Reducing traumatic brain injuries in youth sports: Youth sports traumatic brain injury state laws, January 2009-December 2012
Hosea H., Harvey JD. American Journal of Public Health. 2013; ahead of print.
Take Home Message: In the United States, traumatic brain injury laws reflect a uniform, but not scientifically proven consensus about return to play time, who makes the return to play decisions, and the best delivery method to distribute educational information. None of the laws target injury prevention.
Forty-four states and Washington DC passed legislation to reduce the overall impact of traumatic brain injuries. However, there are no studies comparing the content of the laws with the current scientific literature regarding symptoms, treatment, and the effect the laws have on youth traumatic brain injuries. Therefore, the purpose of this study was to describe the current statewide youth sports traumatic brain injury laws and their relationship to established scientific literature of youth traumatic brain injuries. Westlaw and Lexis-Nexis databases were used to create a 50-state dataset of youth sports traumatic brain injury laws enacted between January 2009 and December 2012. The laws were coded to identify key variables, which included types of sports covered, age of target population, and reporting protocols. The laws primarily focus on secondary problems that arise following traumatic brain injuries and are modeled on the Lystedt framework (Washington; i.e., removal from play, evaluation by a health professional, and distribution of concussion information). None of the states enacted any primary prevention protocols. Forty-two laws include a mandatory removal from play when a concussion is suspected. Most laws require a minimum of 24 hours before return to play. Forty states and Washington DC require a young athlete to be cleared by third party before returning to play and almost all of these laws express that this third party must be a health professional. Only 26 states require that the health professional be trained in traumatic brain injury identification or management. Furthermore, 34 jurisdictions require traumatic brain injury information to be distributed to parents and/or guardians of student athletes. The content within the information packets are not specified in the laws, but the CDC’s material have been specifically mentioned in some of the laws. Out of the 45 jurisdictions that have traumatic brain injury laws only 25 explicitly require coach education in recognizing the symptoms of traumatic brain injuries in youth sports and the training requirements range from annually to every several years.
States across the U.S. are responding to the increased public awareness of traumatic brain injuries in youth sports by passing laws to improve identification and management. These laws vary little in their content across the states and none of the states focus on prevention. Many states implemented a minimum of a 24-hour removal period; however, 24 hours may not be enough time to safely monitor symptoms and conduct a graduated return-to-play protocol (McCrory et al., 2013). States seem to diverge the most regarding who is qualified to make the return to play decision. There are 19 jurisdictions that do not require traumatic brain injury specific training and there is no research whether or not this is appropriate and safe for youth athletes. The educational component is one of the most important aspects of the laws, but is lacking in its efficacy in helping parents prevent, identify, and respond to traumatic brain injuries because the content of the required educational information in most cases is not specified. Lastly, because youth sports typically do not have athletic training or medical personnel coverage during practice or games traumatic brain injury training for coaches is vital but the training standards are lacking in the laws. Furthermore, the laws do not try and regulate the content of sports activity like how many impacts is safe or banning specific maneuvers. This all suggests that we need to evaluate the existing laws to develop more comprehensive laws governing traumatic brain injuries in youth sports. It is important that we encourage not just evidence-based practice for traumatic brain injuries but also evidence-based legislation. As clinicians and researchers in sports medicine, we must work with the legislatures to improve the existing laws and when we believe the legislation is lacking we should help fill the gaps by raising the standards of education, awareness, and prevention in our communities.
Questions for Discussion: Do you think the current laws in place substantially improve the recognition and management of traumatic brain injuries in youth sports? Do you think changing the laws will help prevent concussions? What aspects of the laws do you think are the most or least beneficial?
Written by: Jane McDevitt PhD, ATC, CSCS
Reviewed by: Jeffrey Driban
Related Posts:Harvey HH (2013). Reducing traumatic brain injuries in youth sports: youth sports traumatic brain injury state laws, january 2009-december 2012. American Journal of Public Health, 103 (7), 1249-54 PMID: 23678903