In the past decade, few subjects at the intersection of medicine and sports have generated as much public interest as sports-related concussions - especially among youth. Despite growing awareness of sports-related concussions and campaigns to educate athletes, coaches, physicians, and parents of young athletes about concussion recognition and management, confusion and controversy persist in many areas. Currently, diagnosis is based primarily on the symptoms reported by the individual rather than on objective diagnostic markers, and there is little empirical evidence for the optimal degree and duration of physical rest needed to promote recovery or the best timing and approach for returning to full physical activity.

Sports-Related Concussions in Youth: Improving the Science, Changing the Culture reviews the science of sports-related concussions in youth from elementary school through young adulthood, as well as in military personnel and their dependents. This report recommends actions that can be taken by a range of audiences - including research funding agencies, legislatures, state and school superintendents and athletic directors, military organizations, and equipment manufacturers, as well as youth who participate in sports and their parents - to improve what is known about concussions and to reduce their occurrence. Sports-Related Concussions in Youth finds that while some studies provide useful information, much remains unknown about the extent of concussions in youth; how to diagnose, manage, and prevent concussions; and the short- and long-term consequences of concussions as well as repetitive head impacts that do not result in concussion symptoms.

The culture of sports negatively influences athletes' self-reporting of concussion symptoms and their adherence to return-to-play guidance. Athletes, their teammates, and, in some cases, coaches and parents may not fully appreciate the health threats posed by concussions. Similarly, military recruits are immersed in a culture that includes devotion to duty and service before self, and the critical nature of concussions may often go unheeded. According to Sports-Related Concussions in Youth, if the youth sports community can adopt the belief that concussions are serious injuries and emphasize care for players with concussions until they are fully recovered, then the culture in which these athletes perform and compete will become much safer. Improving understanding of the extent, causes, effects, and prevention of sports-related concussions is vitally important for the health and well-being of youth athletes. The findings and recommendations in this report set a direction for research to reach this goal.

Contents

• THE NATIONAL ACADEMIES
• COMMITTEE ON SPORTS-RELATED CONCUSSIONS IN YOUTH
• Reviewers
• Acknowledgments
• Abbreviations and Acronyms
• Summary
  • EPIDEMIOLOGY
  • COMMITTEE'S APPROACH
  • COMMITTEE'S FINDINGS
  • REFERENCES
• 1. Introduction
  • COMMITTEE'S APPROACH TO ITS CHARGE
  • OVERVIEW OF CORE ISSUES
  • REPORT ORGANIZATION
  • FINDINGS
  • REFERENCES
• 2. Neuroscience, Biomechanics, and Risks of Concussion in the Developing Brain
  • NORMAL BRAIN DEVELOPMENT
  • BIOMECHANICS OF CONCUSSION
  • NEUROCHEMISTRY OF CONCUSSION
  • RISK FACTORS FOR CONCUSSION IN THE DEVELOPING BRAIN
  • FINDINGS
  • REFERENCES
• 3. Concussion Recognition, Diagnosis, and Acute Management
  • SIDELINE ASSESSMENT
  • CLINICAL EVALUATION
  • NEUROPSYCHOLOGICAL TESTING
  • ACUTE CONCUSSION MANAGEMENT
  • FINDINGS
  • REFERENCES
• 4. Treatment and Management of Prolonged Symptoms and Post-Concussion Syndrome
  • DIAGNOSTIC DEFINITION
  • SHORT-TERM PREDICTORS OF A PROLONGED SYMPTOMATIC PERIOD POST CONCUSSION
  • SYMPTOMATOLOGY IN PROLONGED RECOVERY AND POST-CONCUSSION SYNDROME
  • CLINICAL MANAGEMENT OF PROLONGED SYMPTOMS AND POST-CONCUSSION SYNDROME
  • EFFECTS OF PROLONGED RECOVERY ON FAMILY
  • ACCESS TO CARE FOR INDIVIDUALS WITH PROLONGED RECOVERY
  • FINDINGS
  • REFERENCES
• 5. Consequences of Repetitive Head Impacts and Multiple Concussions
  • NEUROPSYCHOLOGICAL AND NEUROPHYSIOLOGICAL CONSEQUENCES
  • MULTIPLE CONCUSSIONS AND DEPRESSION AND SUICIDE
  • EXPERIMENTAL MODELS
  • BIOMARKERS AND RISK FACTORS
  • LONG-TERM NEURODEGENERATIVE CONSEQUENCES
  • FINDINGS
  • REFERENCES
• 6. Protection and Prevention Strategies
  • PROTECTIVE EQUIPMENT
  • SPORTS RULES
  • CONCUSSION EDUCATION
  • STATE CONCUSSION LEGISLATION
  • FINDINGS
  • REFERENCES
• 7. Conclusions and Recommendations
  • SURVEILLANCE
  • EVIDENCE-BASED GUIDELINES FOR CONCUSSION DIAGNOSIS AND MANAGEMENT
  • SHORT- AND LONG-TERM CONSEQUENCES OF CONCUSSIONS AND REPETITIVE HEAD IMPACTS
  • AGE-APPROPRIATE RULES AND PLAYING STANDARDS
  • BIOMECHANICS, PROTECTIVE EQUIPMENT, AND SAFETY STANDARDS
  • CULTURE CHANGE
  • PARTNERSHIPS
• APPENDIXES
  • Appendix A Public Workshop Agendas
  • Appendix B Biographical Sketches of Committee Members
  • Appendix C Clinical Evaluation Tools

This study was supported by contracts between the National Academy of Sciences and the Centers for Disease Control and Prevention (CDC) (200-2011-38807); the CDC Foundation (Unnumbered Award) with support from the National Football League; the Department of Defense (HT0011-12-C-0023); the Department of Education (ED-OSE-12-P-0049); the Health Resources and Services Administration (HHSH250200976014I); the National Athletic Trainers' Association Research and Education Foundation (0512SETGRANT); and the National Institutes of Health (HHSN263201200074I). Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project.

Suggested citation:

Institute of Medicine (IOM) and National Research Council (NRC). 2014. Sports-related concussions in youth: Improving the science, changing the culture. Washington, DC: The National Academies Press.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.