Concussions: Who is Grading Them and Will the Truth be Told?

Milford Regional Medical Center had 596 patients with a diagnosis of concussion last year, according to Terri McDonald, director of public relations and marketing. Not all of these concussions came from sports, but this tally is significant.

More than 62,000 concussions are sustained each year in U.S. high school contact sports and the likelihood of suffering a concussion while playing a contact sport is estimated to be as high as 19 percent for each year of play, according to the U.S. Centers for Disease Control (CDC). 

A study commissioned by the NFL reported that neurological diseases appear to be higher in those who had football concussions, quoting a rate of 19 times the normal rate for men ages 30 through 49. Although more than 90 percent of concussions are mild, they can cause significant neurological impairments (such as problem solving, planning, and memory) especially if the person sustains multiple concussions.

A concussion occurs when the head hits any object, typically while in motion, and the brain shakes inside the skull. The CDC lists symptoms of concussions as:

• Prolonged headache
• Vision disturbances
• Dizziness
• Nausea or vomiting
• Impaired balance
• Confusion
• Memory loss
• Ringing ears
• Difficulty concentrating
• Sensitivity to light
• Loss of smell or taste 

On March 1, a new concussion policy approved by the Milford school officials will sideline student athletes for a year if they receive a severe concussion or several milder ones. My understanding is that this policy requires a player be sidelined for a year after three mild, two moderate or one severe concussion. The policy was adopted, in part, based on recommendations from Milford pediatrician Dr. Felix Perriello, who told School Committee members the policy was "revolutionary."

After a thorough review of the CDC, MIAA, NCAA, American Academy of Neurology and American Academy of Pediatrics guidelines for treatment and return to sport, I discovered agreement on removing any student with head injury for the remainder of that day, evaluate for symptoms of concussions and when symptom free, and returning the student slowly with a progressive athletic step-up type program.

The many resources encouraged evaluation of symptoms during activity because concussion symptoms may be absent at rest, but return upon exertion. This would defeat the purpose of a pre-season evaluation at a cost of $1,000.

There was, however, a lack of agreement about how to manage second or third concussions in the same athlete. In addition, no guidelines are offered for the management of serial concussions of different grades. In none of these resources was there any mention of removing a student from sports for a full calendar year. Even with a Grade 3 concussion, the CDC recommended side lining for one month of no symptoms before the progressive return was evaluated and “following repeated concussions, a player should be sidelined for longer periods of time and possibly not allowed to play for the remainder of the season.”

The long-term neurological ramifications of concussions are concerning and as a daughter devastated by a parent with early-onset dementia, I want to protect my children as much as I can. However, I fear what Dr. Perriello referred to as “revolutionary” is a blanket policy that has obstacles and may bite us in the health butt.

The first obstacle resides in the difficulty with deciphering the level of a concussion. Confusion and consciousness may be an obvious diagnosis, but a mild injury to the brain may be undetectable in routine neurological examinations.

The second obstacle resides in reporting of symptoms by the student. Part of the policy will emphasize coaches discussing the new regulations, which may hinder reporting of minor symptoms such as headaches, light sensitivity, nausea or pain.

A third obstacle resides in those who are injured after March 1, and those who have documented concussions to date. If prevention from neurological harm is the goal, what should a coach or trainer do with the student they know has sustained one (or more) concussions prior to this date? And what training do the coaches and trainers receive for evaluating and grading concussions?

The last obstacle resides in coaches, trainers and parents judging and reporting symptoms of concussions. Anyone who has ever played sports, coached sports or watched a child play (especially in playoffs) wants to be in the game and might be tempted to under-report symptoms to prevent being sidelined for a year. This is a serious health concern.

I hope I am wrong about these obstacles and find the concussion policy helps improve the health of Milford children now and in the future. Now lets make a policy on decreasing sugar in schools and sports drinks and watch this town's health really transform!