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New Research Findings Lead UPMC Sports Concussion Doctors To Caution High School Athletes On Premature Return To Play

PITTSBURGH, August 18, 2003 One in 10 high school athletes involved in contact sports sustains a concussion each year. Sixty-three percent of the approximately 62,000 concussions expected to occur this year will be in football players.

This fall, doctors at the University of Pittsburgh Medical Center (UPMC) Sports Medicine Concussion Program are cautioning athletes, coaches, athletic trainers, team physicians and parents to be aware of new research data on concussion symptoms and effects, and the dangers of returning concussed athletes to the playing field too soon before the brain has had time to heal. The doctors heed comes after they have published the results of six separate research studies in major medical journals since last fall's sports season.

A lot has changed since last year. Our research findings have given us new objective information that impacts directly on how the severity of a concussion is measured and how it is determined when an injured athlete can safely return to play, said Mark R. Lovell, Ph.D., a neuropsychologist who is director of UPMCs sports concussion program.

The UPMC studies were the first-ever published studies of the effects of concussion specifically in high school athletes the population most at risk for concussion the doctors say. Following are summaries of the major findings in the studies:

Amnesia - not loss of consciousness - may be the main indicator of concussion severity and the best predictor of post-injury neurocognitive deficits. ( American Journal of Sports Medicine; Clinical Journal of Sport Medicine)

It was long thought that loss of consciousness was the main marker for injury severity. But, we have proven that an athlete can have a severe concussion with significant effects without losing consciousness, said Dr. Lovell. Amnesia and confusion on the field after injury may be as important, if not more important, in determining injury severity and making a return-to-play decision. Amnesia is any period of memory loss occurring either before or after the hit.

Even seemingly mild concussions can have significant effects. ( Journal of Neurosurgery)

There is no such thing as just a bell ringer, said Michael Collins, Ph.D., assistant director of the UPMC sports concussion program. Our study showed that many athletes with mild concussions whose symptoms disappeared within 15 minutes still showed significant decline in memory processing and other symptoms within one week post-injury, which means they werent healed. However, current guidelines sometimes allow athletes with mild concussion to return to play even in that particular game, in some cases, if the symptoms disappeared within the 15-minute period.

Effects of multiple concussions can be cumulative. ( Neurosurgery)

Our research has documented for the first time the common assumption that prior concussions may indeed lower the threshold for subsequent concussion injury and increase symptom severity in even seemingly mild subsequent concussion, said Joseph C. Maroon, M.D., a professor and vice chairman of neurological surgery at UPMC and team neurosurgeon for the Pittsburgh Steelers. In the study, high school athletes with a history of three or more concussions who sustained a new concussion were up to nine times more likely to experience common symptoms compared to athletes with no history of concussion.

Headache symptom likely indicates incomplete recovery. ( American Journal of Sports Medicine)

In another study, high school athletes with headache one week post-injury also had significantly more other symptoms and performed more poorly on neurocognitive tests measuring reaction time and memory than concussed athletes who reported no headache at one week post-injury. Headaches should be taken seriously because they also appear to be associated with a more severe concussion, lingering problems and incomplete brain recovery, said Dr. Collins.

High school athletes may take longer to recover from concussion than college athletes. ( Journal of Pediatrics)

In the first study to examine age as a factor in concussion recovery, researchers found that high school athletes demonstrated prolonged memory dysfunction requiring longer recovery compared to college athletes. Our study was the first to suggest that there may be differing vulnerabilities to concussion at different ages and current return-to-play guidelines may not be appropriate for all age groups, said Dr. Maroon. Current guidelines assume a standard use for all levels of play, from school age to professional.

Pittsburgh Steelers team orthopaedist and study co-author James Bradley, M.D., said, This new research has changed the way that I manage concussion in high school athletes. When I diagnose a concussion in a high school athlete from the sideline, I sit him out until they can be more fully evaluated.

A concussion is defined as any change in mental status that results when the brain is violently rocked back and forth inside of the skull due to a blow to the head, neck or upper body. Symptoms may include amnesia, confusion, disorientation, headache, nausea, uncoordinated hand-eye movements and, in some cases, loss of consciousness.

Most athletes who sustain an initial concussion can recover completely as long as they do not sustain a second concussion before the brain has had time to heal from the first one, said Dr. Lovell. Returning to play too soon puts the athlete at greater risk for sustaining a second concussion and more severe damage. No athlete with a concussion or suspected concussion should ever return to play before the brain has healed and all related symptoms have disappeared.

Thus, it is important for everyone to be aware of the new research data regarding on-the-field markers of concussion severity in relation to post-injury symptoms and neurocognitive deficits, added Dr.Lovell. Our studies also suggest that the currently used grading scales and return-to-play guidelines crucially need to be re-defined and further researched. Every athlete should be evaluated individually and not by following generalities of a grading scale.

In all of the research studies, the UPMC team used a computerized concussion evaluation tool, which they have developed, called ImPACT (Immediate Post-concussion Assessment and Cognitive Testing). ImPACT is the first system that can objectively evaluate the severity of injury and help determine when it is safe for an injured athlete to return to play by testing the athletes neurocognitive functional state with tests of brain processing speed, memory and visual motor skills. ImPACT is currently used by more than 200 high schools nationwide.

The UPMC Sports Medicine Concussion Program is an ongoing clinical service and research program that focuses on the diagnosis, evaluation and management of sports-related concussion in athletes of all levels. For more information, please refer to our concussion archives. For patient scheduling or clinical information please call 1-800-533-UPMC (8762).

Note to editors: To arrange interviews with doctors at the UPMC Sports Medicine Concussion Program, please contact Susan Manko, UPMC Media Relations, at mankosm@upmc.edu or 412-647-3555.

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