IOM wants more research on sports concussions in kids

An Institute of Medicine (IOM) panel says that despite public concern about concussions in young people, we really know precious little about them, including how often they occur and their short- and long-term effects.

Among other things, it is unclear whether repetitive head impacts and multiple concussions can result in neurodegenerative diseases such as Alzheimer disease and the “emerging diagnostic entity” of chronic traumatic encephalopathy (CTE), says the 17-member panel of experts in neuroscience, head trauma in pediatric populations, sports medicine, and bioengineering.

The yearlong project included an extensive literature search and 2 public workshops.

There is a lack of data on concussion incidence across a variety of sports. However, 1 estimate of 1.6 million to 3.8 million annual US sports- and recreation-related traumatic brain injuries including concussions is probably conservative, as noted in the study itself, because many concussions go unreported. Yet the numbers indicate a significant public health problem, says the report.

There are also little data on concussions, as opposed to the more severe head injury of CTE, in children aged 5 to 12 years; there are few published studies on interventions including protective devices to lower concussion risk; and there are few data on “the psychometric properties of sideline screening tools.”

The lack of evidence extends to the questions of treating concussions. The panel notes evidence that “the brain is more susceptible to injury while recovering,” indicating it is best to lower the risk of repeat injury.

The committee provides some other hints on what should be done now, even with the limitations of knowledge. It warns that in the current culture there is a lack of appreciation of the risk of concussions, with young people being encouraged by coaches or their fellows to “play through it.”

Use of properly fitting helmets should be promoted, say these experts, because there is evidence they reduce injuries including skull fractures, although there is limited science on whether they help prevent sports-related concussions. The same is true of mouthguards or facial protection, despite marketing statements that head or other gear reduce concussion risk.

Some studies on young people playing ice hockey and soccer show that rule enforcement and fair play policies can help reduce concussions, the report notes. Also, the concept of limiting the number of head contacts for any one player over a specific time is “fundamentally sound” but also without scientific evidence.

In its discussion of treatment and management of prolonged concussion symptoms and postconcussion syndrome, the report says there is limited research on interventions and when to begin them. Although there is some evidence that noncontact aerobic exercise may help with persistent symptoms, the research is limited on that tactic as well.

To remedy the dearth of evidence, the panel calls for numerous research activities by public agencies and private organizations. For example, it recommends that the Centers for Disease Control and Prevention establish a national surveillance system on the incidence of sports-related concussions, including those in children and young adults aged 5 to 21 years.

It also recommends that the National Institutes of Health and the Department of Defense undertake or fund various research projects, including “controlled, longitudinal, large-scale studies to assess short- and long-term cognitive, emotional, behavioral, neurobiological, and neuropathological consequences of concussions and repetitive head impacts over the life span.”

The 286-page report, Sports-Related Concussions in Youth: Improving the Science, Changing the Culture, is available for free download at www.nap.edu.

MS FOXHALL is a freelance writer in the Washington, DC, area. She has nothing to disclose in regard to affiliations with or financial interests in any organizations that may have an interest in any part of this article.