Concussion: Definition, Demographics, Signs & Symptoms Andrew Gregory, MD, FAAP, FACSM Associate...

Vanderbilt Sports Concussion Center

Concussion: Definition, Demographics, Signs &

Symptoms

Andrew Gregory, MD, FAAP, FACSMAssociate Professor Orthopedics &

PediatricsTeam Physician, Vanderbilt & Belmont

Universities


Objectives• Definition of concussion• Discuss common signs & symptoms• Review demographics

– Who, what, when and how


Is this a concussion?• 11 yo was swinging on a tree limb, fell 5-6’ and

hit the back of his head on the ground• Loses consciousness for one min according to

other kids• Then has headaches and blurry vision• Vomits twice


Is this a concussion?• Seen at the Emergency Room - “normal

exam”, CT Scan negative• Goes back to school with headaches needing

Ibuprofen• Headaches get worse with physical activity

(including practicing with his travel baseball team)


Self Reported Symptoms• Headache – 3/6• Trouble Sleeping – 3/6• Drowsiness – 2/6• Sensitivity to light – 2/6• Feeling like “in a fog” – 1/6• Difficulty concentrating – 1/6• All others - 0/6


Did this child have a concussion?


What is a Concussion?• Lots of terms

– Ding, bell rung, shaking off the cobwebs, closed head injury, mild traumatic brain injury (mTBI)

• “A trauma induced alteration in mental status that may or may not involve loss of consciousness”—AAN 1997

• Headache plus…• Transient Neurological

Phenomenon


Definition of Concussion

1. Caused either by a direct blow to the head, face, neck or elsewhere on the body with a resultant force transmitted to the brain.

2. Typically results in the rapid onset of short-lived changes in neurological function that resolves spontaneously.

3. May result in structural brain changes, but the symptoms largely reflect a functional disturbance rather than a structural injury.

4. Usually follows a progressive course of improvement

5. Imaging studies (brain CT/MRI) are usually normal.


Signs and Symptoms of Concussion

Signs• Appears dazed or stunned• Confused about assignment• Forgets plays• Is unsure of game, score, or

opponent• Moves clumsily• Answers questions slowly• Loses consciousness• Shows behavior or personality

change• Forgets events prior to play

(retrograde)• Forgets events after hit

(posttraumatic)

Symptoms • Headache • Nausea • Balance problems or dizziness • Double vision • Sensitivity to light or noise • Feeling sluggish • Feeling “foggy” • Concentration or memory

problems • Change in sleep pattern (appears

later) • Feeling fatigued


Common symptoms of concussion from a series of injured high school athletes

• Three most common symptoms:1. Headaches (55%)2. Dizziness (42%)3. Blurred vision (16%)

• 46% experienced either cognitive or memory problems

• 9% had loss of consciousness (“knocked out”)


Do you have to be “knocked out” to have a concussion?

• NO!!!!!• In fact, only a SMALL number of concussed athletes were

“knocked out”• Many studies have now shown that amnesia (inability to

remember) is a much more common sign of concussion and ALWAYS indicates that a brain injury has occurred


What are the “Grades” of a concussion?

• In the past concussions were often classified into grade 1, 2, or 3 based on the severity and duration of symptoms at the time of injury

• Many research studies have showed that these grading scales were useless in predicting the severity of injury or how long to recover

• Grading scales are no longer used


If you have a history of a previous concussion are you more likely to have a

longer duration of symptoms?

• Available research says “yes”


Does having a concussion increase your chances for a future concussion?

• Some research says “yes”

• 92% of the in-season repeat concussions occurred within 7-10 days of first


Epidemiology of Concussion

• 1.5-3.8 million reported cases of brain injury per year in the US

(CDC)

• 20% (300,000-760,000) are sports-related

• 53,000 deaths each year• 70-90,000 permanently disabled

• Highest sports incidence: ages 15-24

• Cost estimated at > $60 billion annually


HS RIO™ Injury Surveillance System

• Internet-based high school sports-related injury surveillance system

• Weekly data capture 2005 - 2010 academic years • Representative sample of 100 US high schools

– Geography (4 US census regions)– Size (≤1,000 vs >1,000 students)

• 20 sports– Boys’ - football, soccer, basketball, wrestling, baseball, lacrosse, ice

hockey, swimming & diving, track & field, volleyball– Girls’ - volleyball, soccer, basketball, softball, lacrosse, field hockey,

gymnastics , swimming & diving, track & field, cheerleading

16


Rates per 1,000 Athletic Exposures

Sport

# ofConcussion

s

NationalEstimate

s Practice Competition Overall

Football 1392 357,114 1.3 11.4 2.9

B Soccer 182 89,237 0.3 3.0 1.1

G Soccer 243 132,062 0.3 4.6 1.6

G Vball 54 17,326 0.2 0.6 0.3

B Bball 111 27,404 0.2 1.3 0.6

G Bball 184 47,439 0.4 2.7 1.1

Wrestling 152 33,979 0.6 1.9 1.0

Baseball 32 9,569 0.1 0.4 0.2

Softball 66 23,692 0.4 0.8 0.5

Concussion Rates, 2005- 2010

17

Includes concussions resulting in <1 day time loss (non timeloss = 2% of all concussions)


Concussion Severity 2005-2010

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Football

B Soccer

G Soccer

G Volleyball

B Basketball

G Basketball

Wrestling

Baseball

Softball

Sport

1-2 days 3-6 days 7-9 days 10-21 days 22 Days +Time lost (days)

18Time lost means days missed from sport due to concussion


Concussion Mechanisms 2005-2010

19Includes only time loss concussions


Activity Associated with Concussions,

Soccer 2005-2010 Activity Boys’ soccer Girls’ soccer

Heading ball 36% 30%

Goaltending 17% 13%

General play 10% 11%

Defending 9% 17%

Chasing loose ball 11% 15%

Ball handling/dribbling

6% 5%

Receiving pass 6% 3%

20Includes only time loss concussions


Activity Associations Basketball 2005 - 2010

21

Activity Boys’ basketball Girls’ Basketball

Rebounding 30% 21%

Chasing loose ball 17% 17%

Defending 20% 27%

General play 14% 7%

Shooting 10% 6%

Ball handling/dribbling

6% 10%

Receiving pass 1% 7%

Includes only time loss concussions


Activity Associations Baseball/Softball 2005 -2010Activity Baseball Softball

Batting 37% 8%

Running bases

22% 4%

Fielding 15% 25%

Pitching 6% 5%

Catching 6% 33%

Sliding 12% 5%

22* Includes only time loss concussions


Football Concussions 2010

23

Concussions resulting from player-to-player contact

Type of contact: head to head (66%), head to other body site (26%), head to playing surface (8%)

Position of head during contact: head-up (38%), head-down (25%), no flexion (4%), unknown (33%)

Direction of impact: front (45%), side (22%), top (8%), back (5%), unknown (20%)

Did athlete see impact coming: yes (37%), no (27%), unknown (37%)


Girls’ Soccer Concussions 2010

24

Concussions resulting from player-to-player contact Type of contact: head to head (48%), head to

other body site (45%), head to playing surface (7%)

Position of head during contact: head-up (21%), head-down (26%), no flexion (7%), unknown (46%)

Direction of impact: front (24%), side (43%), top (3%), back (14%), unknown (16%)

Did athlete see impact coming: yes (55%), no (25%), unknown (20%)


Summary• Concussion is a temporary disruption of ANY function of the

brain caused by trauma• All coaches and parents should become familiar with common

signs and symptoms of concussion and be alert for them• No return to play if concussion is suspected• Grading scales are no longer used• ANY athlete in ANY sport at ANY age is at risk for concussion

Concussion: Definition, Demographics, Signs & Symptoms Andrew Gregory, MD, FAAP, FACSM Associate...

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