Conor Kelly Dr.

Dietel-McLaughlin Multimedia Writing & Rhetoric Fall 2011 November 3, 2011 Annotated Bibliography Concussions & the Media Overview A traumatic brain injury (TBI) is caused by sudden trauma, which temporarily disrupts the normal functioning of the brain. A concussion is a mild form of TBI that occurs when the brain inside the skull moves quickly back and forth as a result of either a sudden bump directly to the head or a fall or blow to the body. My interest in this topic is because, during a December 2009 high school basketball game, I collided head-on with another player. I received a large bump above my right eye, and suffered periodic headaches. I rested and stayed away from playing basketball for a few weeks. I also play in a game, lacrosse, which has one of the highest incidences of concussions among players. While a concussion is not a serious injury, if a person is not properly diagnosed and treated, it can lead to permanent brain damage and sometimes death. The purpose of this paper is to discuss the causes and treatment of concussions and evaluate the medias role in increasing the publics awareness of the short term and long-term health concerns of this type of injury, especially when it goes untreated. Annotated Bibliography Center for Disease Control and Prevention. Nonfatal Traumatic Brain Injuries Related to Sports and Recreational Activities Among Persons Aged 19 Years United States, 2001-2009. MMWR Morbidity and Mortality Weekly Report. October 7, 2011; 60(39): 1-6. For the study, the CDC analyzed data from the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) for the period 2001-2009. They found that during this period, approximately 173K children ( 19) were treated annually in emergency departments (EDs) for traumatic brain injuries (TBIs) suffered while engaged in sports or recreational activities. For the 10 to 19 year old age group, they found that the sports with the highest incidence of TBI-related ED visits were bicycling and football for males, and bicycling, basketball, and soccer for girls. Over the nine-year period, the number of ED visits for non-fatal TBIs increased significantly, especially among males in the 10 to 19 year old age group. They suggest that the increase may be attributed to an increase in sports participation, increased occurrence of TBIs among participants, and/or greater awareness of the importance of early diagnosis of TBIs. As discussed in other studies, the CDC recommended the use of protective equipment, and a greater emphasis on sportsmanship and safe practices to reduce the incidence of TBIs. They also stressed the importance of detecting and responding quickly when TBI is suspected. And, finally, to protect the long term health of athletes, they reiterated the importance of removing the player from the game when TBI is suspected and keeping them away from the game until

they have been medically cleared to return. Gessel, Luke M., Sarah K. Fields, Christy L. Collins, Randall W. Dick, and R. Dawn Comstock. Concussions Among United States High School and Collegiate Athletes. Journal of Athletic Training. 2007; 42(4): 495-503. In this study, the authors used data from the 2005-2006 High School Sports-Related Injury Surveillance Study, Reporting Information Online (RIO) system that collected data on U.S. athletes who were injured while participating in one of nine sports (boys football, soccer, basketball, wrestling, and baseball, and girls soccer, volleyball, basketball, and softball). Of the 4,431 injuries that were reported, 396 (or 8.9%) were concussions. With the exception of girls softball and volleyball, the rate of concussion (injury/athletic exposure) was higher in practice than in competition. Full and partial contact sports (football, wrestling, soccer, basketball) reported the highest concussion rate. For sports played by both genders, the concussion rate among girls was higher. The authors suggest that this may be because: 1) girls have weaker necks and smaller head to ball ratios so they may suffer more concussions, 2) society is more protective of girls and therefore may take the diagnosis and treatment of concussion more seriously with a girl, and 3) boys who suffer from a concussion may not report their symptoms because of bravado and not wanting to lose playing time. The authors also found that the overall rate of concussions was higher in collegiate sports than the same sport in high school. This result is contrary to previous studies. While some studies suggest that the concussion rate in high school is higher because of factors such as lower skills and lower quality protective equipment, these authors suggest that because college athletes are bigger, stronger, and faster, the level of play is higher and may predispose these athletes to more concussions. Finally, the authors mention that their results show a higher overall concussion rate than previous studies. They suggest that this may be due to greater awareness now of the health issues related to undiagnosed and untreated concussions. They specifically mention the CDCs Heads Up educational programs (tool kits) as the sources for the increased push for getting the word out. Guskiewicz, Kevin M., Michael McCrea, Stephen W. Marshall, Robert C. Cantu, Christopher Randolph, William Barr, James A. Onate, and James P. Kelly. Cumulative Effects Associated With Recurrent Concussion in Collegiate Football Players. The Journal of the American Medical Association. 2003; 290(19): 2549-2555. The authors studied 2,905 football players from 25 U.S. colleges over three football seasons (1999, 2000, and 2001). At the beginning of the study, the authors collected baseline measurements including each players concussion history. Specifically, the authors used the Graded Symptom Checklist (GSC) to create a preseason baseline measurement for each player. The GSC was also used for players to rate the presence and severity of 17 symptoms that are often experienced following a concussion. If during the three seasons, a player suffered a concussion, the schools athletic trainer would

administer the GSC. In the study, 6.3% of the players suffered a concussion. and 6.5% of those players had a repeat concussion during the same season. The authors found that a player who had three or more concussions in the past was 3-times more likely to suffer a concussion than a player who did not have a history of concussions. Moreover, the players recovery time was longer, and he was more susceptible to re-injury within a short period of time following the first reported concussion. Guskiewicz, Kevin M., Nancy Weaver, Darin Padua, and William E. Garrett. Epidemiology of Concussion in Collegiate and High School Football Players. The American Journal of Sports Medicine. 2000; 28(5): 643-650. By using the results of surveys completed by athletic trainers at high schools and colleges during three football seasons, the authors found that of the 17,549 players in the study, 5.1% suffered at least one concussion and 14.1% of those sustained a second concussion during the same season. Finding that concussion incidence was higher among high school and Division III athletes, the authors concluded that there was a relationship between level of play and likelihood of injury. Similar to the other Guskiewicz study, there was a finding that a player who sustained one concussion in a season was three times more likely to suffer another concussion in the same season. They suggested that a probable reason for this is the quickness in which injured players return to play. Specifically, they found that about 30% of players returned to play on the same day, after only 13 minutes of rest, on average. The authors suggest that there needs to be better guidelines to help clinicians on the sidelines make objective assessment of the return to play decision because failure to do so can lead to severe health issues for the athlete. Halstead, Mark E., Kevin D. Walters, and The Council on Sports Medicine and Fitness. Clinical Report--Sport-Related Concussion in Children and Adolescents. American Academy of Pediatrics. September 2010; 126(3): 597-615. The authors begin their paper quoting many of the statistics reported in the studies summarized above. The importance of this paper, I believe, is the medical viewpoint of correctly identifying the signs of concussions and managing the treatment once diagnosed. The authors divide up the signs and symptoms of concussions into four categories:1)physical, 2) cognitive, 3) emotional, and 4) sleep. The authors mention that these symptoms are very similar to those associated with depression, anxiety, and attention-deficit disorder. And, in fact, concussions may exaggerate these symptoms in patients with pre-existing mental health disorders. The authors suggest that if a concussion is diagnosed, the athlete should be removed immediately from the practice or game and should be monitored for several hours after to make sure his or her condition does not worsen. The athlete should be taken to the emergency room if he or she is vomiting, experiencing slurred speech, numbness in extremities, seizures and/or severe headaches. When recovering from a concussion, athletes should avoid cognitive exertion such as doing schoolwork, reading, watching television, and/or playing vide games. Athletes should not return to play until they are without symptoms at rest. The authors

provide a quote that reads: When in doubt, sit them out. The authors conclude their paper with a discussion of prevention and education. They suggest that better equipment, rule changes, and identifying players at risk can reduce the number of concussions. And, like in the Gessel study, the authors applaud the CDC for its efforts in educating coaches, parents, school administrators, and clinicians about the importance of taking seriously the dangers associated with undiagnosed and untreated concussions in student athletes. Lincoln, Andrew E., Shane V. Caswell, John L. Almquist, Reginald E. Dunn, Joseph B. Norris, Richard Y. Hinton. Trends in Concussion Incidence in High School Sports: A Prospective 11-Year Study. The American Journal of Sports Medicine. 2011; 39(5): 958-963. The authors examined the incidence and relative risk of concussion in twelve high school sports in 25 high schools within the Fairfax public school system between the academic years of 1997-1998 and 2007-2008. For boys, the sports were football, lacrosse, wrestling, soccer, basketball, and baseball. For girls, the sports were field hockey, lacrosse, soccer, basketball, cheerleading, and softball. During the two time periods, there were 2,651 concussion injuries. Of the total, approximately 75% were in boys sports with football having the largest percentage at 53%, followed by lacrosse with 9.2% and soccer with 3.9 percent. Helmeted boys sports had twice the concussion rate as nonhelmeted sports. Among the girls sports, soccer had the highest number of concussions at 7.4%, followed by lacrosse at 4.3% and basketball at 4.5%. For all sports, the concussion rate increased over the 11-year period by 16%. Where the sport is essentially the same for both genders, the concussion rate was higher for girls. Similar to other studies, the authors conclude that the higher number of reported concussions among student athletes may be attributed to increases in injury occurrence or greater coding sensitivity as information on the short term and long term health effects of concussions are disseminated to the public.