent of respondents underestimated their risk of injury and between 42 percent and 63 percent underestimated their risk of concussion.

To measure the accuracy of football players’ risk estimations, the researchers modeled individual athletes’ probabilities of sustaining a concussion or injury and compared model estimates to athlete perceptions. While recognizing that many people underestimate health risks, the authors point out that the risks college football athletes face may be more severe or debilitating than those faced by many in the general population. Given this elevated risk profile, they say it is concerning that athletes tend to underestimate the likelihood of these risks. These results raise questions about informed consent and how much risk should be acceptable in the context of a game, Baugh and her co-authors write.

Continue reading “College Football Players Underestimate Risk of Injury and Concussion”

Concussion rates are nearly double what we thought — and summer is prime injury time

(TORONTO, Canada) – With concussions seeming more common than ever before, researchers at Toronto Rehabilitation Institute – University Health Network, set out to answer the question, Are we looking at a true epidemic, or just better recognition?

By embarking on the largest-scale study on concussions ever undertaken in Canada, the researchers discovered that 150,000 of Ontarians (1.2% of province’s population) are diagnosed with a concussion each year. That’s almost twice as high as previously recorded, and may represent a closer estimate of the true picture of concussion in Ontario.

Their findings were published the Journal of Head Trauma Rehabilitation.

“Past research has looked at the incidence of concussion by examining a particular population; cause of injury; or use a single reporting source, such as records from the Emergency Department. This can under-represent estimates of the real incidence of concussion,” says lead author, Laura Langer.

“Our study revealed concussion rates that are almost double what has been previously reported, and highlights the critical importance of looking at everyone who sought medical attention for their concussion.”

Continue reading “Concussion rates are nearly double what we thought — and summer is prime injury time”

New concussion laws result in big jump in concussion treatment

Press Release:

ANN ARBOR–New laws regulating concussion treatment, bolstered by heightened public awareness, have resulted in a large increase in the treatment of concussion-related injuries for school-age athletes.

Over the past decade, concerns over concussion injuries and media coverage of them have skyrocketed. Since 2009, all 50 states and the District of Columbia have enacted concussion laws regulating concussion treatment–the first laws written to address a specific injury.

A University of Michigan study designed to evaluate the impact of new concussion laws found a 92 percent increase in children seeking medical assistance for concussions in states with the legislation in place. States without concussion laws showed a 75 percent increase in those seeking injury-related health care.

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