The purpose of this chapter is to outline aspects of sport-related concussions most relevant in the management of young athletes seen in practice. At the outset, it is recognized that research-based data for the evaluation and management of sport-related concussions in children and adolescents are limited. Because no guideline or protocol has been specifically studied for its applicability in children and adolescents, a more cautious approach to management of concussions is recommended in this age group.
There is no universal consensus on the definition of concussion.1–4 In its practice parameter on concussion management in sports, the American Academy of Neurology defines concussion as a trauma-induced alteration in mental status that may or may not be associated with loss of consciousness.5 Confusion, loss of memory, and impaired information processing speed, which may occur immediately or several minutes later, are considered to be the key features of concussion and seen in all instances.1–8
The Prague Conference (Second International Conference on Concussion in Sports, 2004, Prague) in its definition includes the following key elements associated with concussion as a result of trauma in sports6:
Concussion may be caused by a direct blow to the head, face, neck, or elsewhere on the body with “impulsive” force transmitted to the head.
Concussion typically results in the rapid onset of short-lived impairment of neurologic function that resolves spontaneously.
Concussion may result in neuropathologic changes, but the acute clinical symptoms largely reflect a functional disturbance rather than structural injury.
Concussion may result in a graded set of clinical syndromes that may or may not involve loss of consciousness. Resolution of the clinical and cognitive symptoms typically follows a sequential course.
Concussion is typically associated with grossly normal structural neuroimaging studies.
The term postconcussion syndrome refers to the persistence of symptoms and signs following the brain injury. Postconcussion syndrome can last for weeks, months, or years. Postconcussion syndrome indicates a more severe injury and precludes athlete's return to high-risk sports.
In addition to direct impact to the head or other part of the body in contact/collision sports, concussion can also occur in noncontact sports as a result of sudden acceleration, deceleration, or rotational forces imparted to the brain.6–9 Thus, absence of a history of direct impact to the head or elsewhere on the body does not rule out the possibility of a concussion.
In high school sports in the United States, 300,000 head injuries are reported every year, and 90% of these are concussions.1–3 Reported incidence of concussions at high school level is 0.14 to 3.66 concussions per 100 player seasons accounting from 3% to 5% of all sport-related injuries.8 The highest number of concussion has been reported in American football (Table 11-1).1–4
Table 11-1. Sports with Relatively Higher Risk for Concussion*