Most U.S. states have passed laws intended to
prevent high school athletes from having a concussion go
unrecognized and risking further danger by continuing to play, but
legislation may not be enough, the researchers say.
Concussion symptoms include memory problems, headache, irritability
or sleeping more than usual, according to the Centers for Disease
Control and Prevention (CDC), and playing with these symptoms can
lengthen recovery time.
"I think that currently the big problem is that kids hide their
symptoms," said Dr. Frederick P. Rivara , who led the study at
Harborview Injury Prevention and Research Center at the University
of Washington in Seattle.
"The laws and attention to concussion have made coaches much more
aware of the issues and I do believe that most coaches want to do
the right thing," Rivara told Reuters Health. Playing with symptoms
increases the risk of a more serious brain injury, he said.
His team's study included male high school football players and
female soccer players in Washington state during the 2012 season. At
the beginning of the season, team coaches filled out questionnaires
designed to assess their personal details and experience and their
level of education with regard to concussions.
Athletes also filled out baseline questionnaires about their history
of head injuries at the beginning of the season, and researchers
contacted them and their parents weekly throughout the season to
report the number of practices, games, head injuries and potential
Over one season, 11 percent of soccer players and 10 percent of
football players sustained a concussion, based on the symptoms they
According to the survey of 778 athletes, 69 percent of those with
concussions reported playing with symptoms and 40 percent reported
that their coach was not aware of their concussion.
"It's disappointing that so many young athletes with apparent
concussions choose not to report their symptoms to coaches or even
parents, but they are often highly motivated to avoid being removed
from play," Keith O. Yeates, a pediatric traumatic brain injury
researcher at Nationwide Children's Hospital in Columbus, Ohio,
"They may also downplay or not realize the risks associated with
concussions," said Yeates, who was not involved in the new study.
Each year, U.S. emergency rooms treat more than 100,000
sports-related concussions in kids age 19 and under, according to
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Rivara expected to see more concussions in football than in
soccer, and was surprised at how common concussions seemed to be
overall. But the previous studies that found more concussions in
football were largely based on athletic trainer reports, and not
athlete reports, he and his coauthors note.
Whether coaches had been educated in concussion symptoms and
management did not seem to affect how likely their concussed players
were to continue participating on the team, the authors report in
the American Journal of Sports Medicine.
Washington was the first state to pass comprehensive concussion
legislation aimed at high school athletes, the researchers write.
The state's Zackery Lystedt Law, enacted in 2009, mandates coach
education on concussions, and that parents sign an information sheet
about concussions before kids can participate in the sport.
In addition, the researchers note, the law requires "removal of
the athlete from practice or play at the time of a suspected
concussion, and written clearance by a licensed health care provider
trained in the evaluation and management of concussions before the
athlete can return to practice or play."
To get more concussed players off the field, "we should focus on
educating not only coaches but athletes and parents as well as to
the symptoms and dangers of concussion," Yeates said. "We also need
research to determine which educational strategies work, and better
tools for identifying concussions on the sidelines," he said.
"Educating coaches is important but it may not be enough," Rivara
"One thing that needs to be done is to address the culture of sport,
of winning at all costs, of 'manning up' and playing despite
symptoms," he said.
Journal of Sports Medicine, online Feb. 25, 2014.
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