Hey Girls, How About a Concussion?

79393642_sqIf you're a woman of a certain age, read that 'teenager,' you're probably almost inexpressibly tired of hearing about the benefits of exercise. Well, as Rick and I discuss on PodMed this week, we're giving you fodder for taking an opposing view with a study identifying at least one risk of exercise for adolescent girls.  At least if you're an elite athlete playing soccer, a study in JAMA Pediatrics demonstrates a real risk for concussion. Add this to the growing body of evidence on long term health consequences relative to concussion, and the necessity to develop interventions seems imminent. It's also a timely message as school is either just about to begin or has begun in much of the US, and sports-related injuries are likely to rise.

The study followed four 'elite' girls' soccer teams comprised of 351 female players from 11 to 14 years of age. The players were followed from March 2008 through May 2012, with over 92% completing the study. Almost 44,000 hours of athletic exposure for the players accumulated over that time period.

The study employed a validated injury surveillance system consisting of a once-weekly email sent to the player's parent with a web link to a survey querying the occurrence of head injury with concussive symptoms. Such symptoms included memory loss, difficulty concentrating, confusion or disorientation, dizziness, drowsiness, headache, more emotional than usual, irritability, losing consciousness, nausea, ringing in the ears, sensitivity to light or blurry vision, and sensitivity to noise, as identified by the 3rd International Conference on Concussion in Sport.

If concussive symptoms occurred the player received a phone call from study personnel, who queried the nature of the injury, whether the player continued to play after sustaining the injury, whether she was seen by a qualified health care professional, and whether a diagnosis of concussion was made.

Here's the data from the study:  "Soccer players experienced 59 concussions, 51 incident and 8 repeat. Among concussed players, 72.9% had 1 and 27.1% had 2 concussions. Mean (SD) length of symptoms was 9.4 (13.2) days (median, 4.0 days), with 11.9% lasting less than 1 day; 52.5% lasting 1 to 7 days; 11.9% lasting 8 to 14 days; 15.3% lasting 15 to 21 days; and 8.4% lasting more than 21 days. Most concussions occurred during a game (86.4%) involving contact with another person (54.3%), the ball (29.8%), or the playing surface (15.9%). Players were heading the ball (30.5%), goaltending (11.9%), chasing a loose ball (10.1%), or getting the ball from an opponent (10.1%) when concussed. Fouls were called in 15.2% of the concussions."

Hmmmm.  As Rick and I discuss in the podcast, this data seems to suggest that helmets might be a good idea for those playing soccer, just as they've been adopted in other sports where head injury is common and problematic.  I'm certain the 'cool factor' could be overcome if the rules simply mandated helmet use.  Another practice that perhaps should be examined is heading the ball, as almost a third of the concussions occurred as a result of this practice.  Finally, Rick and I agree that early and repeated concussion may represent more of a long term health problem for girls as previous research has shown that girls are more susceptible to sports-related concussion than boys.  The significant health benefits of regular physical activity are well-known; let's make it safer if we can.

Other topics this week include a new drug for multi drug resistant TB in NEJM, cancer screening in the elderly in JAMA Internal Medicine and smoking cessation post-hospitalization, in JAMA.  Until next week,y'all live well.

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Julie Chappuis October 13, 2014 at 5:59 pm

Concussion risk is such a hot topic these days, especially with football. This focus only leads to misconceptions about the potential dangers in other sports, especially with female athletes. Thank you for highlighting this interesting study.

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