Doctors raise concussion alarm for kids' sports


Following that advice from the American Academy of Neurology would be a dramatic change for youth sports programs, most of which don't have certified trainers.

The doctors group recognizes it isn't necessarily feasible. One official called it a gold standard to strive for.

"We understand completely that is undoable in today's environment, but we think that is a correct way to organize our priorities," said Dr. Jeffrey Kutcher, chair of the academy's sports neurology section. He said that if a certified athletic trainer is not available to a school, perhaps contact sports should be avoided.

The recommendation was part of broader guidance from the academy on sports concussions. The group also said no athlete with concussion symptoms should be allowed to take part in sports, and that athletes of all ages who are suspected of suffering concussions should be evaluated by a specialist before returning to sports.

The new position statement follows rules already adopted in college sports and pro football aimed at preventing and better treating blows to the head. Research involving NFL players suggests repeated concussions may have long-term consequences such as dementia and Alzheimer's disease.

Medical groups want to get the message "to the athletes, their parents and their coaches that a concussion is not just a ding, or getting your bell rung, but it is an injury to the brain," said Dr. Mark Halstead of Washington University, who co-authored an earlier concussion report for the American Academy of Pediatrics.

Concussions "need to be treated as if they are a big deal. The brain is pretty important."

Signs of a concussion include unconsciousness, unsteadiness, problems with memory or concentration, dizziness or headache.

The neurology academy is the most authoritative medical group when it comes to concussions. And its new advice sweeps across all ages and types of athletes.

Certified athletic trainers now work at about 40 percent of the nation's high schools but are rarely provided for athletes in younger grades, said Kevin Guskiewicz of the University of North Carolina, Chapel Hill, the lead author of the National Athletic Trainers' Association statement on managing concussions. Guskiewicz said it would be a struggle to find enough athletic trainers to meet the neurologists' recommendation.

Jim Louro, a league safety officer for the Jersey Shore Pop Warner Football League, said his league already pays emergency medical technicians to attend games and an ambulance is often on site. Coaches must have specialized training to handle injuries, he said. His league has about 8,000 football players ages 5 to 15.

Nationwide, millions of children and teens play football, he said, and "to have a certified athletic trainer at every single event around the country is very difficult, although they would be more than welcome if they're available."

Rick Bowden, assistant executive director of the Kansas State High School Activities Association, said the neurologists recommendation is "a laudable goal (but) there is no way that could happen in our state."

"There are not enough certified athletic trainers out there, and then there's the expense.... Our member schools have to balance what is desirable with what is possible."

Last week, a 17-year-old Kansas linebacker collapsed on the sidelines and later died after suffering a concussion earlier in the season. A cause of death has not been released. Bowden said he understood that a doctor had approved the boy's return to competition.

Certified trainers take a minimum of four years of training and pass a national certification exam, a much more rigorous procedure than faced by an EMT or a youth sports coach, Guskiewicz said.

Kutcher said the academy's current full guidelines on managing concussions, written in 1997, are inadequate. Experts hope to publish new guidelines by 2012, following a careful review of published studies, he said.

The academy's new statement released Monday is meant to offer guidance in the meantime for child and adult athletes, he said.

Major U.S. sports leagues have already taken steps to reduce head injuries and improve treatment for concussions.

Last December, after reports of research on older NFL players suggested a higher risk for Alzheimer's, the NFL expanded the list of concussion symptoms that would keep a player off the field and ordered teams to consult a neurologist on return-to-play decisions. This season the league cracked down on helmet-to-helmet hits by raising fines and threatening players with suspension for such collisions.

In March, the National Hockey League banned shoulder hits to the head from a player's blind side. Major League Baseball is setting up a new advisory panel on concussions, which will consider a seven-day disabled list just for head injuries. And in college sports, the NCAA's board of directors in April approved new rules on concussions, saying players must be evaluated by a medical professional experienced in dealing with such injuries.

USA Football, the sport's national governing body at the youth and amateur levels, worked with federal authorities to produce a video about concussions that is now part of its coaching certification exam.

In September, the U.S. House voted to have experts draw up federal guidelines on handling concussions in school-aged children. The bill awaits further action. Last year Washington state barred athletes younger than 18 with concussion symptoms from returning to their sports without clearance from a licensed health care provider and several other states have followed suit.

Kutcher pointed to recent studies that suggest long-term consequences like decreased mental ability, dementia, depression, anxiety and changes in personality as helping draw attention to the risk of concussions.

It's long been known that repeated head blows can cause brain degeneration in boxers, he said, but "the degree to which it appears to be happening in other contact sports ... is the new thing."

Another factor is "a change in how society views it too, which I think certainly started at the top, with the attention the NFL was getting," he said. "That has filtered down to the other levels."

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