Monday, March 21, 2016

Tackling the long-term impact of concussions

- Kenny Lin, MD, MPH

After years of publicly denying that football players who sustain repeated concussions are at increased risk for degenerative brain disorders such as chronic traumatic encephalopathy (CTE), the National Football League (NFL) did a dramatic "about face" last week in a hearing before the House of Representatives' Energy and Commerce Committee. Responding to a legislator's question about whether there is a link between CTE and football, Jeff Miller, the NFL's executive vice president of Health and Safety Policy, said, "The answer to that is certainly, yes."

There were other recent signals that the NFL had finally gotten serious about shedding its unscientific and defensive approach to concussions. Last year, the NFL Foundation partnered with the American Academy of Family Physicians (AAFP) to sponsor a series of 3 webcasts for primary care clinicians and a patient brochure addressing head injuries in sports at all levels. Although the long-term effects of concussions in professional football players have been well-documented, there is an urgent need to collect information on the outcomes of concussions in recreational athletes, especially in children and adolescents. In a recent JAMA study, one-third of Canadian children reported persistent somatic, cognitive, or behavioral symptoms 28 days after being diagnosed with an acute concussion in the emergency department.

According to a 2012 AFP article on subacute to chronic mild traumatic brain injury (TBI), patient groups more likely to experience persistent postconcussive symptoms include women, older adults, persons with less education, and persons with a previous mental health diagnosis. Surveillance data from the National Collegiate Athletic Association (NCAA) show that in most comparable sports (soccer, basketball, softball), female athletes experience concussions at significantly higher rates than male athletes. Pink Concussions, which supports research into female concussions caused by sports, abuse, or military service, sponsored an international summit on concussion and TBI at Georgetown University in February.

The coming years will hopefully provide more research findings to inform parents, coaches and health professionals on best practices to minimize the long-term impact of concussions. In the meantime, family physicians can access additional educational resources and clinical tools, including relevant AFP content, on the AAFP's website.