Children have a higher risk of developing post-injury complications if they RTP on the same day
The study was carried out at the Texas Scottish Rite Hospital for Children in Plano, Texas, by Dr. Shane M. Miller, and Meagan Sabatino, senior clinical research coordinator.
According to the authors, this is the largest study to date that examines return-to-play (RTP) patterns in young athletes with concussions. The research analyzed 185 patients over a 10-month period in 2014. Participants were aged between 7-18 years and were all treated for concussion.
The study found that over a third of the participants ignored medical advice and returned to play on the same day.
Out of 185 patients, 71 resumed physical activity, making up 38 percent of the participants.
The risks of same day return to play
Several regulating bodies warn against the dangers of resuming physical activity too soon. The National Collegiate Athletic Association (NCAA) Concussion Policy and Legislation instructs that institutions prevent young players from resuming activity for "at least the remainder of that calendar day."
The NCAA also mandates that relevant institutions only allow athletes to return to play on the same day if they get medical clearance from their physician.
The Centers for Disease Control and Prevention (CDC) define concussions as "a type of traumatic brain injury caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth." They also provide a full list of signs and symptoms.
Once a patient has been diagnosed with a concussion, doctors recommend physical and mental rest. Most concussions are cleared in 7-10 days, and in sports-related concussions, the RTP should be done gradually.
Guidelines from the NCAA recommend increasing physical activities progressively, under the supervision of a physician.
As previous research indicates, premature RTP can lead to greater injuries, which can even prove fatal. If players experience a second jolt before the effects of the first concussion have entirely dissipated, there is the risk of a so-called second-impact syndrome.
A second impact can cause a failure in the brain's ability to regulate its own blood supply, which can lead to a herniation of the brain that is often fatal.
Premature RTP particularly risky for children and adolescents
Studies have pointed out the dangers of resuming athletic activity on the same day as the injury was produced, especially in young athletes. As reported in the Consensus Statement of the 4th International Conference on Concussion in Sport, there is a higher risk of developing neuropsychological deficits in adolescent athletes who return to play on the same day.
Sometimes these deficits do not have immediate symptoms or may go completely unnoticed.
Young athletes should rest for longer periods than adults, even if they do not have any symptoms.
The Consensus report is very clear in prohibiting young athletes from returning on the same day, stating: "It is not appropriate for a child or adolescent athlete with a concussion to RTP on the same day as the injury, regardless of the level of athletic performance."
Because youth athletes have specific risks of developing post-injury complications, they need longer to recover. Age-specific risks include diffuse cerebral swelling, which calls for a particularly gradual RTP procedure.
In the study conducted by Miller and Sabatino, patients who resumed physical activity too soon reported more severe symptoms than immediately after being injured.
After returning on the same day, they were more likely to experience nausea, dizziness, balance problems, and other symptoms commonly associated with brain injury.
Researchers urge industry professionals to protect young athletes
The government has made several attempts to educate sports industry professionals on concussion-related problems. Policies and state mandated training programs such as CDC's Heads Up program, or the information campaign launched by the American Academy of Neurology are a case in point.
However, as this new study suggests, safety recommendations remain largely ignored and we still need to educate young athletes, sports coaches, and athletic trainers alike on the risks of premature RTP.
Both Miller and Sabatino stress the need for continued education and training in concussion-related procedures.
"We need to emphasize the message, 'when in doubt, sit them out - and keep them out - until full recovery.'"
Dr. Shane M. Miller
Sabatino also highlights the importance of concussion education: "Our findings suggest that we still have work to do to change behaviors to protect short- and long-term brain health of youth athletes."
Sabatino and team will present their research at the American Academy of Pediatrics 2016 National Conference & Exhibition in San Francisco, CA, on October 22.