Studies provide new insights into youth and adolescent concussion

By: Christine Baugh

In the past several weeks there have been two studies with important implications for youth and adolescent concussions. They are summarized briefly in this post.

Post-Concussion Rest. Thomas and colleagues recently published a study in the journal Pediatrics examining whether standard of care (1-2 days rest) or 5 days of strict rest (both physical and cognitive) following concussion led to better short-term health outcomes in a population of 11-22 year old patients. The full text of this manuscript is available here. Expert consensus recommends strict rest –of relatively undefined duration — followed by a gradual return to cognitive and then physical activity. The study’s authors hypothesized that increased rest would improve outcomes, but found that the strict rest group did not have measurable health improvements compared to standard of care. In fact, symptom reporting was modestly higher in the strict rest group. Main study limitations include: small sample size and short follow-up period (which does not allow for insight as to longer term implications). This was the first randomized control trial of rest duration following concussion diagnosis in a youth and adolescent cohort, and the study added critical information to an important area of inquiry.

Age of first exposure. In a study by Stamm and colleagues*, published in the journal Neurology, examined a cohort of 42 former NFL players. Based on hypotheses about important neurodevelopmental milestones, Stamm and colleagues divided the former NFL players into two groups: those who began playing football before age 12 and those who began playing football at age 12 or older. In a variety of neurocognitive outcomes, the former NFL athletes who began playing football younger displayed greater difficulties than those who began playing earlier. Areas of cognition where differences between groups were significant include: executive functioning, memory impairment, and verbal IQ. Main study limitations include:  small sample size and the fact that the entire sample had very high level of exposure to brain trauma (may not generalize outside of NFL population). Although the study is the first of its kind, it presents the possibility that head impacts sustained before important stages of brain development may impact later brain development.

More broadly, in order to maximize clinical efficacy health policies need to be based on scientific evidence. Before incorporating into policy, evidence must be critically evaluated and in the best case replicated in additional studies. The two studies described present findings with potentially important implications for youth and adolescent health. Future study in this area is warranted given the large population of youth and adolescents exposed to head impacts through sports.

[This post reflects my own views only.  It does not necessarily represent the views of the Petrie-Flom Center or the Football Players Health Study at Harvard University.]

*For purposes of full disclosure, I was a co-author on the Stamm et al. study.

christinebaugh

christinebaugh

At the end of her fellowship year, Christine Baugh was a PhD student in Health Policy at Harvard University. She received her BA in History and Science from Harvard College in 2010 and her MPH from Boston University School of Public Health in 2012, concentrating in Health Law, Bioethics, and Human Rights. At the time, Christine's primary research area was brain trauma sustained through sport, and she has written about the epidemiology, risk factors, policy approaches and implications, as well as the possible long-term effects of repeated brain injury. Broadly, Christine’s research interests involve the interaction between evolving science, policy, and society. While a student fellow at the Petrie Flom Center, Christine explored conflicts of interest in the collegiate sports medicine setting in a manuscript titled "Trust, Conflicts of Interest, and Concussion Reporting in College Football Players."

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