Tackling Concussions

This week's guest columnists are Drs. Keyana Varnado and Taylor Phillippi, Family Practice residents at the Ochsner University Hospital & Clinics.

“Ow, my ankle!” I yelled across the basketball court, exaggerating a limp. I'd fallen and hit my head. Though I wasn't knocked out, I felt dizzy and knew I'd be pulled from the game for concussion precautions. So, I attempted to distract my high school athletic trainer by faking an ankle sprain. Fortunately for my future brain function, the trainer wasn't fooled, and I was taken out.

Many athletes avoid being diagnosed with a concussion to stay in games or seasons. They want to continue scoring, winning championships and awards, and earning scholarships. Over 10% of high school and college athletes get concussions per year, but about 60% of teams don't have trainers. Vigilance is left instead to parents and coaches who often have the same conflict of interest as the kids; they also want them to win and earn scholarships.

Concussions are dangerous. Just one is bad enough to cause days of headaches, foggy thinking, fatigue and nausea. If kids don't rest, their brains take longer to heal. If kids hit their heads again while concussed, there's a chance the added blow could cause brain swelling, permanent injury, and even death. Though kids, parents, and coaches want to win, no one wants these student athletes to have life-long disabilities, and we really don’t want to attend their funerals.

Tackling concussions takes a team with everyone advocating for young athletes as they play the sports they love. The Centers for Disease Control (CDC) HEADS UP program is a great online resource for coaches and parents. There they can learn more about what concussions look like and how to help kids heal. It's not a substitute for seeing a doctor when there's an injury, but it can provide guidance on how to face fears, save seasons, and protect kids.

We’re sports nuts, particularly concerning our beloved New Orleans Saints. We’ve followed their loser records as kids, through the glorious Brees-Payton era and now still caring about this season's O-line. But that love is now tempered by guilt over head injury risks. The world's strongest men intentionally collide at full speed in what humorist Dave Barry calls the National Football Concussion League. 

To the NFL’s credit, they're enforcing rules that minimize head impacts and removing players with concussions for adequate healing time. Youth coaches should take similar precautions as outlined in their league rules. The American Academy of Pediatrics has helpful tips for parents on spotting concussions. This goes for other high-concussion-risk sports like soccer, basketball, softball and baseball, and cheerleading. Cheerleading?  Yes, cheering too. The risk for injury is high with kids falling off pyramids and being tossed like frisbees. And they haven’t yet invented an attractive cheering helmet.

When athletes get head injuries, staff should use the Concussion Recognition Tool 5 (CRT5). This is a checklist to help coaches and trainers identify players with concussion risk and remove them from play. Such kids also need medical evaluation. The first thing the CRT5 enumerates is “red flags,” the things that say, “call an ambulance.” Things like being knocked out, having a severe headache or experiencing neck pain. Next is assessment for “signs” of concussion, those things you see: players lying motionless, being slow to get up, staring blankly.

Next is assessing “symptoms,” which is what players can tell you they’re experiencing, like if they have headaches, feel dizzy or are nauseated. The last step is assessing “memory” by questioning players about memory loss. Any athlete with a suspected concussion needs to be taken out until seen by a professional and approved to return.