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Concussion as a Public Health Concern

Cydne Marckmann, ARNP

The Centers for Disease Control defines a concussion: "a type of Traumatic Brain Injury (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." A concussion is most commonly a combination of impact with

acceleration/deceleration force (Centers for Disease Control and Prevention, 2015). The Glascow

Coma Scale, a neurologic scale assessing eye opening with verbal and motor response as either

mild, moderate, or severe determines the severity of the TBI. It is important to note that not all

bumps to the head will cause a TBI nor does classification of a severe TBI reflect mortality

(Centers for Disease Control and Prevention: National Center for Injury Prevention and Control,

2014). Effects of TBI can include impaired cognition or memory, coordination or movement

difficulties, visual or hearing changes, and emotional functioning such as personality or mood

changes. These effects can last days or for months and can have devastating consequences to

include student learning, family dynamics, and family economics (Centers for Disease Control

and Prevention, 2015).

The CDC has determined traumatic brain injury a significant health concern, causing an

estimated 30% of all injury-related deaths (Centers for Disease Control and Prevention , 2015).

In fact, according to the CDC in 2010, about 2.5 million emergency department (ED) visits,

hospitalizations, or deaths were associated with TBI (Centers for Disease Control and

Prevention , 2015). Although sport-related concussions are popular in the media, the CDC report

falls are the most common cause of concussion, responsible for an alarming 40% of the total

number. The CDC further reports in those over age 65 falls are the cause of an astonishing 81%

of concussions and 55% in those diagnosed under age 14 (Centers for Disease Control and

Prevention, 2015). The CDC reports blunt force trauma as the second leading cause of injury,

responsible for a total of 15% of all reported cases and 24% in those under age 14 (Centers for

Disease Control and Prevention, 2015). The CDC reports motor vehicle accidents as the third

major cause of concussion among all age groups, responsible for 14% of reported concussions

   

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(Centers for Disease Control and Prevention, 2015). The CDC reports individuals at highest risk

for concussion are those under age 4, aged 15-19, and over 65 (Faul M, 2010).

In sports concussion, the National Electronic Injury Surveillance System-All Injury Program

(NEISS-AIP), which is co-sponsored with the Centers for Disease Control and Prevention

(CDC), the National Center for Injury Prevention and Control (NCIPC), and the Consumer

Product Safety Commission, has been tracking data on non-fatal emergency department

admissions since 2000. The data collected from 2001-2012 demonstrates a statistically

significant increase in sports related concussion, from 73/100,000 admissions in 2001 to

152/100,000 in 2012 (Victor G. Coronado, Tadesse Haileyesus, & Tabitha A. Cheng, 2015).

While the NEISS-AIP data does show more male admissions in the 15-19 year age group with

the leading cause of reported injury bicycle accidents, with football then basketball injuries

reported secondary (Victor G. Coronado, Tadesse Haileyesus, & Tabitha A. Cheng, 2015). For

females, the leading source of reported injuries were bicycle accidents, playground injuries, and

equestrian accidents (Faul M, 2010). Data from the High School Reporting Information System

demonstrates concussion rates highest in football, hockey, and lacrosse for boys and soccer,

lacrosse, and field hockey for girls (Daniel H. Daneshvar, 2011). This data demonstrates that

concussion injuries occur among multiple populations and from multiple causations making TBI

a significant concern in the primary care environment. Washington State does not currently track

concussions injuries through the Health Department, so state-specific demographics are not

available.

Health Outcomes of Concussion

In 2010, the CDC estimated the cost of TBI annually to be 76.5 billion dollars from direct and

indrect care (Centers for Disease Control and Prevention, 2014). The health outcomes of

concussion according to the CDC were dependent upon the severity of the injury based on the

clinical presentation of a patient's neurologic signs and symptoms (Centers for Disease Control

and Prevention: National Center for Injury Prevention and Control, 2014). Concussion sequela

includes cognitive, behavioral, emotional, and physical limitations with varying severity for the

   

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individual. Immediate symptoms often include a headache, visual changes, sleep disorders, mood

changes, cognitive difficulties, nausea with or without vomiting, vertigo, and balance problems.

These symptoms typically will decrease within a few weeks for the majority of concussed

individuals with early recognition and intervention (Centers for Disease Control and Prevention ,

2015). The CDC additionally defines concussion as a chronic process because of learning,

cognitive, and possible prolonged motor disabilities often requiring extensive rehabilitation.

Other chronic sequelae include potential mood disorders and poor social interactions. This

chronic sequela often has a detrimental impact on the surrounding community as well as the

family. It is, for this reason, the CDC additionally defines concussion as a significant public

health burden (Centers for Disease Control and Prevention: National Center for Injury

Prevention and Control, 2014).

Prevention and Treatment

Washington was the first state to pass legislation in 2009 requiring removal of a minor athlete

from play after suspected concussion with passage of RCW 28A.600.190 also known as the

Lystedt Law (Access Washington , 2015). This law also requires the athlete be evaluated by a

provider trained in concussion management evaluate the athlete prior to their return to play

(Access Washington , 2015). The administration at my local school district has been guided to

adhere to the more stringent return-to-play International Consensus Guidelines and must

complete a 5-step exercise protocol prior to play return (McCrory, et. al, 2013). As the cause of

concussion is multi-factoral, so is treatment. To date, there is no equipment (including helmets)

that prevent concussion.

   

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References

Access Washington. (2015). Youth sports—Concussion and head injury guidelines—Injured

athlete restrictions—Short title. Retrieved from Washington Legislature :

http://apps.leg.wa.gov/rcw/default.aspx?cite=28A.600.190

Centers for Disease Control and Prevention. (2015, February 15). What Is a Concussion.

Retrieved from Centers for Disease Control and Prevention/Head's Up/Brain Injury

Basics : http://www.cdc.gov/headsup/basics/concussion_whatis.html

Centers for Disease Control and Prevention. (2014, March 4). Severe Traumatic Brain Injury .

Retrieved from Basic Information about Concussion and TBI:

http://www.cdc.gov/TraumaticBrainInjury/severe.html

Centers for Disease Control and Prevention. (2015, January 12). Traumatic Brain Injury in the

United States: Fact Sheet. Retrieved from Injury Prevention & Control: Traumatic Brain

Injury: http://www.cdc.gov/traumaticbraininjury/get_the_facts.html

Centers for Disease Control and Prevention: National Center for Injury Prevention and Control.

(2014). REPORT TO CONGRESS Traumatic Brain Injury In the United States:

Epidemiology and Rehabilitation . Atlanta, GA: National Center for Injury Prevention

and Control; Division of Unintentional Injury Prevention.

Daniel H. Daneshvar, M. [. (2011, January 30). The Epidemiology of Sport-Related Concussion.

Retrieved from NIH Public Access Author Manuscript Clinical Sports Med :

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2987636/pdf/nihms229700.pdf

Faul M, X. L. (2010). Traumatic Brain Injury in the United States: Emergency Department

Visits, Hospitalizations and Deaths 2002–2006. Atlanta, GA: Centers for Disease Control

and Prevention, National Center for Injury Control and Prevention .

McCrory, P. M. (2013). Consensus statement on concussion in sport:. British Journal of Sports

Medicine, 47, 250-258. doi:10.1136/bjsports-2013-092313

   

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Victor G. Coronado, M. M., Tadesse Haileyesus, M., & Tabitha A. Cheng, M. (2015). Trends in

Sports- and Recreation Related Traumatic Brain Injuries. Journal of Head Trauma

Rehabilitation /May-June 2015, 185-197.