Concussions associated with cognitive, behavioral, and emotional consequences for students
July 22, 2020
Science Daily/University of Texas Health Science Center at Houston
Concussions can have a compounding effect on children, leading to long-term cognitive, behavioral, and emotional health consequences, according to researchers at The University of Texas Health Science Center at Houston (UTHealth), who published their findings in the American Journal of Sports Medicine.
In 2017, approximately 2.5 million high school students in the United States reported suffering at least one concussion related to sports or physical activity in the last 12 months, according to information from the U.S. Centers for Disease Control and Prevention (CDC).
The UTHealth researchers analyzed survey data from more than 13,000 high school students in the United States. According to the authors, it is the first study to report on the association between sports-related concussions and negative health implications based on a representative sample of U.S. high school students.
"We have previously speculated that children who suffer a concussion have more behavioral problems, so this study was able to provide a more comprehensive analysis on the various cognitive and behavioral health issues that this population faces in connection with this type of brain injury," said Gregory Knell, PhD, the study's first and corresponding author. Knell is an assistant professor at UTHealth School of Public Health in Dallas and is research faculty at Children's Health Andrews Institute for Orthopaedics and Sports Medicine.
A concussion is the most common form of traumatic brain injury, caused by a mild blow to the head. Common symptoms include a headache, ringing in the ears, nausea, vomiting, fatigue, drowsiness, and blurry vision.
Participants were asked how many times they had suffered a concussion from playing a sport or during physical activity in the last 12 months. Students were also surveyed on relevant cognitive, emotional, and behavioral factors and related health outcomes, including questions on topics such as academics, suicidal ideation, and substance abuse.
The study revealed that 14.5% of female high school athletes and 18.1% of male high school athletes reported experiencing at least one concussion the previous year. These students also reported at least one factor associated to their behavioral, cognitive, and emotional health. The questions covered topics such as difficulty concentrating, poor grades, drinking and driving, carrying a weapon, getting into a physical altercation, using tobacco or marijuana, binge drinking, feeling depressed, and having suicidal thoughts or actions.
Of the male participants who suffered at least one concussion, 33.8% reported they drank and drove in the last 30 days. For the female athletes who reported suffering more than one concussion, 19% stated they had used marijuana at least once in the last 30 days. Both male and female participants who answered that they had been in at least one physical fight in the last year were significantly more likely to have reported having at least one concussion in that same timeframe.
Other associated factors that were significantly more likely in male students who reported a prior concussion included difficulty concentrating, tobacco/e-cigarette use, and binge drinking. Female students who reported prior concussions were more likely to ride in a car with a driver who had been drinking, and have suicidal thoughts or actions.
"Parents need to understand that a concussion is a very serious brain injury, one which requires treatment every time a concussion is sustained. This study has revealed this type of traumatic brain injury can have a compounding effect on children that could lead to more aggressive behavior, academic problems, and social issues," said study co-author Scott Burkhart, PsyD, a neuropsychologist at Children's Health Andrews Institute for Orthopaedics and Sports Medicine.
The research team encourages future studies to continue the surveillance on the prevalence of concussions among student athletes, as well as the severity of these injuries.
https://www.sciencedaily.com/releases/2020/07/200722163225.htm
Female athletes seek specialty care for concussion later than males
September 17, 2019
Science Daily/Children's Hospital of Philadelphia
Female athletes seek specialty medical treatment later than male athletes for sports-related concussions (SRC), and this delay may cause them to experience more symptoms and longer recoveries. Researchers from the Sports Medicine Program at Children's Hospital of Philadelphia (CHOP), reported these findings after analyzing electronic health records of sports participants aged 7 to 18.
The study raises the question of whether, in youth and high school sports, inequities in medical and athletic trainer coverage on the sidelines are contributing to delayed identification and specialized treatment of concussion for female athletes, leading to more symptoms and longer recovery trajectories. The study was published in the Clinical Journal of Sports Medicine.
"There is speculation in the scientific community that the reasons adolescent female athletes might suffer more symptoms and prolonged recoveries than their male counterparts include weaker neck musculature and hormonal differences," says senior author Christina Master, MD, a pediatric and adolescent primary care sports medicine specialist and Senior Fellow at CHOP's Center for Injury Research and Prevention. "We now see that delayed presentation to specialty care for concussion is associated with prolonged recovery, and that is something we can potentially address."
Dr. Master and her team analyzed a dataset containing records of 192 children between 7 and 18 who were diagnosed with an SRC and seen by a sports medicine specialist. Females took longer to present to specialist care and had longer recovery trajectories than males. The median days to presentation for a subspecialty evaluation was 15 for females with SRC and 9 for males. This delay is important since time to presentation to specialized care greater than 1 week has been described as a factor associated with prolonged recovery.
Five distinct outcomes indicating return to preinjury function were measured to determine "recovery" in this group of athletes. By looking at average-days-to-recovery for female and male patients across these outcomes, researchers found that females returned to school later (4 vs. 3 days), returned to exercise later (13 vs. 7 days), had neurocognitive recovery later (68 vs. 40 days), had later vision and vestibular (balance) recovery (77 vs. 34 days) and returned to full sport far later (119 vs. 45 days).
Importantly, when researchers limited the analysis to those female and male patients that presented to the specialty practice for evaluation within the first 7 days of injury, the differences between males and females on all outcomes disappeared.
In sports where females sustain the highest rates of concussion- -- including those in this cohort of patients -- specifically soccer, basketball, and cheerleading, there is generally less sideline medical coverage for games and inconsistent athletic training coverage for practice because they are categorized as "moderate-risk sports" based on all-cause injury. In stark contrast, many high school leagues require athletic training coverage at all football, ice hockey and men's basketball practices and games.
"It is possible that the lack of athletic training coverage at the time of injury may affect the time to concussion recognition during the first critical hours and days after injury," says Dr. Master. "This period is a window of opportunity where specific clinical management, such as immediate removal from play, activity modification and sub-symptom threshold exercise is correlated with more rapid recovery."
Those who study pediatric concussion have been investigating why some concussions take longer to resolve than others so that they can identify those concussions early and implement appropriate concussion management plans to hopefully prevent persistent post-concussion symptoms. This study builds on that knowledge and suggests a tangible cause and solution: close the gap in athletic training and medical coverage between female and male sports.
https://www.sciencedaily.com/releases/2019/09/190917075828.htm