Sports Medicine Research: In the Lab & In the Field: Time-to-Subsequent Head Injury from Sports and Recreation Activities (Sports Med Res)
Thursday, April 5, 2012

Time-to-Subsequent Head Injury from Sports and Recreation Activities

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

4 comments:

barcelona said...

I read this blog after reading this blog i wanna share with you that i am a instructor in a fitness club.before a couple of years.My student injured during the exercise practice.he hit from his head and he lost his memory for the few days.after testing reports.the boon of his head had broken and that's why after few days he had been dead.....

Bethany said...

This is great to be able to see incidence rates of head injury outside of the typical athletic training setting. This mentioned that men are more likely to sustain head injury and that younger age groups were more likely to go to the ER for a head injury. Did the original article mention anything about the breakdown of age groups at the ER? So, although it said that 14-17 year olds are 4 times more likely to go to the ER, of all the people who went to the ER, how many of them were in the 14-17 age range?

I think that athletic trainers would provide a valuable asset in the middle school and even elementary school settings. The 18-22 age group was less likely to go to the ER than the younger aged individuals; perhaps this is because many people in the 18-22 range are college athletes with access to an athletic trainer? If having an athletic trainer available for middle and elementary school athletes will reduce rates of these age ranges reporting to the ER, the healthcare savings by both parents and the hospital (ER visits are among the most expensive, compared to general doctor visits or even specialist visists) would be astronomical. This, along with the ability to catch some head injuries (as well as other types of injury) that may go unreported, suggest to me that the job setting opportunities available to athletic trainers are sure to expand.

Jane McDevitt said...

Bethany-
The article only gave the number of head injuries overall and by gender. They did not break the number of head injuries down by age group. They assessed the hazard ratio which is where they estimated the 4 times higher likely hood of 14-17 age group getting a brain injury compared to the 30-35 age group. Having athletic trainers at middle school and elementary school events would be beneficial and I beleive that it probably could reduce the head injury rates at the ER. However, you have to keep in mind that this article did not just count school sports-related head injuries. For instance, they included head injuies that occured on a jungle gym, playing with animals, and believe it or not hacky sack was on the list as a mechanism of head injury.

Jeffrey Driban said...

Just to compliment Jane's comment here is the National Cancer Institute's definition of hazard ratio: "A measure of how often a particular event happens in one group compared to how often it happens in another group, over time. In cancer research, hazard ratios are often used in clinical trials to measure survival at any point in time in a group of patients who have been given a specific treatment compared to a control group given another treatment or a placebo. A hazard ratio of one means that there is no difference in survival between the two groups. A hazard ratio of greater than one or less than one means that survival was better in one of the groups."
Reference: http://www.cancer.gov/dictionary?cdrid=618612

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