The Toll of Brain Injury in Amateur Sports
Abstracts & commentary
Sources: Powell JW, Barber-Foss KD. Traumatic brain injury in high school atheletes. JAMA 1999;282:958-963; Collins MW, et al. Relationship between concussion and neuropsychological performance in college football players. JAMA 1999;282:964-970; Matser EJT, et al. Neuropsychological impairment in amateur soccer players. JAMA 1999;282: 971-973.
Powell and barber-foss studied mild traumatic brain injury (TBI) among participants in high school sports. They analyzed the injury records made by 246 certified athletic trainers at 235 U.S. high schools between 1995 and 1997. Data were collected on boys and girls involved in 10 different high school sports. Rates of mild TBI were found to vary by gender and sport. The leading cause of TBI among boys was football (63% of all TBI). Wrestling was a distant second, accounting for 10.5% of all cases. Girls’ soccer was the third leading cause (6.2%) of mild TBI overall, and represented the leading cause of head trauma among high school girls. The injury rate was significantly greater during game play than in practice in all of the sports examined. Collisions between athletes were the most important event leading to mild TBI in this cohort. Extrapolating from their sample, Powell and Barber-Foss estimated the total incidence of mild TBI in high school sports to be nearly 63,000 cases per year.
Collins and colleagues examined the relationship between concussion and neuropsychological performance in college football players. Participants were drawn from a sample of 393 football players at four universities across the United States. Collins et al compared the preseason neuropsychological test performance of 16 athletes who sustained concussions during play to that of 10 other football players who were matched for scholastic aptitude test scores, history of learning disability, and other measures. Collins et al found that a history of learning disability and past history of concussion were associated with lower baseline cognitive test performance. Historically, learning disability has not been found to affect cognitive test performance of nonathletes in the domains measured. Collins et al, therefore, speculate that head trauma and learning disability may act synergistically to influence the risk of cognitive impairment after TBI in college football.
A cross-sectional study by Matser and colleagues documented the occurrence of neuropsychological impairments in 33 amateur soccer players from the Netherlands. Approximately one-fourth of the soccer players had sustained at least one concussion during their career and a nearly equal number had two or more concussions. The control group for this study consisted of amateur athletes involved in noncontact sports, including swimming and track, who were well-matched for age, education, nonsport concussions, and anaesthesia history. An inverse relationship was found between the number of concussions in the soccer players and their performance on six of 16 neuropsychological tests. A greater percentage (39%) of amateur soccer players exhibited impaired performance on tests of planning compared to controls (13%). Likewise, 27% of soccer players were impaired in memory testing, compared to 7% of controls. This study suggests that head trauma associated with participation in amateur soccer can result in chronic cognitive impairments, reminiscent of the kind previously reported in sports such as professional boxing.
Commentary
Head trauma related to amateur sports may be more prevalent than previously appreciated and more likely to cause chronic cognitive sequella. While the impacts sustained by amateur athletes may be less on average than in professional sports, amateurs may be less well-trained in safety measures and more prone to inadvertent collision than their professional counterparts. These studies suggest that concussion and/or repetitive sub-concussive blows occur with sufficient force in amateur sports to leave lasting cognitive impairments in at least some participants.
The study by Collins et al raises the interesting possibility that learning-disabled (LD) athletes may have an increased susceptibility to the effects of sports-related head trauma. Although the cross-sectional nature of their study limits the conclusions that can be drawn, it seems plausible that developmental disabilities could have such an effect by a variety of mechanisms. Insofar as LD is a trait that can be identified by history and cognitive screening tests, identifying LD athletes and judiciously restricting their play could potentially reduce some of the cognitive morbidity associated with TBI in amateur sports.
An accompanying editorial in JAMA (Kelly P. JAMA 1999;282:989-991) suggests that these studies should serve to awaken the American public and medical community to the "silent epidemic" of sports-related head trauma. We agree that more attention needs to be paid to the recognition and prevention of TBI among amateur and professional athletes to avoid negative neurologic outcomes. —nrr
The number of cases each year of mild traumatic brain injury among high school athletes is approximately:
a. 63.
b. 6300.
c. 63,000.
d. 630,000.
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