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The number of Americans diagnosed with concussions is growing, most significantly in adolescents, according to researchers at UC San Francisco. They recommend that adolescents be prioritized for ongoing work in concussion education, diagnosis, treatment and prevention.
The findings appear online August 16, 2016, in the Orthopaedic Journal of Sports Medicine.
“Our study evaluated a large cross-section of the U.S. population,” said lead author Alan Zhang, MD, UCSF Health orthopaedic surgeon. “We were surprised to see that the increase in concussion cases over the past few years mainly were from adolescent patients aged 10 to 19.”
In this study, Zhang and his colleagues evaluated the health records of 8,828,248 members of Humana Inc., a large private payer insurance group. Patients under age 65 who were diagnosed with a concussion between 2007-2014 were categorized by year of diagnosis, age group, sex, concussion classification, and health care setting of diagnosis (emergency department or physician’s office).
Overall, 43,884 patients were diagnosed with a concussion, with 55 percent being male. The highest incidence was in the 15-19 age group at 16.5 concussions per 1,000 patients, followed by ages 10-14 at 10.5, 20-24 at 5.2 and 5-9 at 3.5.
The study found that 56 percent of concussions were diagnosed in the emergency department, 29 percent in a physician’s office, and the remainder in urgent care or inpatient settings. As such, outpatient clinicians should have the same confidence and competence to manage concussion cases as emergency physicians, Zhang said.
A 60 percent increase in concussions occurred from 2007 to 2014 (3,529 to 8,217), with the largest growth in ages 10-14 at 143 percent and 15-19 at 87 percent. Based on classification, 29 percent of concussions were associated with some loss of consciousness.
A possible explanation for the significant number of adolescent concussions is increased participation in sports, said Zhang, MD, who is also assistant professor of orthopaedic surgery at UCSF. It also may be reflective of an improved awareness for the injury by patients, parents, coaches, sports medical staff and treating physicians.
New research from The Children’s Hospital of Philadelphia (CHOP) and the Centers for Disease Control and Prevention (CDC) highlights a substantial gap in how the United States currently estimates the nation’s burden of pediatric concussions. Among 0- to 17-year-olds who have a CHOP primary care physician and were diagnosed with a concussion within CHOP’s regional pediatric network, 82 percent had their first concussion visit at a primary care site, 12 percent at the emergency department, 5 percent within specialty care (sports medicine, neurology, trauma), and 1 percent were directly admitted to the hospital. Many current counts of concussion injury among children are based solely on emergency department (E.D.) visits or on organized high school and college athletics data. Thus, the authors say, we may be vastly underestimating child and youth concussions in the US.
“We learned two really important things about pediatric concussion healthcare practices,” says Kristy Arbogast, PhD, lead author and Co-Scientific Director of CHOP’s Center for Injury Research and Prevention. “First, four in five of this diverse group of children were diagnosed at a primary care practice—not the emergency department. Second, one-third were under age 12, and therefore represent an important part of the concussion population that is missed by existing surveillance systems that focus on high school athletes.”
There’s the tough-minded crowd, throwing all caution to the wind when it comes to concussions, and then there’s the practical-minded crowd—those folks that are beginning to see the light.
Developing brains don’t need trauma. Besides, when it comes to the sport of hockey, the percentage of those 11 and 12-year olds that will ever play in the NHL is miniscule—like all professional sports. So why take the risk? Anything that you can do to decrease the incidence of brain trauma should be implemented, and that’s what’s happening in Canada. Hockey Canada is finally taking action
Even tough guy Jim Peplinski, “best known as the co-captain (with Lanny McDonald) of the 1989 Calgary Flames team that broke a lot of Montreal hearts in a six-game Stanley Cup final,” gets it. He has gone so far as to call “for a nationwide ban on bodychecking until at least age 16 to cut down on the concussion rates.”
Everyone should read this article. It’s insightful, and more importantly tempers the dream with reality. Go to –