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Study Highlights Dangers of Premature Return From Concussions

A number of student-athlete deaths caused by head trauma were potentially preventable with better return-to-play guidelines and more effective equipment, according to a study published Monday in the journal Pediatrics.

The studyRequires Adobe Acrobat Reader analyzes 30 years worth of data from the U.S. National Registry of Sudden Death in Young Athletes (1980-2009), and finds that of 1,827 deaths of student-athletes aged 21 years or younger, 261 of those deaths (or 14 percent) were caused by trauma-related injuries, typically related to the head or neck. An average of nine student-athletes died of trauma-related injuries on an annual basis, with a record 16 deaths in 1986.

Not surprisingly, the largest number of trauma-related deaths came from football (148 deaths, or 57 percent of the total trauma-related deaths). While defensive players were more likely to be involved in deaths than offensive players, running back was the single most common position involved in football deaths (61 percent of all offensive player deaths).

Most notably, 17 of those football deaths came from high school athletes who suffered from second-impact syndrome, which the researchers note is entirely preventable. Those 17 student-athletes had reported sustaining a concussion anywhere between a few days to four weeks before suffering their fatal head injuries.

If the term "second-impact syndrome" rings a bell, you could be thinking of former Colorado high school football player Jake Snakenberg, who died of a fatal head injury back in 2004. Snakenberg is the namesake of Colorado's new student-athlete concussion law, which is considered the toughest in the U.S.

The study's authors conclude that most of the reported fatal injuries were potentially preventable, which speaks to the need for developing better equipment, return-to-play guidelines for concussed student-athletes, and better education for coaches, parents, and student-athletes about the potential dangers of multiple head injuries.

"It gives credence to everything we've been trying to do to make it safer for young athletes out there with proper treatment of concussions," said Dr. Joel Brenner, incoming chairman of the Council on Sports, Medicine and Fitness of the American Academy of Pediatrics, to the Associated Press.

So, what return-to-play guidelines should schools adopt for concussed student-athletes? Ideally, schools would incorporate these two main principles into the guidelines:

• All student-athletes would be required to take a neurocognitive baseline test before the start of the season—ImPACT tests are the most well-known—to have a medical record of how the student-athlete's non-concussed brain responds. After a student-athlete is suspected of having suffered a concussion, he/she would retake the test, and a medical professional would compare the results to the baseline.

Since concussions aren't as easily measured as a broken bone, baseline concussion tests give medical professionals a true sense of when a student-athlete has fully healed from his/her concussion.

• All student-athletes who obtain medical clearance after suffering a concussion would be placed on a gradual return-to-play schedule. The New York State Public High School Athletic Association, for instance, suggests a five-day return-to-play schedule for student-athletes attempting to return from a concussion to ensure that the athlete doesn't return to competition before recovering from all symptoms.

As I've covered before, the NYSPHSAA suggests light aerobic activity on day one, sport-specific activity on day two, noncontact training drills on day three, full contact practice on day four, and returning to competition on day five. If concussion symptoms flare up for a student-athlete during any of those days, he/she would not be allowed to advance through the return-to-play schedule until those symptoms clear up.

While these policies wouldn't prevent student-athletes from sustaining concussions, they would ensure that each individual student-athlete is receiving specialized care based on how quickly he/she heals from the concussion.

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