Experts find concussion is `hidden injury'

New research shows epidemic occurs more than once thought

May 20, 2007|By Ken Murray | Ken Murray,SUN REPORTER

Characterized by the medical community as a "hidden epidemic," concussions - mild traumatic brain injuries, as they are formally known - are sometimes hard to diagnose in professional and college athletes. But they are even more difficult to detect at the high school level.

"It's a hidden injury," said Dr. Kevin Guskiewicz, a certified athletic trainer who does concussion research at the University of North Carolina. "We are calling it a hidden epidemic. It's not like a knee sprain, where you can see swelling, bleeding or deformation of a joint.

"It's hidden because it's in the cranial cavity. You don't know how the brain is responding to this insult."

The epidemic has grown as scientific research reveals more about this shadowy injury. The Centers for Disease Control and Prevention estimate there are between 1.4 million and 3.8 million concussions in this country every year for all ages.

That's up significantly from the CDC's 2005 estimate of 300,000, which was based on loss of consciousness. But getting knocked out is no longer the best indicator for diagnosing a concussion. Loss of memory, the experts say, is a better predictor.

In fact, recognition and treatment of concussions have changed significantly over the past decade. New discoveries have made old practices outdated, if not dangerous.

"In our primary medical community, there is pretty significant need in getting updated," said Dr. Gerard A. Gioia, director of the Pediatric Neuropsychology Program at Children's National Medical Center in Washington.

"The information out in the last five to eight years has revolutionized how we understand these injuries, from elementary-aged kids, or even 4-year-olds, on up through high school. When someone gets injured and goes to a pediatrician or the emergency room, the information they get is wildly variable and the symptoms may not be recognized as a concussion."

With funding from CDC, Gioia has run a five-year research study that involves baseline neurological testing for more than 1,000 kids, ages 5 through 18, from Maryland, the District of Columbia, Pennsylvania, Vermont and New Hampshire.

The National Federation of State High School Associations made concussions a point of emphasis in all rulebooks for the school year. Available to all 18,500 national high schools this year was a tool kit produced by the CDC, including basic concussion information and a DVD.

Bob Colgate, the assistant director of the NFHS and liaison on its sports medicine advisory committee, said the organization is attempting to establish a national injury surveillance system at the high school level, similar to one used by the NCAA.

"Are there a lot of concussions going unreported? Sure there is," Colgate said. "Why? It goes back to [the fact] we don't have a certified athletic trainer in every school, at every game and practice. It's fallen into the hands of the coach, and it's not their expertise. We try to get them as much information as we can, train them the best we can."

But it's not just coaches and emergency medical technicians who must be informed on the most recent studies into concussions. General practitioners and emergency room personnel need the updates as well.

"We do a much better job rehabbing knees and shoulders and ankles," said Diane Triplett, executive director of the Brain Injury Association of Maryland. "We go out and find the best orthopedics. But we don't come close to that when we hurt our brain."

The accepted guideline is that once an athlete has suffered a concussion, he or she should remain out of action for at least seven days. In most sports, a player who has had a concussion must have a doctor's release to return to play. But even that is not foolproof.

"In most cases it takes seven to 10 days [to heal]. But it could be three weeks or longer," Guskiewicz said.

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