The Centers for Disease Control and Prevention estimates that 1.5 to 3.8 million sports-related concussions occur each year in the United States, 65 percent of them in children and teens.
A growing concern about the long-term effects of these injuries, particularly in young athletes, has led to significant changes in diagnosis and treatment, says Amy L. McIntosh, M.D., of Mayo Clinic in Rochester, Minn.
"The developing brains of children and adolescents are more vulnerable to concussion than adult brains are and respond to injury differently," she explains. "Children take longer to recover, and symptoms such as trouble concentrating often show up in the classroom."
That understanding has led to better sideline assessment and rigorous return-to-activity guidelines. "We now have a very clear sense of when a child's brain has recovered enough to resume full mental and physical functioning. That's a major change in the last five years."
A key component in managing concussion is baseline testing, available to student athletes in Minnesota and Arizona through Mayo Clinic and through many schools and centers nationwide.
"Baseline assessments provide an objective measure of how the brain is performing before and after a suspected concussive injury," Dr. McIntosh says. And the evidence is hard to refute, even if players insist they're not injured.
Athletes are diagnosed at the time of injury. Any player who sustains a blow to the head or neck and has post-concussive symptoms such as headache, dizziness, nausea or loss of balance is immediately removed from play and undergoes after-injury cognitive testing.
Concussed players with severe or worsening symptoms receive further evaluation in the emergency department. Those who are stable or improving are referred to Mayo Clinic's Sports Medicine Center. All athletes begin a comprehensive return-to-play program as soon as they're asymptomatic.
"The first step in our return-to-play protocol is complete physical and cognitive rest — no driving, reading, texting, video games or TV," Dr. McIntosh says. "It's definitely challenging for kids, but activities that require concentration and attention delay recovery and can make symptoms worse."
After the first phase — which may last only a day or two — athletes advance through five more stages of graduated physical and cognitive challenges. Those who develop symptoms at any time stop and rest until the symptoms clear. They then resume the program on the level at which they were symptom-free.
Dr. McIntosh says the program, which is the same one used in professional sports, takes a minimum of six to 10 days to complete. Athletes then undergo testing to make sure they're back to baseline before they are cleared to play.
Youth athletes who remain symptomatic receive more-intensive care. "If symptoms last longer than two weeks, we refer patients to the complex concussion team, which includes brain rehabilitation specialists, occupational and speech therapists, and a neuropsychologist," Dr. McIntosh explains. "They manage post-concussion symptoms and assist in making the life adjustments that can help kids recover more easily."
Dr. McIntosh says that the goal is finding the safest and most expeditious way to get young athletes back playing sports. "We have a well-established, comprehensive and highly successful protocol in place to ensure that injured players don't resume play too soon."
The greatest concern is second impact syndrome, which occurs when the brain sustains a second injury while still recovering from the first. "It's fatal in 50 percent of cases," Dr. McIntosh notes. "And it's completely preventable."