Abstract
Background:The risks of repeat concussions and returning to play (RTP) prior to the resolution of concussive symptoms are medically established. However, RTP guidelines for high school sports are varied and often notably absent. The island of Guam, a US territory, has a robust athletics program but lacks structure to reduce concussions or establish RTP protocols. Consequently, there is an opportunity to limit the incidence of “second-hit syndrome” and other harmful effects through education and testing.Methods:We evaluated the feasibility of Sideline Concussion Testing SCT) as a novel feature of Guam high school athletics. Thirteen high school football players were observed over three consecutive football games. They were first given a questionnaire about concussion history, symptoms, medical evaluation, and RTP. Researchers used the King–Devick Test, a SCT tool, and baseline scores were recorded. If players were then observed to have significant head trauma or to show concussive symptoms, they were sidelined and tested.Results:Five of 13 students had a previous concussion and limited awareness of RTP guidelines. Of those five, four received no medical consultation or stand down period before RTP. There was also a lack of understanding of what constitutes a concussion; five out of eight individuals who denied previous concussion confirmed having bell ringers, seeing stars, and other classic concussive symptoms. Over the course of the study the SCT identified three concussions, with significant deviations from baseline time on a test that measured visual and speech disturbances.Conclusions:The feasibility of SCT use in Guam high school football was established and our pilot study identified areas for improvement. Established definitions of concussion and RTP guidelines were lacking. Therefore, an opportunity exists through public health efforts that involve the entire community to increase concussion awareness and reduce injuries in high school sports on Guam.
Highlights
During the 2013-2014 high school football season, we evaluated the feasibility of performing Sideline Concussion Testing (SCT) at high school games
Out of 43 football athletes from one Guam high school who were asked to participate in the study, 13 agreed
Others said their parents refused to sign the informed consent form http://www.surgicalneurologyint.com/content/5/1/91 because they did not want their children involved in a concussion study, or they were concerned that records of concussive events could be used against their children during college recruiting or by the school administration
Summary
Despite the numerous benefits of athletics for children and adolescents, the unique risks of concussion on the developing brain are a genuine health concern that is driving change in high school sports.[1,5,15,18] At the forefront are contact sports, and most medical and sports societies offer definitions of concussive events and guidelines for return to play (RTP).[10,13,20] The risks of repeated concussions and the dangers of RTP prior to complete resolution of the concussive symptoms are firmly established, and ongoing research continues to add new information to formal guidelines in the future.[10,11,20] the success of implementing these guidelines throughout high school sports programs has been mixed. As Guam’s adolescent population grows,[2,17] so does their participation in interscholastic sports, but at present, the schools in Guam have no formal guidelines to reduce concussion, or to delay RTP after a concussion has occurred. Given this lack, and the recent advancements in concussion research, Guam may benefit from increasing high school awareness of concussions, and a more formalized program to reduce them, in order to limit the potential long‐term deleterious effects of concussions on Guam’s youth. There is an opportunity to limit the incidence of “second‐hit syndrome” and other harmful effects through education and testing
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