Time-to-subsequent head injury from sports and recreation activities
Harris AW, Voaklander DC, Jones A, Rowe BH. Clinical Journal of Sports Medicine. 2012:22;91-97
In recent years, head injuries have received more attention largely driven by elite athletes sustaining multiple head injuries as well as recent research that have suggested poor long-term outcomes as a result of multiple head injuries. However, much of the research has been focused on specific athletic populations and not the general population. The objective of this study was to assess a population-based sample of individuals presenting with head injuries to the emergency room (ER) and examine the duration between subsequent head injuries. A retrospective design enabled researchers to evaluate 8,958 patient reports. This study included patients who were 35 years old and younger and reported with head injuries to 1 of 5 ERs in Canada between 1997 and 2008. Records were excluded if head injuries did not result from a sports and recreational activity (SR; e.g., fall, car accident), had other factors that contributed to the head injury, the records indicated the patient was transferred between health care facilities, had repeated head injuries within a 14-day period, and was not a resident of the Capital region. Patients that reported to ER due to head injuries were between 1 and 35 years of age and those with subsequent head injuries were between 4 and 34 years of age. Males accounted for most of the patients with initial (73%) as well as subsequent head injuries (77%). SR activities, which resulted in the greatest odds of sustaining an initial head injury, were animal-related activities (e.g., rodeo, horseback riding; ~3.5 times likely), rugby (~2.6 times likely), and vehicle (e.g., all-terrain vehicles, motor cross; ~2 times likely) activities as compared to miscellaneous SR activities (e.g., sky diving, recreation flying, badminton, table tennis, triathalon). Basketball had the lowest odds of sustaining head injuries (0.38 times likely) compared to the miscellaneous set of SR activities. Researchers found a significant trend indicating that the greater the number of SR head injuries the shorter time period between head injuries. The amount of time between the first SR-head injury and subsequent SR-head injuries is almost nine years and the time between 2nd SR-head injury and 3rd SR-head injuries is almost 5 years. Patients with a history of 1 or 2 SR-head injuries had a 2.6 and ~6- fold increase in the odds of sustaining future SR-head injuries in this sample, respectively. Younger patients tended to be more likely to come to an ER for a SR-head injury compared to patients between 30 and 35 years of age: patients’ ages 7 to 13 (4.3 times more likely), 14 to 17 (4 times more likely), and 18 to 22 (2 times more likely). In addition, 77% of those who sustain 3 SR-head injuries were between the ages 13 to 17 years.
Clinicians and sports medicine personnel need to be aware of an increased risk of multiple concussions. Most of the activities that had higher odds of sustaining a head injuries (e.g., animal activities, motor cross, rugby) may have resulted because helmets were not always utilized, of an increased risk of falls, or the higher speed of the activities. While these sports may warrant more attention it is also important to note that most of the recurring SR-head injuries occurred within the 13 to 17 age group; however, there has been little research on the cumulative effects of head injuries in this demographic. Furthermore, the decrease in days between subsequent head injuries may suggest an incomplete recovery from the prior head injuries or that the brain may be more susceptible following an initial brain injury. This study provides us with valuable information about SR-head injuries among various age groups and SR activities but it is important to note that this data may be underestimating the true SR-head injury occurrence because patients who did not require immediate ER attention may have went to a walk in clinic, sports medicine personnel, or family physician. Based on the data showing that the pediatric population are at more risk for SR-head injury do you believe that athletic trainers should be covering working with elementary schools and youth sport organizations (e.g., rodeo, hockey, rugby)?
Written by: Jane McDevitt MS, ATC, CSCS
Reviewed by: Jeffrey Driban
Related Posts:Harris AW, Voaklander DC, Jones CA, & Rowe BH (2012). Time-to-Subsequent Head Injury From Sports and Recreation Activities. Clinical Journal of Sport Medicine, 22 (2), 91-7 PMID: 22252163