Month: December 2015

Being Smart About Your Child’s Brain (New York Times)

PROBABLY no one tracks concussions among young athletes in the United States more closely than Dawn Comstock, and in many ways, she’s encouraged by what she sees.

It’s now less common for a player whose head has collided violently with a ball, a wall, the ground or another player to return to competition right away. It’s now more common for him or her to get medical attention.

But Comstock, an epidemiologist at the Colorado School of Public Health, is frustrated by stubborn gaps between truly safe behavior and the status quo. She told me that more than half of the high schools with football teams don’t have a full-time athletic trainer, so there’s no immediately available person with the specific mission of preventing and treating injuries.

There are also sports other than football — and trauma other than concussions — that don’t attract nearly the vigilance they should, she added. Above all, there’s an enduringly strange, dangerous relationship between parents and sports, specifically between parents and coaches.

“What I would love to see is parents taking as much time to investigate their child’s coach, the league that they’re putting their child into and the officials officiating the game as they do a day care center when their child is young,” she told me. “They don’t have trouble challenging a teacher, even a pediatrician. But somehow they have trouble challenging a sports league.”

This coming week, the major Hollywood movie “Concussion” opens. It stars Will Smith as a scientist who sounded the alarm about the long-term impact of repetitive head injuries in professional football.

And it reflects a storm of attention over the last decade to the serious, sometimes fatal damage done to the vulnerable brains of football players of all ages — and of soccer players, too. We’ve learned, for example, that soccer carries a greater risk of concussion for girls than it does for boys.

But the talk of a “concussion crisis” and the pronounced concern about football and soccer are blinding us somewhat to a larger picture, a broader lesson: Our veneration of sports, our adulation of athletes and our ethos of toughing it out put kids needlessly at risk of all sorts of preventable injuries in all kinds of improvable sports.

“I worry that we’ve been so focused on football that parents are pushing their kids out of that and into something else and not realizing that there are dangers there, too,” said Kevin Guskiewicz, one of the directors of the Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center at the University of North Carolina at Chapel Hill. “We need to improve safety in all the sports that children play.”

Did you know that while the incidence of injuries in cheerleading is much lower than in the majority of high school sports, nearly a third of those injuries are concussions? The reason, Comstock explained, is a shocking lack of common sense and caution in monitoring an activity that isn’t automatically associated with violence.

“We’ve seen cheerleaders who’ve sustained concussions because they were practicing on the asphalt in the parking lot or on the cement sidewalk — or in the school cafeteria on a tiled floor,” said Comstock, adding that grass or mats would be infinitely more appropriate. “Why on earth would parents let that happen?”

Guskiewicz drew my attention to a study published just a few months ago in The American Journal of Sports Medicine that determined that among college athletes, concussions were most likely in wrestling, followed by men’s ice hockey and then women’s ice hockey. And women’s soccer and women’s basketball, in that order, were right behind football in terms of the danger of concussion.

Comstock, who supervises an ongoing national inventory of athletic injuries among high school students, said: “I have 22 sports in my surveillance system, and concussions have been reported in all but one of them. That includes swimming.” A distracted kid will swim head-on into the wall or into someone coming from the other direction. The sport without concussions, she said, was tennis.

BUT head injuries are just one peril, and not necessarily the chief one, even in football. There are many more deaths among football players of all ages from indirect trauma, including heatstroke and cardiac arrest, than from such direct trauma as head and spinal-cord injuries.

Douglas Casa, the chief executive officer of the Korey Stringer Institute at the University of Connecticut, said that from 2000 through 2009, which was the last full decade studied, such indirect-trauma deaths outnumbered direct-trauma deaths by 108 to 41.

Casa, who monitors and compiles that data, told me that he knows of 14 deaths among football players below the college level since July 1, which is about when practice for the fall season usually begins. Four were from cardiac arrest and two were from heatstroke.

“Anytime you hear about a kid dying from heatstroke in high-school football, it was 100 percent preventable,” he added. And he said that there are an even greater number of preventable cases of severe heatstroke that leads not to death but to prolonged or permanent health complications.

Last August, for instance, a 16-year-old in Riverhead, N.Y., who developed heatstroke during practice ended up in the hospital, where he spiked a 108-degree fever, was treated for serious kidney damage and spent the next five weeks.

Casa said that heat acclimatization — or the incremental acceleration of practices during a season’s start — can guard against heatstroke. But while many leagues and teams have implemented that, many haven’t.

Players’ posture can affect the likelihood of head injury but often isn’t studied and adjusted. And Comstock said that there’s no widespread, dependable monitoring of the nature and incidence of injuries among athletes in elementary and middle school.

“Don’t get me wrong: I’m not against sports,” she said. “I was a three-sport player. And I played contact sports. I played rugby for 13 years.” She and Guskiewicz both stressed that, at a time when too many kids are obese or diabetic, they want more of them to play sports,

But they also want more prudence in the mix. Some parents obsess about a high school’s success or failure in getting kids into Ivy League colleges but know nothing of the school’s athletic teams’ safety protocols. Some question the amount of homework more readily than the number of laps athletes run on a 95-degree day.

Some shop for lenient physicians who will declare their child healed and let him or her back out on the field. Athletic glory beckons.

“Sports has achieved an almost mythologized place in our country,” Comstock said. She’s wrong about the “almost.” She’s right about this: It’s not concussions per se but an unquestioning worship of sports that puts young lives in jeopardy.

Source: New York Times

Experts Alarmed Over 13 High School Football Deaths This Season (People)

For freshman Tyrell Cameron, it was a fractured neck after being hit during a punt return. Ben Hamm took a hit to the head. The same was true for Kenny Bui and Andre Smith.

Cam’Ron Matthews felt woozy before he collapsed on the sidelines. Evan Murray also felt woozy, this following a hit to his stomach, while Luke Schemmcollapsed on the sidelines soon after he got hit a final time.

Within hours or days of their respective collisions or tackles, all seven of these high school football players were dead.

In all, 13 high school and one youth football players have died since July 1, to according to Doug Casa, Ph.D., the chief executive officer of the Korey Stringer Institute at the University of Connecticut, which researches sudden death in sport.

Seven of the deaths have been linked indirectly to the sport, with causes including cardiac conditions, heat stroke and exertional sickling (a medical emergency occurring in athletes carrying the sickle cell trait), says Casa, director of athletic training education, department of kinesiology at the University of Connecticut.

“Nearly all non-traumatic deaths in sport,” says Casa, “are preventable.”

On July 7, for example, 14-year-old Collin Kelly, a sophomore at Pike High School in Indiana died one day after passing out at a conditioning practice. The Marion County Coroner’s Office determined that Kelly died of heatstroke suffered at the practice.

“You can’t think of a bigger tragedy than a heatstroke death because all you need is ice water and a tub,” Casa says. “Imagine parents finding out their child dies and it was a $150 tub and ice and water that the school had, it’s the difference between their child living and dying.”

The deaths related to on-field injuries make Robert Cantu, M.D., medical director for the National Center for Catastrophic Sport Injury Research at the University of North Carolina-Chapel Hill “very concerned personally,” he says.

How a Second Concussion Can Prove Fatal

Cantu, a professor of neurosurgery at the Boston University School of Medicine, thinks that several of the direct deaths – those related to on-field play – sound like they may be second impact syndrome: acute, sometimes fatal brain swelling that occurs when a second concussion is sustained before complete recovery from a previous concussion.

It is “a preventable condition and it would be a real tragedy if that were really the situation,” Cantu says.

An astounding 70% of high school athletes with concussions played despite their symptoms, and 40% reported that their coaches didn’t know of the injury, according to a 2014 study in the American Journal of Sports Medicine. Many players don’t reveal injuries, says Cantu, since they know it may keep them from playing or disappoint their teammates.

However, “it’s only as important as life and death,” Cantu says of a football player participating with the symptoms of concussion. (A concussion is an injury to the brain that produces a temporary loss of brain function with symptoms including dizziness, lightheadedness, confusion, headache and vision changes. Usually, nothing will be seen from an imaging test.)

“You are setting yourself up for the second impact syndrome, which has a 50 percent mortality rate if it happens,” Cantu says. “And, unfortunately, it has an almost 100 percent morbidity rate meaning even if you survive, you survive with neurologic deficits.”

Senior wide receiver Kenney Bui of Evergreen High School in Burien, Washington, had suffered a concussion one month before a game on October 2, for which a doctor cleared him to play. In the fourth quarter, when Bui seemed dazed, an ambulance took him to the hospital, where he died three days later. An autopsy found that he died of blunt force trauma to his head.

With great concern about concussions and the safety of football, one school board in Missiouri disbanded its football program earlier this year.

As shocking as these deaths are, however, the rate is far lower than its peak in 1968, when 26 high school players died from on-field play, according to a recent  NCCSIR report.

The past ten years have had between zero and 8 deaths per year directly attributable to playing the game, per the NCCSIR report. In 2013, for example, eight players died from injuries sustained on the field, a rate of .73 deaths per 100,000, while last year five high school and one college player died, a rate of 0.45 per 100,000.

Why Is This Happening to High School Players?

Some 1.1 million high school students are playing football as compared to 100,000 playing at the college and pro levels, according to the NCCSIR. Yet even with those huge numbers of players in high school, a 2007 study in The American Journal of Sports Medicine found that the incidence of catastrophic head injuries in football is dramatically higher at the high school level than at the college level. The researchers concluded that, “an unacceptably high percentage of high school players were playing with residual symptoms from a prior head injury.”

Cantu, an author of the 2007 study and who published 2012’s Concussion and Our Kids, says the still-developing brains of high school athletes makes them more vulnerable to catastrophic head injuries as compared to players in the NFL.

Yet he notes that it’s the younger players who hit the most, “which is crazy,” he says.

“The coaches of those younger players say ‘you have to teach them,’ but you don’t have to teach them by bashing heads. They way practice is conducted and how frequently you hit needs to change.”

Another factor contributing to these deaths is the lack athletic trainers (highly-trained medical personnel) at all practices and games, says Casa.

The Importance of First Responders

Despite high school football accounting for the vast majority of catastrophic injuries, just 37 percent of high school have a fulltime athletic trainer, and only 50 percent have a trainer at all practices and games, according to a recent study in the Journal of Athletic Training.

“What you do in the first 5 or 10 minutes will dictate if the athlete lives or dies,” says Casa, of the study’s authors. “We can’t just call an ambulance and put our hopes on EMS or an EMT, we can’t put our hopes on the ER doc. The initial care needs to be resolved on the field.”

The most common causes of death in high school athletes, according to the Korey Stringer Institute, include heat stroke, cardiac arrest and head, neck and spinal injuries.

“If you look at indirect deaths, the deaths are almost always preventable,” Casa says. “If an AED [automated external defibrillator] is placed within a minute, 90 percent of cardiac cases survive. With heat stroke, if you cool a person down properly, 100 percent survive.”

Casa, an author of the NCCSIR study, notes that while direct deaths have seen a decrease since the 1960s, “we are in the middle of a four decade rise in indirect deaths.

“When it comes to cardiac, heat stroke and sickling death, it is without question getting more dangerous to play football,” he says.

“But those are preventable, it’s not necessarily the sport of football, it’s not because two people run into someone on a field, it’s what we’re doing in terms of conditioning and not having proper education for coaches, they’re not doing smart things in their training.”

Pre-Existing Conditions

“Any death of a young athlete is a tragedy, it is emotionally heart rending and absolutely horrible,” says Dr. Doug Zipes, a cardiologist and distinguished professor, Indiana University School of Medicine, who helped write the American Heart Association’s recently updated guidelines for athletes with heart problems.

There has been a debate among experts on the extent of screening athletes for cardiac problems, on top of their required physical examinations, he says.

“Some places add an electrocardiogram or other things but adding those things has not been cost-efficient and they lead to false negative and false positive diagnosis,” he says.

“The electrocardiogram can look normal and someone can still have heart problems, or the electrocardiogram can look abnormal and someone doesn’t have heart problems. The issues are complex.”

Zipes calls for AEDs at all practices and athletic events. “Knowing we have difficulty identifying the athlete at risk, let us be prepared to respond to that athlete who does have sudden cardiac death and the best response is a defibrillator,” he says. “And if that is applied to an athlete within minutes, we can save that life.”

Cantu bemoans the current system of finding the cause of death with football players who die after on-field play, as it is up to a medical examiner, not a neuropathologist, who is highly trained in determining causes of death on the field.

In light of the high school football deaths this year, two congressmen last week introduced legislation that would require the Centers for Disease Control and Prevention to take some action.

“We desperately need a mechanism that would allow experts to examine each of these fatalities so we could be absolutely about what caused them,” Cantu says, adding that even one death, “is too many.”

Source: People