A new study in Pediatrics points to a gap in the education and training of health care providers who are now required by law to determine when a concussed athlete can safely return to play:

Although pediatric primary care and emergency medicine providers regularly care for concussion patients, they may not have adequate training or infrastructure to systematically diagnose and manage these patients. Specific provider education, decision support tools, and patient information could help enhance and standardize concussion management.

Over the last several years, pediatricians at Pediatric Alliance have been trained by the experts at the UPMC Sports Medicine Concussion Program in the diagnosis and management of children who sustain concussions during sports and other activities.  With an emphasis on thorough, serial histories and physical exams, along with the use of baseline and post-concussion computerized neuro-cognitive (“ImPACT”) tests, pediatricians who are appropriately trained can now manage children with concussions safely and effectively.

The goals of treatment for children who suffer a concussion are (in this order):

  • Make them feel better.  Ongoing and severe headaches, nausea, balance problems, and fogginess are some of the symptoms that may  force us to “shut down” concussed kids until they are feeling better.  This means restricting their physical (sports), mental (school), and visual (reading, video games, TV) activities, sometimes completely.  This can take a considerable amount of time and patience.
  • Get them back in school.  Most kids who suffer concussions will miss at least some school.  Many will miss a lot of school.  Pediatricians can work with families and schools to make sure a child returns to school, with appropriate academic accommodations, as soon as the child demonstrates readiness.
  • Get them back in sports.  Nowadays, the bar is set very high.  And, when we determine that kids can get back into sports, they must satisfy “back-to-play” criteria before they can begin full participation and contact again.


Laura Landro at WSJ.com has more:

New research is also leading to a better understanding of concussion, which occurs when a sudden movement or direct force to the head sets brain tissue in motion within the skull. Studies show, for example, that each patient may experience concussion differently, and some patients are more genetically predisposed to sustaining a concussion. Tests are helping identify those patients who may have protracted recovery periods.

For example, people who get migraine headaches are more likely to sustain a concussion after a head blow, and they predictably may take longer to recover.  Girls are also more prone to concussions, perhaps due to having relatively weaker neck muscles, than boys.

Managing these kids so carefully is important to prevent two major complications:  post-concussion syndrome and second-impact syndrome:

One risk is post-concussion syndrome, which includes chronic difficulties such as mood changes, nausea and problems with sleep, thinking, memory and attention.  A second injury sustained during recovery from concussion can result in second-impact syndrome, which can cause brain swelling, bleeding and permanent disability or death.

Read more of Laura Landro’s article here.

Read Pediatrics abstract here.

More from UPMC Sports Medicine Concussion Program here.