Criteria used to diagnose sports head injuries found to be inconsistent

In recent years it has become clear that athletes who experience repeated impacts to the head may be at risk of potentially serious neurological and psychiatric problems. But a study of sports programs at three major universities, published in the October 2 Journal of Neurosurgery, finds that the way the injury commonly called concussion is usually diagnosed – largely based on athletes' subjective symptoms – varies greatly and may not be the best way to determine who is at risk for future problems. In addition, the way the term concussion is used in sports injuries may differ from how it is used in other medical contexts, potentially hindering communication about the factors most relevant to patient outcomes.

"The term '' means different things to different people, and it's not yet clear that the signs and symptoms we now use to make a diagnosis will ultimately prove to be the most important pieces of this complicated puzzle," says Ann-Christine Duhaime, MD, director of the Pediatric Lab at Massachusetts General Hospital (MGH), who led the study. "Some patients who receive a diagnosis of concussion go on to have very few problems, and some who are not diagnosed because they have no immediate symptoms may have sustained a lot of force to the with potentially serious consequences."

The current study is part of a larger investigation into the biomechanical basis of concussion and the effects of repeat impacts to the head, conducted over five years at Brown University, Dartmouth College and Virginia Tech. A total of 450 students – members of all three schools' football teams, two women's and two men's ice hockey teams – wore helmets equipped with instruments that measured the frequency, magnitude and location of head impacts experienced during practice sessions, scrimmages and games. Team trainers and physicians followed their standard procedures for assessing and diagnosing potential concussions and prescribing treatment.

During the study period more than 486,000 head impacts were recorded in participating athletes. Concussions were diagnosed in 44 participants, four of whom were diagnosed a second time for a total of 48 diagnosed concussions. A specific impact could be associated with the concussion 31 times, but no clearly associated impact was identified in the other 17 instances. The most commonly reported symptoms were mental cloudiness, headache and dizziness, and only one athlete lost consciousness. An immediate diagnosis was made only six times, and many of the athletes did not begin experiencing symptoms until several hours after the game. Although measured head impacts in those diagnosed with concussions tended to be higher, some concussion-associated impacts had considerably less measured acceleration/deceleration of the head. The authors note that the injuries reported in this study contrast with those usually seen in patients diagnosed with concussion in emergency departments, in whom a single, clearly identified head impact is typically associated with immediate changes in consciousness.

The authors add that developing strategies to prevent and manage short- and long-term consequences of head injuries requires accurate tools to determine which patients have sustained impacts that may affect the brain in significant ways, and that currently used criteria based on reported symptoms may be unreliable predictors of actual injury to the brain. They propose that replacing the single term 'concussion' with the concept of a concussion spectrum may be useful in determining the range of factors that can influence .

"A lot of work is needed before we can understand to what extent patients' reported symptoms – compared to such factors as the actual force imparted to the brain, previous head injuries and genetic background – influence the eventual consequences of repeated head impacts, consequences that may vary from patient to patient," says Duhaime, who is director of Pediatric Neurosurgery at MassGeneral Hospital for Children, director of Neurosurgical Trauma and Intensive Care in the MGH Department of Neurosurgery, and the Nicholas T. Zervas Professor of Neurosurgery at Harvard Medical School. "For now, however, it's sensible to err on the side of safety, realizing that more specific answers will take more time and research."

add to favorites email to friend print save as pdf

Related Stories

Concussions can happen in all kids, not just athletes

Sep 06, 2012

(Medical Xpress)—The gridiron is back in action. From little leagues to professional teams, football frenzy has begun, and with it, concerns about concussions. But it's not just jarring tackles that can lead to concussions ...

Concussions not taken seriously enough, researcher says

Jan 18, 2010

Despite growing public interest in concussions because of serious hockey injuries or skiing deaths, a researcher from McMaster University has found that we may not be taking the common head injury seriously enough.

Second concussion can be serious for young athletes

Sep 22, 2009

(PhysOrg.com) -- Sustaining a second concussion shortly after a first one can lead to serious problems for young athletes, making it extremely important for players to be correctly diagnosed after being hit in the head.

Recommended for you

Virtual motion, real consequences

9 hours ago

Ludwig Maximilian University of Munich researchers have shown that virtual optical stimuli can lead to aftereffects that significantly alter our perception of self-motion. This finding has implications for ...

User comments

Adjust slider to filter visible comments by rank

Display comments: newest first

Parsec
not rated yet Oct 11, 2012
Making an spectator sport of people bashing their brains out on a field is as barbaric as the Roman times events where people fought to the death.

The solution to the problem is adequate head protection, or if that can't happen because of the nature of the sport, outlawing of the sport.

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.