A new study published online July 29, 2019, in the journal Brain Injury found sports and recreation to be the leading cause of nonfatal TBI in adolescents ages 5 to 19. The Pacific Institute for Research and Evaluation assessed National Electronic Injury Surveillance System data collected from 100 U.S. emergency rooms between 2010 and 2013. They wanted to determine which consumer products (home furnishings and fixtures, like beds) and which sports caused the most TBIs in people younger than 20 years old. Of more than four million nonfatal TBIs seen in emergency departments, home furnishings and fixtures accounted for the highest rate of TBIs in infants less than 1 year old and children ages 1 to 4. Sports and recreation like football contributed to 53.9 percent of TBIs in children ages 10 to 14 and 38.3 percent in 15- to 19-year-olds. Football was the fifth leading cause of TBI for 5- to 9-year-olds. “Football is clearly in the line of sight in this particular issue given all the high profile cases,” says Wayne Moss, executive director of the National Council of Youth Sports. “It’s a pandora’s box as far as having public conversations about TBI, especially as the science is evolving on this issue.” According to the UPMC Sports Medicine Concussion Program, around 20 percent of high school athletes who play contact sports, including soccer, sustain concussions each year. The effect these injuries have on kids largely depends on severity and early intervention. RELATED: Does My Child Have a Concussion?
Health Effects of TBIs
Bina Ali, PhD, a researcher at the Pacific Institute for Research and Evaluation in Beltsville, Maryland, and one of the study’s authors, says the fact that the data in this study only included patients who sought care in emergency departments suggests these TBIs were serious cases that required medical attention. Still, other studies, such as one published in August 2017 in the journal Brain Science, estimated that as many as 90 percent of TBI cases that pass through U.S. emergency departments every year are considered mild, putting the odds of recovery on the patient’s side. “About 85 percent of people will fully recover from a mild TBI, so the injury will likely not cause long-term effects in most people,” says Min Jeong Park Graf, MBBS, medical director of the traumatic brain injury outpatient program at Hennepin Healthcare in Minneapolis, noting that the remaining 15 percent could suffer permanent damage. (Some research shows an association between TBIs and a higher risk of developing Alzheimer’s disease and dementia, and an increased risk of suicide, although more research is needed to draw any conclusions.) Park says getting an injured player out of the game or practice immediately is crucial to minimizing the impact of a brain injury. So is keeping an athlete on the sidelines until she or he is fully healed. “The adolescent brain is more vulnerable because it isn’t fully developed, and kids are more susceptible to sustain another TBI when they already have one,” says Park, noting that this repeat scenario is more dangerous and in rare cases it could even lead to death.
Increased Awareness Is Key
The extent of TBI education has come a long way in recent years. In the past decade all 50 states have passed Return to Play laws, which lay out a clear plan for how concussions in young athletes should be handled, according to the Centers for Disease Control and Prevention. Dr. Ali, Dr. Park, and Moss agree that parents, coaches, and athletes all appear to be more aware of the signs of brain injury and what should be done if one is suspected. Inspecting gear and discarding or repairing damaged pieces also minimizes risk. Moss says coaches should audit playing surfaces for uneven or unpaved areas, and that bikers need to be taught to be aware of drivers and respect traffic signals.
Youth Sports Organizations Are Taking the Lead
There are still cracks in the system that education has not, and maybe cannot fill. But that’s where new rules and regulations come in. “We do still have a culture in some places where winning and playing time for young people is important,” says Moss. “Whether that pressure is coming from the athlete, the coach, or even the parent, there’s more education needed around this issue so we don’t put any young person in a situation where their safety could be compromised.” Moss says Pop Warner, the nation’s largest youth football organization, has been a leader in minimizing risk in youth sports. It’s eliminated kickoffs for the three youngest divisions (5- to 10-year-olds) and reduced the allowable amount of practice time dedicated to hits to 25 percent.
Benefits of Playing Sports Outweigh Risk
The risk of TBI should not deter parents from enrolling their kids in sports — the benefits they provide far outweigh the risks, especially since taking precautions is becoming the new normal. Exercise can reduce stress and depression, and sports teach real-world skills, like teamwork and discipline. “There are so many good things about sports, you just have to do it in a safe way,” says Park.
