Jan. 31, 2003 PITTSBURGH, Jan. 30 – High school athletes who sustained even mild concussions showed significant decline in memory processing and other symptoms within one week post-injury, in a study conducted by researchers at the University of Pittsburgh Medical Center (UPMC) Sports Medicine Concussion Program. The study, published in the February Journal of Neurosurgery, is the first to evaluate recovery from mild concussion in high school athletes and the first to show that even mild concussions can have significant effects, suggesting the need for more cautious return-to-play guidelines.
"Our findings underscore the need for more careful on-the-field evaluation of even seemingly mild concussions," said principal investigator Mark Lovell, Ph.D., who is a neuropsychologist and director of the UPMC Sports Medicine Concussion Program. "Furthermore, our study results may lead to a suggestion that any high school athlete with a suspected concussion of any severity be kept out of that particular game and not return to play until further neurocognitive testing can be done," he said.
Current return-to-play guidelines commonly used nationwide stipulate that a mildly concussed athlete whose on-the-field symptoms disappear within 15 minutes may be allowed to return to play in that particular game.
"We also believe that our study results suggest an urgency for more research into the effects of concussion in high school athletes, as well as the access to formal neurocognitive testing at the high school level," added Dr. Lovell.
"There are 1.25 million high school athletes playing contact sports, which represents the population with the highest participation in contact sports and the highest risk for sports-related concussion. An estimated 63,000 concussions occur in this group each year. Yet, our study is the first in which the recovery process in this age group has been investigated using formal testing," he added.
"Mild concussion is the most frequently occurring type of concussion. Because on-the-field symptoms disappear within a few minutes and the athlete reports he or she is fine and appears to the sports medicine team to be fine, mild concussions often are unrecognized, overlooked or considered a trivial injury, and often the athlete is allowed to return to play," said Michael Collins, Ph.D., study investigator and neuropsychologist who is assistant director of the UPMC program.
"We are concerned about returning a concussed athlete to play too soon before the brain has had time to heal because previous research has shown that once an athlete sustains an initial concussion, he is more susceptible to further, more serious damage," added Dr. Collins, who also was principal investigator for a recent UPMC study, proving that the effects of multiple concussions in high school athletes can be cumulative.
Concussion occurs when the brain is violently rocked back and forth inside of the skull due to a blow to the head or upper body, much like an egg yolk inside of an eggshell. Concussion is a trauma-induced alteration of mental status that may or may not result in loss of consciousness. Other symptoms may include disorientation, confusion, dizziness, amnesia and uncoordinated hand-eye movements.
"Most athletes who sustain an initial concussion can recover completely as long as they are not returned to contact sports too soon. However, the concern is that concussion symptoms are not always straightforward and not always reported by the athlete. On-the-field evaluation of the injury's effects and knowing when it is safe to return the athlete to play can be difficult to objectively measure," according to study investigator Joseph Maroon, M.D., professor of neurological surgery at UPMC.
"No area of sports medicine involves more clinical uncertainty and controversy than the management of concussion," concurred Dr. Lovell.
The UPMC team studied the recovery of 64 male and female high school athletes throughout the country who sustained concussions during the 2000-2001 school year. The athletes who sustained mild concussions were those whose symptoms disappeared within 15 minutes of injury. They were evaluated on the field by a certified athletic trainer or team physician, who documented the injury details. The athletes were then evaluated at 36 hours post-injury, four days post-injury and seven days post-injury.
Athletes with mild concussions demonstrated significant declines in memory processes that were still evident at four and seven days post-injury. Other self-reported symptoms – including headaches, dizziness and nausea – resolved by day four.
The mild concussion group was further divided into two sub-groups according to the duration of their on-the-field symptoms. One sub-group represented athletes whose on-the-field symptoms disappeared within five minutes, and were considered less severely injured. The other sub-group included athletes whose symptoms lasted between 5 minutes and 15 minutes, and were considered more severely injured. The study found that the duration of on-the-field symptoms served as a prognostic indicator of post-injury symptom duration. The group whose on-the-field symptoms lasted longer than 5 minutes had longer lasting post-injury symptoms and was five times more likely to demonstrate a major drop in memory performance at 36 hours post-injury.
All of the study participants were evaluated with ImPACT© (Immediate Post-Concussion Assessment and Cognitive Testing), a 20-minute computerized assessment tool that includes tests of neurocognitive function including attention, memory, reaction time and information processing speed. All of the study participants had undergone pre-season baseline testing with ImPACT so that post-injury data could be compared to baseline data.
ImPACT, developed by Drs. Lovell, Collins and Maroon and colleagues at Henry Ford Health System in Detroit, has been used for several years by the National Football League, the National Hockey League, Major League Baseball and numerous other professional and collegiate athletic teams and organizations. Approximately 250 high schools across the country also use ImPACT.
Other investigators in this study are: Grant Iverson, Ph.D., University of British Columbia; Melvin Field, M.D., department of neurological surgery, UPMC; Robert Cantu, M.D., Emerson Hospital, Concord, Mass.; Kenneth Podell, Ph.D., Henry Ford Health System; John W. Powell, Ph.D., A.T.C., and Mark Belza, M.D., Michigan State University; and Freddie Fu, M.D., department of orthopaedic surgery, UPMC.
The UPMC Sports Medicine Concussion Program focuses on diagnosis and management of sports-related concussions in athletes of all levels. The program's internationally known team of clinicians and researchers are leaders in studying the neurocognitive effects of sports-related concussions and developing better methods of post-concussion evaluation to determine when it is safe for an athlete to return to sports. For more information, please access http://www.upmc.com/NewsBureau.htm .
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