Concussion Recommendations in Children and Adolescents in Sports Related Injuries

In recent years, concussions have made their way into the media more and more. Something that we once thought was a simple injury that could be shaken off is now being thought of as a serious injury.  There are specialists who dedicate their practice to concussions.  This type of injury is commonly associated with sports.  Concussions are a common injury that occurs in sports especially football.  It has been somewhat of a controversy this past decade because the NFL has made changes in their roles and regulations to protect the players from concussion injuries.  Children and adolescents are also affected from these injuries.  This article looked at how providers are supposed to handle young patients that have sustained a head injury.

Within 1 to 2 days of the injury, the patient should be presented to a physical to have symptoms checked.  The patient should not be left unattended within 48 hours of the injury.  Rest for the first 1 to 2 days is critical to the patient’s recovery.  It is not, however, recommended for the patient to have prolonged bed rest.  The notion that patients should rest until there are no longer any symptoms is not the preferred method of treatment anymore.  Patients should return to school and normal activity within a couple weeks to avoid depression and other negative symptoms.  Accommodations can be made but can usually be discontinued within 2 weeks.

A system was developed called SAFE (Symptoms, Assessment, Follow-up, Execute, and return to pay) to help providers decide what actions need to be taken with the patient.  This system was made into a flow chart so that a provider can follow the protocol for each patient.  This system can help determine when a patient should be referred to a specialist and what kind of tests need to be performed.  It also helps figure out back to school and return to play times.  There have been laws passed in all 50 states to help outline when a patient is ok to come to back and play for their sport.  This article shows how important it is to have a standard method of treatment for patients with concussions.  Each patient may be different, but this method could help make sure that the provider is doing their best to follows the protocol treatment for each patient.

ORTHOPEDICS. 2016; 39: 24-30

http://ORTHOPEDICS. 2016; 39: 24-30

Association between physical activity and the duration of concussion symptoms

Concussions have been a big debate in the world of sports medicine. This month Howell and colleagues published a cohort study, which is a longitudinal observational study, that looked at the association between physical activity and symptom durations of a concussion. The study began with 364 patients that were seen by a doctor within three weeks of being diagnosed with a concussion. Each patient completed a questionnaire that ask questions regarding a post concussion symptom scale, prior concussions, loss of consciousness or amnesia, and prior treatment received for headaches. At later follow-up appointments each patient self-reported their own levels of physical activity. The data was complied and a model was created to determine the association between initial responses, reported physical activity, and symptom duration. They found that the participants aged 13 to 18 had shorter symptom duration with an increase in physical activity. These findings indicate that physical activity may not be detrimental to the recovery of concussion symptoms as previously thought in the medical world.

This is really interesting to me, because having been an athlete, it was always immediate protocol to halt physical activity after any signs or symptoms of a concussion. Seeing that stopping physical activity may not be completely necessary in younger individuals is against all that has been associated with concussion treatment and it is really surprising. There has been a lot of research on concussion prevention and treatment lately because of the seriousness of the injury. Seeing that some progression is being made is promising and even opens up the door to see if pharmacists can one day make an impact on concussion treatment.

Am J Sports Med. http://ajs.sagepub.com/content/early/2016/02/02/0363546515625045.abstract (published online 2 February 2016)