John D. Cowden, MD, associate editor with NEJM Journal Watch Pediatrics and Adolescent Medicine,
Youth American football players suffer concussions as frequently as high school players, but have fewer symptoms, a JAMA Pediatrics study finds. Researchers analyzed data from injury reporting systems for youth (ages 5–14 years), high school, and college football teams from 2012 to 2014.
College athletes had the highest rate of concussions per 1000 athlete exposures (3.52 in games, 0.47 in practices), followed by youth (2.13, 0.53), and high school athletes (1.61, 0.47). High school and college athletes had more symptoms (mean, 5.6) than youth athletes (4.8). The most common symptoms were headache, dizziness, and difficulty concentrating; loss of consciousness was rare. Compared with college athletes, youth and high school athletes were each nearly three times more likely to wait at least 30 days before returning to play.
Despite the difficulty in detecting and characterizing concussions in young athletes (who may recognize and describe symptoms differently than older athletes), these findings suggest that concussions are as common in youth football as in high school football, and that they cause similar symptoms. The findings will help us counsel parents and assess athletes in the clinical setting.
Personal comment: I think the time is soon coming when players will have to be formally evaluated after each significant head injury. It is possible that a combination of software (that asks questions according to a protocol) and telemedicine with a qualified physician will become an alternative to sending the player home to be evaluated by his own doctor. But given all that is being written about the effects of head injury (especially in younger developing brains), this issue will demand more attention. By the way, a close by urgent care center could do a full evaluation and have the player back at the game in a short time.
JAMA Pediatrics article (Free)
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