Pillar One – Bibliography and Annotated Guide

Home / Smartest Team Movie  / Pillar One – Bibliography and Annotated Guide

Introductory comment: The importance of concussion education cannot be underestimated.  And it isn’t just parents, coaches, and players who require more concussion education: physicians do, too.

Original Sources:

  1. Benson B, McIntosh A, Maddocks D, et. al. What are the most effective risk-reduction strategies in sport concussion? Br J Sports Med 2013;47:321-326 (citing studies @ n. 51-54)(“Despite the interest generated by media exposure and public education programmes, there appears to remain widespread misconceptions about the diagnosis and management of concussion, as well as knowledge gaps among athletes, parents, and coaches.”).
  2. Esquivel A, Haque S, Keating P, Marsh S, Lernos S. Concussion Management, Education, and Return-to-Play Policies in High Schools: A Survey of Athletic Directors, Athletic Trainers, and Coaches. Sports Health: A Multidisciplinary Approach.2013;20(10). Published online ahead of print as doi:10.1177/1941738113476850 (accessed February 23, 2013
  3. Sarmiento K, Mitchko J, Klein C, Wong S. Evaluation of the Centers for Disease Control and Prevention’s concussion initiative for high school coaches: “Heads up concussion in high school sports.” J Sch Health 2010;80(3):112-118.
  4. Bagley AF, Daneshvar DH, et. al. Effectiveness of the SLICE Program for Youth Concussion Education. Clin J Sport Med 2012;22(5):385-389.
  5. Chrisman SP, Schiff MA, Rivara FP.  Physician Concussion Knowledge and the Effect of Mailing the CDC’s “Heads Up” Toolkit.  Clin. Ped. 2011;50(11):1031-1039
  6. Echlin PS, Editorial. A prospective study of physician-observed concussion during a varsity university ice hockey season. Part 1 of 4. Neurosurg Focus 2012;33(6):E1 (published online ahead of print)(accessed December 10, 2012)
  7. Zonfrillo MR, Master CL, Grady MF, Winston FK, Callahan JM, Arbogast KB.  Pediatric Providers’ Self-Reported Knowledge, Practices, and Attitudes About Concussion.  Pediatrics 2012;130(6). DOI: 10.1542/peds.2012-1431)(published online ahead of print)(accessed November 19, 2012
  8. Tomei KL, Doe C, Prestigiacomo, Gandhi CD.  Comparative analysis of state-level concussion legislation and review of current practices in concussion.  Neurosurg Focus 2012;33(6):E11.
  9. Shenouda C, Hendrickson P, Davenport K, Barber J, Bell KR.  The effects of concussion legislation one year later – what we have learned: a descriptive pilot survey of youth soccer player associates. PM R 2012;4:427-435.
  10. C.S. Mott Children’s Hospital National Poll on Children’s Health, Vol. 10, Issue 1 (June 14, 2010)
  11. Burke M, Chundamala J, Tator C. Deficiencies in Concussion Education in Canadian Medical Schools.  Canadian J NeuroSci 2012;39(6):763-766.

Articles

Concussion Education For High School Soccer Players Lacking, Survey Finds

Pediatricians and ER Doctors: More Concussion Training Needed

Concussion Knowledge of Primary Care Doctors Falls Short, Study Says

—–“I’d been hearing a lot about concussions. It just kept popping up, NFL players that had too many concussions are killing themselves. Then our state passes a law about concussion. You know, it’s a hot topic.”(Newcastle mother, Kerali Davis)(3:08)

Original Sources:

  1. Senate Enrolled Bill No. 1700 (signed by Gov. Brad Henry, May 13, 2010)(https://www.sos.ok.gov/documents/legislation/52nd/2010/2R/SB/1700.pdf)(accessed March 30, 2013)
  2. http://www.lawatlas.org/preview?dataset=sc-reboot (an outstanding, comprehensive, searchable data base of all the state concussion laws) (accessed May 23, 2013).

Articles:

Youth Sports Concusson Laws: Oklahoma

Strong Concussion Safety Laws in Place In Most States

Athletes’ Resistance To Self-Reporting of Concussion Continues Despite Increased Education

Comment: All 50 states and the District of Columbia have enacted so-called “Zackery Lystedt” laws  (named after the high school football player in Washington State whose brain injury prompted passage of that state’s groundbreaking law).  Although each law is different, all require that high schools, and, in some states, middle schools and independent youth sports organizations:

  1. educate youth athletes and their parents, and, in some cases, coaches, about the signs and symptoms of concussions, the dangers of continuing to play with concussion, and acknowledge receipt of a concussion information form in order to play sports;
  2. remove from play any youth athlete suspected of having suffered a concussion and not allow them  return to play that day; and
  3. require written clearance from a licensed health care professional trained in the evaluation and management of concussions before an athlete can return to play.

How effective such laws will be in improving concussion safety, all of which have been passed since May 2009, remains to be seen. A survey of Washington State adults a year after passage of the original Lystedt law found that 85% of the study population was aware of the law and over 90% had a good understanding regarding the definition, diagnosis and potential severity of a concussion. See Shenouda C, Hendrickson P, Davenport K, Barber J, Bell K.  The effects of concussion legislation one year later – what we have learned: a descriptive pilot survey of youth soccer player associates. PM R 2012;4:427-435.  But, as a 2013 study noted, “Despite the interest generated through media exposure and public education programmes, there appears to be remain widespread misconceptions about the diagnosis and management of concussions, as well as knowledge gaps among athletes, parents, and coaches.” Benson B, McIntosh A, Maddocks D, et. al. What are the most effective risk-reduction strategies in sport concussion? Br J Sports Med 2013;47:321-326 (citing studies @ n. 51-54).

Moreover, a number of studies suggests that, even when athletes have received concussion education and are aware of the dangers of continuing to play with concussion symptoms, most are, unfortunately, willing to continue to take that risk. One study reported that an astounding 91 percent surveyed felt that it was okay for an athlete to play with a concussion, 75 percent said they would play through any injury to win a game, 53 percent said they would “always or sometimes continue to play with a headache sustained from an injury,” and only 54 percent would “always or sometimes report symptoms of a concussion to their coach,” and only 4 in 10 would tell their coach immediately if they had concussion symptoms.  Anderson B, Pomerantz W, Mann J, Gittelman M. “I Can’t Miss the Big Game”: High School (HS) Football Players’ Knowledge and Attitudes about Concussions. Paper presented at the Annual meeting of the Pediatric Academic Societies, Washington, D.C. May 6, 2013.  Thus, while increased concussion education is critically important, it is by no means a panacea or cure-all, and must be part of a comprehensive concussion risk management strategy.

It is also important, as the British Journal of Medicine study noted, that concussion safety laws “be open to ongoing review and amendment as new scientific knowledge about sports concussions is discovered and the best and most effective ways to implement such laws are learnt.”

—–“There was a time I got a concussion. I didn’t think much of it. Just a headache. Move on with it. Keep playing.Happened I think last year. Yeah. Hit pretty hard, helmet to helmet. Couldn’t see, saw stars everywhere. Just walked back on the field, started playing again. Didn’t even tell anyone. It’s not like I was laying down, couldn’t get up or anything. I thought I was fine.”  (Newcastle player, Justin Ledford)(3:54)

Comment: Justin’s attitude is typical of the way many football players think, and of a “warrior” culture that tells athletes to keep playing and hide their symptoms.  It is this culture we need to work to change.  Change is going to come incrementally, and it may take an entire generation or more to accomplish.

Like Justin, many athletes also still believe the myth that a concussion requires a loss of consciousness, or that continuing to play as long as they are unable to get up is okay.  The most recent statistics show that the vast majority of concussions in high school sports (95%) do not involve loss of consciousness., and that continuing to play with a concussion not only puts the athlete at increased risk of a longer recovery but puts at risk their long-term cognitive health.

Original Sources:

  1. Meehan W, d’Hemecourt P, Comstock D, “High School Concussions in the 2008-2009 Academic Year: Mechanism, Symptoms, and Management” Am J Sports Med 2010; 38(12): 2405-2409
  2. McCrory P. et al. Consensus Statement on Concussion in Sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Br J Sports Med 2013; 47:250-258.
  3. Halstead, M, Walter, K. Clinical Report – Sport-Related Concussion in Children and Adolescents. Pediatrics. 2010;126(3):597-615.

Articles:

Vast Majority of Concussions Do Not Involve Loss of Consciousness

Chronic Under-Reporting Of Concussion: Is Changing The Culture A Realistic Solution?

—–“I take some Ibuprofen/Tylenol, to get some of that away.” (Newcastle players, Casey Freeman and Jarod Missey)(4:34, 4:43)

Comment: While several Newcastle players told producer Brooke de Lench that they took Ibuprofen (Advil) during and after football games for pain, including headache, which studies consistently show is the number one symptom of concussion, the use of aspirin and anti-inflammatory medications by concussed athletes is considered unwise, although the risk is believed more theoretical than proven in controlled studies..

Original Sources:

  1.  Sport Concussion Assessment Tool – 3rd Edition (SCAT3): Br J Sports Med 2013;47:259.
  2.  Harmon K, Drezner J, Gammons M, et. al.  American Medical Society for Sports Medicine position statement: concussion in sport.  Br J Sports Med 2013;47:15-26. (noting that, in the acute setting, treatment options for headache are limited; in general, aspirin and non-steroidal anti-inflammatories (NSAIDS) are not recommended because of the theoretical risk of bleeding)

Articles:

Concussions: Parents Are Critical Participants in Recognition, Treatment, Recovery

—–“One of things about concussions it’s so terribly under-recognized. It’s called the ‘silent epidemic.'” (Joseph Congeni, MD)(4:55)

Original Sources:

  1. Carroll, L, Rosner D. “The Concussion Crisis: Anatomy of a Silent Epidemic” (Simon & Schuster 2011)
  2. Langlois HJ, Marr A, Mitchko J, Johnson R. Tracking the silent epidemic and educating the public: CDC’s traumatic brain injury-associated activities under the TBI Act of 1996 and the Children’s Health Act of 2000. J Head Trauma Rehab. 2005;20(3):196-204.

Article:

The Concussion Crisis: Anatomy of a Silent Epidemic

—–“Studies show anywhere from 65 to 80% of initial concussions are missed, because the symptoms initially are subtle,  and people are looking for things like you see with a brain bleed, or they are looking for somebody totally knocked out and carted off the field.”  (Dr. Congeni)(4:55)

Original Sources:

  1. McCrea M, Hammeke T, Olsen G, et. al.  Unreported concussion in high school football players: implications for prevention.  Clin J Sport Med 2004;14:13-17.
  2. Echlin P, Tator C, et al. A prospective study of physician-observed concussions during junior ice hockey: implications for incidence rates.  Neurosurg Focus 2010;29(5):E4.
  3. Echlin PS, Skopelja EN, Worsley R et al.  A prospective study of physician-observed concussion during a varsity university ice hockey season: incidence and neuropsychological changes. Part 2 of  4.  Neurosurg Focus 2012;33(6):E2
  4. Meehan W, d’Hemecourt P, Comstock D. High School Concussions in the 2008-2009 Academic Year: Mechanism, Symptoms, and Management. Am J Sports Med. 2010;38(12): 2405-2409.

Articles

Vast Majority of Concussions Do Not Involve Loss of Consciousness

—–“The word ‘concussion’ means to violently shake.  And that’s really what’s happening to the brain.” (Dr. Congeni)(4:55)

Original Sources, e.g.:

   1. McCrory P, et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012.  Br J Sports Med 2013;47:250-258.

Article

Each Concussion Is Different But All Share Four Characteristics

—– “You can have a host of different symptoms …” (Drs. Moser and Congeni).  … There’ so many different ways concussion can present that it’s very hard to tell a kid, a coach or parent … this is the one symptom to look for because there’s all these symptoms.  Are you kidding me?” ( Dr. Congeni)(5:53)

Original Sources:

  1. McCrory P, et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012.  Br J Sports Med 2013;47:250-258.
  2. MccRea M, Iverson G, Echemendia, et al. Day of injury assessment of sport-related concussion.  Br J Sports Med 2013;47:272-284.
  3. SCAT3. Br J Sports Med 2013;47:259.
  4. Child SCAT3. Br J Sports Med 2013;47:263

Articles

Concussion Signs and Symptoms

Concussion Evaluation, Management, Return to Play Different for Children

—–“If you have a strong hit or strong blow. You don’t even have to hit your head. It could just be whiplash, and you feel dazed or like you got your ‘bell rung,’ it’s what we used to call it, then that’s a concussion. Tell somebody about it, and remove yourself from the game.” (Dr. Moser)(6:04)

Original Sources: 

  1.  McCrory P, et al.  Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012.  Br J Sports Med 2013;47:250-258.
  2. Cantu, R., Hyman M. Concussions and Our Kids (2012 Houghton Mifflen Harcourt)
  3. Broglio, et. al, Head Impacts During High School Football: A Biomechanical Assessment. J Ath Tr 2009; 44(4): 342-349.
  4. Daniel R, Rowson S, Duma S. Head Impact Exposure in Youth Football. Annals of Biomed Eng 2012: DOI:10.1007/s10439-012-0530-7 (accessed February 15, 2012)

Articles

Each Concussion Is Different But All Share Four Characteristics
Concussions: No Direct Blow to Head or Specific Impact Magnitude Required
Sports Concussion Myths and Misconceptions

—–“One of the major myths that we have to dispel is that [a concussion] always occurs from a blow to the head. One of the fastest growing concussions is what’s called an indirect concussion, it’s a body shot, it’s a whiplash type mechanism, it’s a snapback. They maybe weren’t even hit in the head at all. And we’re approaching nearly 50 percent of concussions now are of the indirect variety, so you don’t have to have a direct hit to the head. A snapback whiplash type mechanism can cause concussion.” (Dr. Congeni)(6:19)

Original sources:

  1.  Broglio S, Surma T, Ashton-Miller J. High School and Collegiate Football Athlete Concussions: A Biomechanical Review. J Biomed Engineering. 2011; DOI:10.1007/s10439-011-0396-0 (published online October 13, 2011)(“It is thought that both post-impact linear and angular head acceleration may be predictive biomechanical variables to concussion, but there is no clear indication if one plays a bigger role in predicting concussion or concussion severity than the other.  Some have suggested that linear acceleration is the primary component while others have speculated that angular acceleration may be the most important variable in determining damage to the brain.”)(discussion at notes 34, 36).
  2. Cantu R, Hyman M. Concussions and Our Kids. (Houghton Mifflin Harcourt 2012), pp. 4-5 (“Concussions are caused by two types of acceleration … linear [and] rotational … the force of the collision violently whips the ball carrier’s head to one side.  … On virtually every hit …, both linear and rotational accelerations are present. Among researchers and other experts, it’s believed that rotational forces are more injurious.”)
  3. Broglio S, et al. Biomechanical Properties of Concussion in High School Football.  Med Sci Sports Exerc. 2010;42:2064-2071 (rotational acceleration chief predictor of concussion).
  4. King A, Yang H, Zhang L, Hardy W, Viano D. Is head injury caused by linear or angular acceleration? Presentation Paper, Proceedings of the International Research Conference on the Biomechanics of Impact (IRCOBI), Lisbon, Portugal, September 2003. (accessed at http://ebookbrowse.com/king-ircobi-2003-pdf-d402756581)
  5. Rowson S, Duma S. Brain Injury Prediction: Assessing the Combined Probability of Concussion Using Linear and Rotational Acceleration. Ann. Biomed. Eng. 2013;41(5):873-882 (“Traditionally, research investigating the biomechanics associated with brain injury have focused on two injury modes: injury resulting from linear acceleration and injury resulting from rotational acceleration.”).

—–“Typically, you have a rapid onset of symptoms and a gradual resolution.” (Dr. Congeni)(6:19)

Original Source:

McCrory P, et al.  Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012.  Br J Sports Med 2013;47:250-258.

Comment:  While rapid onset of symptoms is typical, it is not at all unusual, particularly with but not exclusively with younger athletes, for the appearance of symptoms or cognitive deficits to be delayed several hours following a concussive episode.  One recent study of college athletes, for example (Duhaime A, Beckwith J, Maerlender A, McAllister T, Crisco J, Duma S, et. al. Spectrum of acute clinical characteristics of diagnosed concussions in college athletes wearing instrumented helmets. J Neurosurg. 2012; 117(6):1092-1099 (epub ahead of print October 2, 2012. DOI: 10.3171/2012.8.JNS112298), found that: (1) many players had delayed onset of symptoms after an impact event; (2) the majority of players had delayed diagnosis (delays of hours to days); (3) more than a third of diagnosed concussions were not associated with a specific impact; and (4) the force of the impact event that triggered the concussion varied widely.

Such findings, in the view of the study’s authors, “may raise questions about whether current diagnostic methods and operational definitions of concussion in the context of athletics, based largely on self-report of specific clinical symptoms, capture those individuals actually at risk for short-, intermediate- and long-terms consequences of injury. The findings also point out the differences between diagnosis of concussion in the context of sports and the cases typically seen by consulting neurosurgeons in emergency departments, in which a single clearly identified event is associated with immediate onset of symptoms including alteration of mental status.”

As a result, experts advise that concussion be seen as an evolving injury in the acute stage. See, e. g., McCrory P, et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012.  Br J Sports Med 2013;47:250-258;

—–“But here’s the key: everyone’s symptoms resolve at a different rate, so it’s no cookbook anymore. When I started in ’87, they would say ‘Grade 1 concussion means 1 week out, and Grade 2 …’ And that was ridiculous. Now that we have seen lots of concussions, we know that’s not the case.”  (Dr. Congeni)(6:19)

Original Sources:

  1. Cantu RC. Posttraumatic retrograde and anterograde amnesia, pathophysiology and implications in grading and safe return to play. J Athl Train 2001;36(1):244-248.
  2. Colorado Medical Society. Report of the Sports Medicine Committee: Guidelines for the Management of Concussions in Sport (Revised). Denver, CO: Colorado Medical Society; 1991
  3. American Academy of Neurology. Practice parameter: the management of concussion in sports (summary statement). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 1997;48(3):581-585.
  4. Halstead, M, Walter, K. Clinical Report – Sport-Related Concussion in Children and Adolescents.  Pediatrics2010;126(3):597-615.
  5. McCrory P, Johnston K, Meeuwisse W, et al. Summary and agreement statement of the 2nd International Conference on Concussion in Sport, Prague 2004. Br J Sports Med 2005;39(4):196-2004.
  6. McCrory P, Meeuwisse W, Johnston K. et al. Consensus statement on Concussion in Sport: the 3rd International Conference on Concussion in Sport held in Zurich, November 2008.  Br J Sports Med 2009: 43:i76-i84.
  7. McCrory P, et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012.  Br J Sports Med 2013;47:250-258.
  8. Giza C, Kutcher J, Ashwal S, et al.  Summary of evidence-based guideline update: Evaluation and management of concussion in sports: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology (published online ahead of print, March 18, 2013); DOI:10.1212/WNL.ob013e31828d57dd (accessed March 24, 2013).

Articles

Concussion Grading Scales Abandoned—Concussion grading systems and cookie cutter return to play guidelines abandoned

—–“Some concussions resolve in a week, some resolve in a month, some take six months of resolve.” (Dr. Congeni)(6:19)

Original Sources:

  1. Gessel LM. Fields SK. Collins CL. Dick RW. Comstock RD. Concussions among United States high school and collegiate athletes. J Athl Train 2007; 42(4): 495-503
  2. Meehan W, d’Hemecourt P, Comstock D, High School Concussions in the 2008-2009 Academic Year: Mechanism, Symptoms, and Management. Am J Sports Med 2010; 38(12): 2405-2409 (accessed December 2, 2010 at http://ajs.sagepub.com/content/38/12/2405.abstract?etoc).
  3. Meehan WP, d’Hemecourt P, Collins C, Comstock RD, Assessment and Management of Sport-Related Concussions in United States High Schools. Am J Sports Med 2011;20(10)(published online on October 3, 2011 ahead of print) as dol:10.1177/0363546511423503 (accessed October 3, 2011).
  4. Harmon K, Drezner J, Gammons M, et. al.  American Medical Society for Sports Medicine position statement: concussion in sport.  Br J Sports Med 2013;47:15-26.

Articles:

Concussion Statistics in High School Sports

Concussion Management: A Review of Recent Guidelines

—–“There’s some point that kids go from recovering fully from their concussion, to where now they start having permanent symptoms, and these symptoms are cumulative. Is it 5 percent, is it 10 percent, is after the kid’s had 2 concussions, or 3 bad ones, or? We don’t know. Nobody’s quite sure, but all of a sudden people start having concentration issues, depression, chronic headaches.” (Dr. Congeni)(6:19)

Original Sources:

  1. McCrory, P, et al. Consensus Statement on Concussion in Sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012.  Br J Sports Med 2013:47:250-258. (neureoimaging studies suggest that depressed mood after concussion may reflect an underlying pathophysiological abnormality)(citing studies @ notes 87-97)
  2. Chen JK, Johnston KM, Petrides M, et al. Neural substrates of symptoms of depression following concussion in male athletes with persisting postconcussion symptoms.  Arch Gen Psychiatry 2008;65:81-89.
  3. Guskiewicz KM, Marshall SW, Bailes J, et al. Recurrent concussion and risk of depression in retired professional football players. Med Sci Sports Exerc 2007;39:903-909.
  4. Moser RS, Schatz P. Enduring effects of concussion in youth athletes. Arch Clin Neuropsychol 2002;17:91-100.
  5. Moser RS, Schatz P, Jordan BD. Prolonged effects of concussion in high school athletes. Neurosurgery 2005;57(2):300-3006.
  6. Schatz P, Moser RS, Covassin T, et al. Early indicators of enduring symptoms in high school athletes with multiple previous concussions.  Neurosurgery  2011;68:1562-1567.

Articles

Concussions Linked to Depression

Depression Common Where Concussion Recovery Prolonged (video)

—–“And here’s of course the big one that got everybody talking is the permanent brain damage issues. So a thing called second impact syndrome, where kids do die in this country every year, playing sport with a concussion, cause the brain already was injured, they play again, they get hit again.” (Dr. Congeni)(6:19)

Original Sources:

  1. McKee A, Cantu R, et. al. Chronic Traumatic Encephalopathy in Athletes: Progressive Tauopathy After Repetitive Head Injury. J Neuro Exp. Neurol  2009; 68(7): 709-735
  2. Gavett B, Stern R, Cantu R, Nowinski C, McKee A. Mild traumatic brain injury: a risk factor for neurodegeneration. Alzheimer’s Research & Therapy 2010; 2:18
  3. Schatz P, Moser RS, Covassin T, Karpf.  Early Indicators of Enduring Symptoms in High School Athletes with Multiple Previous Concussions.  Neurosurgery  2011;68:1562-1567 at n. 3
  4. Stern R, Riley D, Daneshvar D, Nowinski C, Cantu R, McKee A. Long-term Consequences of Repetitive Brain Trauma: Chronic Traumatic Encephalopathy.  Phys Med & Rehab 2011;3;S460-S467. DOI:10.1016/j.pmrj.2011.08.008.
  5. Boston University Center for Alzheimer’s Research. Selected CSTE Cases: Eighteen year old high school football player. 2010; http://www.bu.edu/cste/case-studies/18-year-old/ (Accessed March 2, 2011).
  6. Kirkwood MW, Randolph C, Yeates KO. Sport-Related Concussion: A Call for Evidence and Perspective Amidst the Alarms.  Clin J  Sport Med 2012;22(5):383-384.
  7. Bazarian JJ, Zhu T, Blyth B, Borrino A, Zhong J.  Subject-specific changes in brain white matter in diffusion tensor imaging after sports-related concussion.  Magnetic Resources Imaging 2012; 30(2): 171-180.
  8. March N, Bazarian JJ, Puvenna V, Janigro M, Ghosh C, et. al. Consequences of Repeated Blood-Brain Barrier Disruption in Football Players. PLoS ONE 2013;8(3): e56805. doi: 10.1371/journal.pone.0056805.
  9. McCrory P, et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Br J Sports Med 2013;47:250-258 (“cause and effect relationship has not yet been demonstrated between CTE and concussions or exposure to contact sports.”)
  10.  McKee A, et al. The spectrum of disease in chronic traumatic encephalopathy. Brain 2012; doi:10.1093/brain/aws307 (published online ahead of print December 2, 2012)(accessed March 20, 2013).
  11. D’Alessandro D, “Scientists claim that link between concussions and CTE is ‘unproven’ could impact NFL lawsuits.” NewJersey.com (March 17, 2013)http://www.nj.com/ledger-dalessandro/index.ssf/2013/03/scientists_claim_that_link_between_concussions_and_cte_is_unproven_could_impact_nfl_lawsuits.html (accessed March 20, 20tt-13).
  12. Guskiewicz KM, Marshall SW, Bailes J, et al. Association between recurrent concussion and late-life cognitive impairment in retired professional football players. Neurosurgery 2005;57:719-726.

Comment: Second Impact Syndrome (SIS) is also referred in the medical nomenclature as “diffuse cerebral swelling.” The condition is not well understood or studied, and is quite rare. As the position statement on concussions in sport issued by the American Medical Society for Sports Medicine and endorsed by the National Athletic Trainers’ Association and the American College of Sports Medicine states, “There is significant debate as to whether SIS is related to a prior head injury or if it represents a … malignant brain edema, a form of diffuse cerebral swelling described in children. … Whether or not a discrete entity of SIS exists, the association with concussion is a compelling reason why an athlete should not return to play before symptoms of his/her concussion have completely resolved.”

Original Sources:

  1. Kirkwood MW, Randolph C, Yeates KO. Sport-Related Concussion: A Call for Evidence and Perspective Amidst the Alarms.  Clin J  Sport Med 2012;22(5):383-384.
  2. Meehan WP, Kids, Sports, and Concussion (Praeger 2011), pp.54-6
  3. Saunders, RL, Harbaugh RE. The Second Impact in Catastrophic Contact-Sports Head Trauma. JAMA 1984:253(4):538-39.
  4. McCrory P, Berkovic S. Second Impact Syndrome. Neurology  1998:50(3):677-683.
  5. Harmon K, Drezner J, Gammons M, et. al.  American Medical Society for Sports Medicine position statement: concussion in sport.  Br J Sports Med 2013;47:15-26.
  6. Cantu R. Second-impact syndrome.  Clin Sports Med 1998;17:37-44.
  7. Cantu R, Gean A.  Second-impact syndrome and a small subdural hematoma: an uncommon catastrophic result of repetitive head injury with a characteristic imaging appearance.  J Neurotrauma 2010;27:1557-1564.
  8. McCrory P. Does second impact syndrome exist? Clin J Sports Med 2001;11:144-149.
  9. McCrory P, Davis G, Makdissi M. Second impact syndrome or cerebral swelling after sporting head injury.  Curr Sports Med Rep. 2012;11:21-23.

Articles:

Second Impact Syndrome: A Rare But Usually Fatal Condition

Second Impact Syndrome, Though Rare, Poses Catastrophic Risk To Concussed High School Athletes (video)

Suddenly And Silently: Second Impact Syndrome Is Killing Our Children

Second Impact Syndrome Risk Requires Caution in Return-to-Play Decision

 

—–“My son had made a tackle, grabbed a foot of the opponent, and one of his players came around accidentally and hit him helmet to helmet. And when he did, it knocked Noah back. We watched him, and when he got up he was very dazed, you know, you could tell that he was kind of walking sideways and going towards the opponent’s sideline.A trainer came over from the other side to check on one of our players who had hurt his shoulder, and he looked over to Noah, and said, ‘Coach. What’s wrong with this one?’  And he said, ‘Well, he got hit helmet-to-helmet.’  And I said, you know I’m going to get my car, and I’m just going to take him [to the hospital]. As I’m halfway there, parents start running towards me, saying,  ‘You’ve got to come quick! He’s completely collapsed.'” (Newcastle mother, Robin Gibson)(7:52)

Original Sources:

  1.  McCrory P, et al.  Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012.  Br J Sports Med 2013;47:250-258.
  2. Sports Concussion Assessment Tool 3. Br J Sports Med 2013;47:259.
  3. Child SCAT3. Br J Sports Med 2013;47:263
  4. Harmon K, Drezner J, Gammons M, et. al.  American Medical Society for Sports Medicine position statement: concussion in sport.  Br J Sports Med 2013;47:15-26 (a concussed player should not be left alone if the decision is made to keep him on site, and regular monitoring for deteriorating physical or mental status is essential).

Articles:
Concussion Signs Requiring Immediate Hospitalization

Concussions: Parents Are Critical Participants in Recognition, Treatment, and Recovery

As Seen On PBS. Watch Full Documentary (Above)                                    Watch Trailer (Below)
 
Show Buttons
Hide Buttons