Nov 3 2011
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Public Health Challenges of Sports-Related Head Injury

Sports-related concussions aren’t a new problem, but their long-term public health implications are just now starting to capture the public’s attention. The urgency of this issue was underscored by the fact that Sen. Tom Udall (D-NM) was a special guest at an APHA 2011 Annual Meeting session on the subject. Udall is a vocal supporter of legislation (and research) to protect student and professional athletes from concussion, urging the audience to “find more ways to encourage physical activity while making sports safer for children.”

Julie Gilchrist, from the Centers for Disease Control and Prevention Injury Center, shared data from her research on brain injuries among children and adolescents seen in emergency rooms (ERs) each year. She and her colleagues saw a 57 percent increase in the rate of diagnosis of traumatic brain injury from 2000-2009, but attribute that to a corresponding rise in awareness of this type of injury. But Gilchrest said a major limitation of emergency data is that only a small proportion of athletes experiencing head injuries are seen in the ER.

Gilchrest shared further epidemiological data from the National High School Sports Injury Surveillance Study, which collects data on all diagnosed concussions during practices or games. Concussion has often been thought of as a male problem, but data from this study show that in comparable sports like basketball, female athletes are actually more likely to suffer a concussion.

Gerald Gioia, a doctor and researcher at Children’s National Medical Center here in Washington, has seen a lot of sports-related head injuries and knows how difficult it is classify and fully diagnose those injuries that have the potential to cause lasting damage. He thinks of a concussion as an injury to the “software” of the brain, rather than the “hardware,” or the actual structure of the brain. Because of that, the symptoms can vary widely, from loss of consciousness to amnesia to dizziness, so Gioia and his colleagues believe that it is vital for coaches to know all of the possible signs that should mean an athlete should not return to a game.

Can concussions be prevented? Stephen Marshall, an epidemiologist from the University of North Carolina, thinks so. Even “basic awareness-raising” and education about the symptoms of concussion are useful, he said. And even though the number of professional athletes is very small, Marshall knows how influential these people are to young people, so he and others are working with the NFL to encourage them to take concussions seriously. He also believes that template legislation for states interested in mandating better concussion prevention by coaches and others is sorely needed. And, of course, helmet technology is getting better and better. But unless student and professional athletes report their concussion symptoms every single time they have any, none of this education and awareness-raising will make a difference.

New York Times writer Alan Schwarz has become somewhat of a hero in the last four years for raising the public’s awareness about the incidence of concussion in sports and about the long-term brain damage that scientists believe results from repeated blows to the head over an athlete’s career. Schwarz is a self-proclaimed “math geek” and said that much of his investigative reporting was supplemented by his ability to see the methodological flaws in the NFL’s own study on the long-term effects of concussions. By translating the data into lay language that proved just how serious concussions can be for athletes—amateur and professional—Schwarz captured the attention of parents, Congress and sports fans, causing this issue to finally be addressed.

Tags: APHA, Injury, Public health, Public health law, Safety, School Health