Concussions in Youth Sports Erin Caffrey, PA-C, ATC Surf Pediatrics and Medicine

What is a concussion? A CONCUSSION IS A BRAIN INJURY! “Traumatic induced alteration of mental status that may or may not include the loss of consciousness” -American Medial Society Avoid referring to concussions as “getting your bell rung”, “ringer”, or a “ding” A CONCUSSION IS A BRAIN INJURY!

Why we should care about concussions Account for 1.4 million visits to the emergency room yearly Of those, 47% are kids 12-15 years old! Proper diagnosis is required to prevent more serious injury and/or long term effects Younger athletes are more susceptible to long term effects from concussions It is thought that the overall number of mTBI is close to 3.8 million to account for the numbers that go undiagnosed or are not seen in the ED More severe injury as a result of subsequent head impacts prior to the complete resolution of the initial injury; SIS Long term sequelae: cognitive deficits, learning disabilities, depression, possibly CTE More susceptible because brain is still developing

Ways to obtain a concussion Hit, bump, or blow to the head OR body that causes the brain and head to move back and forth quickly

Signs & Symptoms Physical Cognitive Emotional Sleep Headache Feeling “in a fog” Irritable Drowsiness Nausea/Vomiting Feeling slowed down Sadness Sleeping more than usual Balance problems Difficulty concentrating More emotional Sleeping less than usual Dizziness Difficulty remembering Nervousness Difficulty falling asleep Visual problems Confusion Fatigue Answers questions slowly Light sensitivity Repeats questions Sound sensitivity Numbness/tingling Dazed Stunned An “invisible injury.” Onset of progressive symptoms beginning within minutes to hours up to 36-48 hours post-injury. Bolded symptoms are more common

What to do when a concussion is suspected Tell a coach! No one should be allowed to return to activity on the day of injury if concussion is suspected Evaluation by Physician, Physician Assistant, Nurse Practitioner, or Certified Athletic Trainer before returning to activity

Red flag symptoms Take your child to the emergency room IMMEDIATELY if any of the following symptoms are present after head injury! Loss of consciousness Worsening headache in a short period of time Drastic personality/speech/balance changes in a short period of time Different pupil sizes (bigger, unreactive to light, or unequal sizes) Blood or fluid coming out of ears or nose Bruising underneath eyes or behind ears Repeated and worsening vomiting Seizures or convulsions

Treatment Typical recovery: MINIMUM of 7-10 days An athlete cannot return to sports until he or she does not have any symptoms! Physical Rest Cognitive Rest Avoiding all sports, PE class, or recess No screen time: cell phone, tablet, computer, or TV Scheduled rest breaks during school work Make sure to inform teachers of injury in case classroom accommodations need to be made

Returning to sports Must be completely symptom free for 24 hours Return to play guided by Physician, Physician Assistant, Nurse Practitioner, or Certified Athletic Trainer

Returning to play progression Stage Physical Activity 1 Light cardio activity 2 Medium paced cardio activity, body weight resistance exercises 3 Fast cardio activity, interval training, sport specific agilities 4 Non-contact practice drills 5 Full practice participation, controlled contact 6 Full participation in competition Light cardio: walking, jogging Non-contact practice: warm-up, sport specific drills without contact If symptoms return, stop activity for 24 hours and the pick back up with the previous stage completed prior to symptom onset MUST BE CLEARED BY PROVIDER TO PROGRESS TO STAGE 5 Overall, minimally recovery from symptoms takes 7-10 days and the RTP takes another 6-7 days on top of that so expect a child to be out of full competition for 2-2.5 weeks best case scenario *Each stage is separated by 24 hours. Athlete must be symptom free to progress to next stage

Questions? Check out the CDC “Heads Up” program for more references: http://www.cdc.gov/headsup/index.html Email me: ecaffrey.surfpeds@gmail.com