The number of children going to the emergency room for concussions they suffered while playing competitive sports has more than doubled in recent years, which some say may be due in part to a growing awareness of the brain injury.
A study published Monday in the journal Pediatrics found that, although most of the increase in hospital visits came from high school athletes, 40 percent of sports-related pediatric concussion patients seen in the ERs were between the ages of 8 and 13. The study was conducted by four physicians affiliated with the Brown University Medical School.
The findings prompted the American Academy of Pediatrics to issue an updated clinical report about concussion care in children and adolescents. A concussion is caused by a blow to the head or upper body that causes the brain to shake inside the skull. Symptoms may include disorientation, confusion, dizziness, amnesia and uncoordinated hand-eye movements.
The report emphasized that the brains of children are more susceptible to injury, and that concussions in children tend to be more damaging and take longer to heal than do concussions in teenagers or adults. In addition to rest, treatment calls for a break from sports until symptoms are gone.
According to the study, 502,000 children in the U.S. made visits to the emergency room for treatment for concussion from 2001 to 2005. Half were related to sports.
Although participation in organized team sports declined between 1997 and 2007, the number of emergency room visits for concussions by 8- to 13-year-olds doubled, the study said.
Moira Davenport of Allegheny General Hospital, who is board certified in emergency medicine and sports medicine, said there are two reasons to doubt the surge in sports-related concussions has been as great as these data make it appear.
The first is that because people are more aware of the symptoms of concussions and the harm they can cause, concussions are more likely to be reported today than they were in years past, Dr. Davenport said.
"The number of visits is increasing, but part of that is because of greater awareness," she said. "There is definitely a trickle-down effect."
The second is that the definition of a concussion is broadening.
"It used to be that you had to have a loss of consciousness to be considered a concussion," Dr. Davenport said. "Now it is any time you sustain a direct blow to the head, or an indirect transmission of force to the head."
Jerry McFarland, the head athletic trainer for the Moon Area School District, said the district had an increase in concussions among student athletes in the past few years. But, he added, "that might come from better recognition."
"I'm not sure whether we're seeing more injuries or that people are more aware, so that they're being reported more," said Bob Bozzuto, athletic director for the North Allegheny School District.
Awareness and diagnosis of sports-related concussions is a high priority in Western Pennsylvania. University of Pittsburgh Medical Center and Allegheny General Hospital are two of nation's leaders in sports medicine, and it was here that the ImPACT test was developed.
ImPACT -- Immediate Post-concussion Assessment and Cognitive Testing -- is a 20- to 25-minute video game played on a computer that tests cognitive skills such as memory and reaction time. If an athlete has taken a baseline test, a post-concussion ImPACT test can determine the extent of impairment or recovery.
ImPACT was born when former Steelers head coach Chuck Noll asked Joseph Maroon, the team neurosurgeon, to devise an objective measure for determining whether he should hold players out of a game. The concept was refined by two neuropsychologists, Mark Lovell and Michael "Micky" Collins, the director and assistant director, respectively, of UPMC's pioneering Sports Medicine Concussion Program.
The ImPACT test is now used by all professional football and hockey teams, most college and many high school athletic teams.
The Moon Area School District sponsored a "concussion awareness night" Aug. 12.
"We had some concussions last year, and we thought it would be a good idea to inform the parents and the kids about concussions, to make them aware of the symptoms, to make them aware that if they are suffering symptoms or see another player suffering symptoms, to speak up," Mr. McFarland said. "A lot of times, kids will try to hide symptoms. They don't want to let their team down."
Concussions are most frequent in contact sports such as football and hockey. Girls are more likely than boys to suffer concussions playing soccer or basketball.
Bicycling accidents were the principal cause of concussions in individual recreation sports, accounting for 17.8 percent of emergency room visits by 8- to 13-year-olds and 7.3 percent of visits by 14- to 19-year-olds, the study said.
For younger children, playground accidents were the second-largest cause of concussions in this category. For older children, it was snow-skiing accidents.
Jack Kelly: firstname.lastname@example.org or 412-263-1476.