Sports Practice Sessions an Opportunity to Prevent Concussion?

Meg Barbor

October 15, 2015

NEW ORLEANS — Concussion rates are highest in college athletes during competition. However, concussion rates are also high during practice sessions, a finding that may offer an opportunity to intervene and reduce concussion rates among young athletes, new research suggests.

"In the year 1905 alone, there were 18 deaths from college football — mostly coming in the form of severe brain injuries," said Scott L. Zuckerman, MD, Department of Neurological Surgery at Vanderbilt University Medical Center in Nashville, Tennessee. "Due to the game's mortality, a lot of people were calling for college football to be outlawed."

So, President Theodore Roosevelt called a summit to establish rules to improve the game's safety, leading to what is now known as the National Collegiate Athletic Association (NCAA). "The NCAA was really created over the issue of severe head injuries," he said.

According to Dr Zuckerman, there is a paucity of data on the epidemiology of concussions in collegiate student athletes. Using data from the NCAA Injury Surveillance Program, Dr Zuckerman and colleagues set out to describe the epidemiology of collegiate sports-related concussions (SRCs) during the 2009-2010 to 2013-2014 academic years.

The results of the analysis were presented here at the Congress of Neurological Surgeons (CNS) 2015 Annual Meeting.

Higher Rates of Concussion in Women

For the study investigators assessed incidence rates, injury mechanisms, symptoms, and length of participation restriction among NCAA athletes with SRCs from a sample of 150 schools across all divisions.

All injuries were reported by certified athletic trainers with detailed event reports. The definition of concussion used across all schools was the Concussion in Sport Group 2012 definition: "a complex pathophysiological process affecting the brain, induced by biomechanical trauma."

During the 2009-2010 to 2013-2014 academic years, a total of 1670 concussions were reported, for an injury rate of 5.56/10,000 adverse events (AEs) (practice rate, 3.26/10,000 AEs; competition rate, 14.59/10,000 AEs). Overall, more SRCs occurred in competitions (53.2%), although in all but four sports, more SRCs occurred in practices.

"What we see is that concussion rates are much higher in games than in practice," he stated. "This is fairly obvious in football (30 concussions in the game compared to 4 in practice), but if we shift over to total counts, we see that in a lot of sports the majority of concussions are occurring in practice, which leads us to say that practice is really an important area of possible intervention."

In 6 of the 10 sports with highest participation, over half of the reported concussions occurred in practice.

"Secondly, we see that the sports with the highest participation may not be the most dangerous," he added. The most popular sport is football, followed by soccer and basketball, with lacrosse, wrestling, and hockey maintaining the least participation within the NCAA.

"But if we see which sports had the highest concussion rates, it's really a flipping of the two — sports that may not get the most attention, or have the highest participation, such as wrestling and hockey, actually had the highest rate of concussion," he said.

The largest concussion rates were in men's wrestling (10.92/10,000 AEs), men's ice hockey (7.91/10,000 AEs), women's ice hockey 23 (7.50/10,000 AEs), and men's football (6.71/10,000 AEs).

Most concussions were due to player contact (68.0%), followed by surface contact (12.6%) and ball contact (9.4%). Women, in general, had higher concussion rates than men.

Recurrent Injury a Significant Problem

Of all the SRCs, 9.0% were recurrent. Investigators found that 20.1% of concussions sustained in men's ice hockey were repeat or recurrent concussions, followed by those in women's field hockey (13.3%) and men's basketball (13.1%).

"If we're looking at the injury profile of these athletes, it's really a different injury when it's the second, third, or fourth concussion sustained by a player," said Dr Zuckerman.

"These athletes have more symptoms, more disabling symptoms (balance problems, drowsiness, visual disturbance and insomnia), longer symptom resolution time and longer return to play." All of these parameters were statistically significant among athletes with concurrent concussion.

In addition, investigators observed an interesting trend in return-to-play. In 2009, 43% of athletes with concussion sat out from their sport for a week or more. Five years later, that number went up to 70%. "So athletes are taking more time to return to sport, which could signify a more significant injury or could be a result of the legislation being more careful about how we return these athletes to play," he stated.

Four sports had a statistically significant linear trend in increasing amount of concussions: football, women's ice hockey, men's lacrosse, and men's basketball.

"This could be due to many reasons, including a more dangerous style of play, increased sensitivity so our threshold for concussion is lower than what it has been in years past, or just general increased participation — more people are playing sports now than they were 5 years ago," added Dr Zuckerman.

"One of the most important themes from our results is really the importance of practice," he said. "Practice represents a controlled environment where coaches and teams can make changes to improve the safety of the games."

"Also, recurrence is a significant problem," he added. "It represents a different injury with a more severe injury profile."

The investigators conclude that injury surveillance data can inform targeted interventions for concussion outcomes.

Timely Research

"This is timely research about a subject that's very important to the public and probably applies to athletes pre-college, in high school, and even down to younger athletes," said Gregory Murad, MD, assistant professor and associate residency program director in the Department of Neurosurgery at the University of Florida College of Medicine in Gainesville.

"We should continue to monitor this field in order to get a better idea of injury data," he told Medscape Medical News. "There are already limits on how much time NCAA athletes can practice, but there are no limits applying to kids before college; is that something that someday we'll have to talk about?"

This abstract won the Depuy Synthes Award for Resident Research on Brain and Craniofacial Injury at the Congress of Neurological Surgeons 2015 Annual Meeting. Dr Zuckerman and Dr Murad have disclosed no relevant financial relationships.

Congress of Neurological Surgeons (CNS) 2015 Annual Meeting. Abstract 174. September 29, 2015.

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