Many Sports-Related Concussions May Go Untreated in Children, Study Finds

— -- Nearly 2 million children may be suffering sports- and recreation-related concussions (SRRCs) every year, and many of those may go untreated, according to a new study published today.

Researchers from the University of Washington and Seattle Children’s Research Institute, together with colleagues at the University of Colorado, found that between 1.1 and 1.9 million children may suffer an SRRC every year.

The researchers came to these findings, published in the medical journal Pediatrics, after analyzing three national databases that contained injury information reported to various healthcare settings, including emergency departments, inpatient and outpatient medical providers, and certified high school athletic trainers.

Alarmingly, researchers estimated that between 511,590 and 1,240,972 SRRCs went untreated in children under 18 each year.

The study comes as concerns over concussions and their long-term effects on the brain have increasingly gained attention, especially as related to chronic traumatic encephalopathy (CTE).

Concussions, which are a mild form of traumatic brain injury, can be the result of any direct blow to the head. They can also be caused by any impact to the body that is strong enough to shake the brain inside the skull.

Dr. Steven Flanagan, chair of Rehabilitation Medicine at NYU Langone Medical Center and an expert in traumatic brain injuries including concussions, said more attention needs to be paid to concussive injuries and identifying teens or other children with these injuries early.

He pointed concussive impacts can cause bruising of the brain or can cause the nerve cells to twist or stretch, causing injury. Whenever a concussion is suspected, the athlete should be taken out of play until they are evaluated and cleared by a healthcare provider. This is to avoid what Flanagan calls “second impact syndrome,” which occurs when a child or adolescent sustains another concussion without fully recovering from the first. Although extremely rare, this can lead to massive brain swelling that can lead to severe brain damage, according to Flanagan.

However, Flanagan stresses that “the most important aspect with regards to concussion is recognizing it.”

So what signs should parents be aware of? It’s important to remember that a concussion is not always accompanied by a loss of consciousness. Symptoms that may occur at the time of injury include feeling dazed or confused, blurred vision, or amnesia for the time of the injury. Additional symptoms later on may include difficulty paying attention, becoming more irritable, or sleepiness. Most people with a concussion will get better within days to a couple weeks.

Certain symptoms indicate a need for immediate evaluation by a healthcare provider. These include nausea, vomiting, worsening headache, trouble staying awake, or if symptoms don't clear up after a few days.

“Many folks get worried about concussions, and rightfully so, but the vast majority really do well over a short period of time,” said Flanagan. However, he notes that parents know their children best, and advises that “when in doubt, seek out professional help.”

According to Flanagan, the most generally accepted treatment early on is physical and cognitive rest, which includes limiting time spent watching TV or reading.

Dr. Alex Diamond, a pediatric sports medicine specialist and director of the Program for Injury Prevention in Youth Sports at Vanderbilt, said that the significance of this study lies in the fact that “the number of concussions that we’ve all been reporting is probably less than what it is in reality. There is an entire vulnerable population of kids that we’re missing.”

While high school athletes have easy access to people trained in recognizing concussive symptoms, many children may be injured during free play or during recreational sports.

Per Diamond, “What we have to do is address this population group and provide better ways for parents or other people involved in recreational sports or play to understand what the potential signs and symptoms are, how to better recognize and respond to them.”

He also noted that there is a disparity in the amount of money and resources provided to children not participating in an organized sport versus those who are, especially as medical providers are increasingly promoting more physical activity for all children and adolescents.

Dr. Maryam Jahdi is a psychiatric resident at The Ohio State University Wexner Medical Center. She is a resident in the ABC News Medical Unit.