Youth Sports Concussion: Clinical Pearls Blog

Gerard Kiernan, MD, FAAFP, FHMClinical Pearls, Family Medicine, Pediatric Medicine

sports related concussion clinical pearls blog cover

Concussion

Clinical Pearls of Wisdom Q&A Case

A concussion is a type of traumatic brain injury—or TBI—caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells..

Concussion is more common than you might think. Being struck by another person or object is the leading cause of unintentional injury for teens and young adults ages 15 to 24, according to Injury Facts, and sports-related concussions are a significant contributor.  An estimated 1.6 to 3.8 million athletes (both boys and girls) annually suffer concussion, according to the Brain Injury Research Institute.

Often, cases are underreported and undiagnosed. A study by the American Academy of Pediatrics shows the number of sports-related concussions is highest in high school athletes, but they are significant and on the rise in younger athletes.

The CDC created the HEADS UP program to help coaches protect their athletes from concussion related injuries, but clinicians will still see plenty of concussion cases.

Try this sports-related concussion board review question case and pick up another "pearl of wisdom" from Med-Challenger.

Concussion Case:

A 13-year-old girl presents with her parents after sustaining a concussion playing soccer the afternoon prior.  She was playing in a game and had a collision with another player, striking her head against the other player. She momentarily lost consciousness but did not have any seizure or focal neurologic deficit.  She was removed from play and evaluated on the sidelines by the athletic trainer and team physician.

On the sidelines, she had poor recall of the events prior to her injury and she had some global headache, light sensitivity, and difficulty concentrating. She stayed out of the remainder of the game and was recommended to have further evaluation the following day.

Now, she still has some symptoms of headache, concentration difficulty and she is sensitive to light and sound.

Her past medical history is unremarkable and she has no history of learning disability, migraines, depression, or anxiety.

On physical examination, she has no focal deficits. She mentions that her team has playoffs in four days, and that she is important to their possibility for success.

Question:

Which of the following is the most appropriate management approach for this athlete with a concussion?

Answer Options:

 Refer for CT head to rule out intracranial hemorrhage as a source of symptoms

Recommend a day or two of physical and cognitive rest, followed by introduction of activities that don’t worsen symptoms

Given the history of brief loss of consciousness, recommend five days of rest with low lights and low sound, with avoidance of any cognitive or physical exertion

Recommend not resuming physical activity until symptoms of headache and difficulty concentrating have completely resolved

See the Answer:


About the Author:

Gerard Kiernan, MD, FAAFP, FHM is a Dartmouth-Hitchcock Clinic hospitalist in Keene, NH. He attended the University of Rochester School of Medicine and Dentistry, followed by a Family Medicine residency at the University of Wisconsin, Madison, where he was a chief resident. Dr. Kiernan is a Lean Six Sigma Greenbelt and has led hospital medicine quality improvement efforts. He is a fellow of both the American Academy of Family Physicians and the Society of Hospital Medicine. He has achieved the Recognition of Focused Practice in Hospital Medicine offered through the AAFP and ABIM via their joint examination pathway.

About Clinical Pearl of the Month:

Med-Challenger's Clinical Pearl Blog Series is a recurring segment of Med-Challenger's popular Medical Education Blog. Med-Challenger provides online medical education products and services to physicians, nurses, and other medical specialists as well as medical training programs and healthcare groups world-wide via its web-based medical education library and world-class assessment platform at challengercme.com.

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