A new report released today by the Institute of Medicine (IOM) may help dispel some common misconceptions about sport-related concussions in youth—for example, that wearing helmets can prevent them. First and foremost, however, it highlights the large gaps in knowledge that make it difficult for parents, coaches, and physicians to navigate decisions about prevention and treatment. The report also suggests where federal research agencies should focus their attention.
The study, by a 17-member committee assembled by the Washington, D.C.-based IOM, which advises the government on health issues, comes amid growing concern about sports-related brain injuries. Although much of the attention has focused on adult professional athletes playing American football, health professionals have highlighted the need to understand risks among young athletes as well. To help clarify matters, a number of agencies, including the Centers for Disease Control and Prevention (CDC), the Department of Defense, and the Department of Education, asked IOM to conduct its study.
The most glaring obstacle to understanding youth concussion at this point is a lack of data, the report finds. Most published research on sports-related concussions has been conducted in adults, and “there’s little-to-no information about concussions in youth,” particularly for ages 5 to 21, says panel member Susan Margulies, a bioengineer at the University of Pennsylvania. It’s dangerous to assume that findings in adults can be mapped onto children, she says, because of the changes that occur during brain development. “It’s possible that the threshold for injury might be different across different age ranges.”
Still, some general conclusions can be drawn from the existing literature, the report says. It’s clear that, overall, getting a concussion is not good, and that the closer together multiple concussions occur, the more likely it is that negative symptoms will result. Roughly 10% to 20% of concussion cases in youth result in symptoms that last for weeks to years, the study found—most commonly headaches, memory impairment, and processing speed.
However, there’s not yet enough scientific data to guide safety programs such as the Hit Count Initiative launched last year by the Sports Legacy Institute, which aims to set a threshold for a “safe” number of hits to the head, the report finds. Without sufficient evidence, any such recommendation at this point could give parents a false sense of security, says panel member Kristy Arbogast, a pediatrician and engineer at the Center for Injury Research and Prevention at the Children’s Hospital of Philadelphia in Pennsylvania.
Also unclear is the benefit of preventative measures such as wearing helmets or mouth guards. Although helmets can prevent skull fractures and protect the face, eyes, and mouth, no available evidence suggests that they prevent concussion, contrary to many commercial claims, the report says. It’s “very common on the sidelines” to hear parents say that they believe a specially designed helmet they have purchased for their child will help protect them from concussions, says Rebekah Mannix, a pediatrician at Boston Children’s Hospital, who was not involved in the IOM report. The report could help “cut through some of the misconceptions out there,” she says. Some common-sense measures, such as playing fair and by the rules, do appear to reduce concussions in youth sports, the report finds.
Large, controlled, randomized studies will be needed to answer the most burning questions asked by worried parents—such as whether concussions sustained in childhood can result in long-term problems, like the degenerative brain disease thought to have contributed to retired football player Junior Seau’s suicide last year. However, there is some evidence from studies of retired professional athletes that a history of concussions increases depression risk, the report found. Among other suggestions, the panel recommends that CDC set up a national surveillance system to monitor the incidence of sports-related concussions, including in ages 5 to 21. That system should gather information about factors that may contribute to how children recover from concussions, such as age, sex, preexisting conditions such as learning disabilities, and socioeconomic status, it suggests.
The report also recommends that the National Institutes of Health, the Department of Defense, and organizations such as the National Collegiate Athletic Association support research to develop better age-specific recommendations and rules, and educate parents, coaches, and schools to help change the “culture of resistance” that surrounds concussion in many sports, according to the report. “All of those that interact with an injured child need to recognize that this is an injury that requires serious attention,” Arbogast says.