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    Concussion Information

    Concussion in High School Sports Guide
    (Information adapted from the CDC's TBI Coaches Guide)

    The Facts

    • A concussion is a brain injury.

    • All concussions are serious.

    • Concussions can occur without loss of consciousness.

    • Concussions can occur in any sport.

    • Recognition and proper management of concussions when they first occur can help prevent further injury or even death.

    Concussions are sometimes called mild traumatic brain injuries (MTBI). They are caused by a bump, blow, or jolt to the head. Concussions can occur in any sport, including these:1, 2

    Baseball Gymnastics Softball
    Basketball Ice Hockey Volleyball
    Field Hockey Lacrosse Wrestling
    Football Soccer  

    The potential for concussions is greatest in athletic environments where collisions are common.3 Environmental factors also can cause injury. For example, a player may collide with an unpadded goalpost or trip on an uneven playing surface.

    Sometimes people do not recognize that a bump, blow, or jolt to the head can cause a concussion. As a result, athletes may receive no medical care at the time of the injury, but they may later report symptoms such as headache and dizziness. These symptoms can be a sign of a concussion.4

    • An estimated 300,000 sports- and recreation-related head injuries of mild to moderate severity occur in the United States each year.5 Most can be classified as concussions.

    • Collegiate and high school football players who have had at least one concussion are at an increased risk for another concussion.6, 7

    • A repeat concussion that occurs before the brain recovers from the first—usually within a short period of time (hours, days, or weeks)—reportedly can result in brain swelling, permanent brain damage, and even death. This condition is called second impact syndrome.8, 9
       

    Signs and Symptoms

    One or more of these signs and symptoms may indicate that a concussion has occurred.10 Remember that concussions can also occur with no obvious signs or symptoms. Any of the symptoms listed in this table should be taken seriously. Athletes who experience these signs or symptoms after a bump, blow, or jolt to the head should be kept from play until cleared by a health care professional.

     

    SIGNS OBSERVED
      SYMPTOMS REPORTED BY ATHLETE
    Appears dazed or stunned             Headache
    Is confused about assignment   Nausea
    Forgets plays   Balance problems or dizziness
    Is unsure of game, score, or opponent   Double or fuzzy vision
    Moves clumsily   Sensitivity to light or noise
    Answers questions slowly   Feeling sluggish
    Loses consciousness   Feeling foggy or groggy
    Shows behavior or personality changes   Concentration or memory problems
    Can’t recall events prior to hit   Confusion
    Can’t recall events after hit  

     
     
    Prevention and Preparation


    Insist that safety comes first. Teach athletes safe playing techniques and encourage them to follow the rules of play. Discourage all unsportsmanlike conduct and support strict officiating of games. Make sure athletes wear the right protective equipment for their activity (such as helmets, padding, shin guards, and eye and mouth guards). Protective equipment should fit properly, be well maintained, and be worn consistently and correctly.

    Teach athletes that it’s not smart to play injured. Sometimes players, parents, and other school officials wrongly believe that it shows strength and courage to play injured. Discourage others from pressuring injured athletes to play. Don’t let athletes persuade you that they’re “just fine” after they have sustained any bump, blow, or jolt to the head.

    Prevent second impact syndrome. Keep athletes with known or suspected concussion from play until appropriate medical personnel have evaluated them and have provided permission for returning to play. Remind your athletes: It’s better to miss one game than the whole season.

    When a Concussion Occurs
    If you suspect that a player has a concussion, implement your action plan by taking
    the following steps:

    1. Remove the athlete from play. Learn how to recognize the signs and symptoms of concussion in your players. Athletes who experience signs or symptoms of concussion should not be allowed to return to play. When in doubt, keep the player out of play.

    2.  Ensure that the athlete is evaluated by an appropriate health care professional. Do not try to judge the severity of the injury yourself. Health care professionals have a number of different methods that they can use to assess the severity of concussion.

    3. Inform the athlete’s parents or guardians about the known or possible concussion and give them the fact sheet on concussion. Make sure they know that the athlete should be seen by a health care professional.

    4. Allow the athlete to return to play only with permission from an appropriate health care professional. Prevent second impact syndrome by delaying the athlete’s return to the activity until the player receives appropriate medical evaluation and approval for return to play.



    References
    1. Powell JW, Barber-Foss KD. Traumatic brain injury in high school athletes. Journal of the American Medical Association 1999;282:958–963.

    2. Harmon KG. Assessment and management of concussion in sports. American Family Physician 1999 Sep 1;60(3):887–892, 894.

    3. Powell JW. Cerebral concussion: causes, effects, and risks in sports. Journal of Athletic Training 2001;36(3):307–311.

    4. Kushner DS. Mild traumatic brain injury. Archives of Internal Medicine 1998;158:1617–1624.

    5. Sosin DM, Sniezek JE, Thurman DJ. Incidence of mild and moderate brain injury in the United States, 1991. Brain Injury 1996;10:47–54.

    6. Guskiewicz KM, Weaver N, Padua DA, Garrett WE. Epidemiology of concussion in collegiate and high school football players. The American Journal of Sports Medicine 2000;28(5):643–650.

    7. Zemper ED. Two-year prospective study of relative risk of a second cerebral concussion. American Journal of Physical Medicine and Rehabilitation 2003 Sep;82:653–659.

    8. Institute of Medicine (US). Is soccer bad for children’s heads? Summary of the IOM Workshop on Neuropsychological Consequences of Head Impact in Youth Soccer. Washington (DC): National Academy Press; 2002.

    9. Centers for Disease Control and Prevention (CDC). Sports-related recurrent brain injuries—United States. Morbidity and Mortality Weekly Report 1997;46(10):224–227. Available at: www.cdc.gov/mmwr/preview/mmwrhtml/00046702.htm

    10. Lovell MR, Collins MW, Iverson GL, Johnston KM, Bradley JP. Grade 1 or “ding” concussions in high school athletes. The American Journal of Sports Medicine 2004;32(1):47–54.



    Additional Resources

    Centers for Disease Control and Prevention
    This website has English and Spanish fact sheets and brochures on concussion and traumatic brain injury. www.cdc.gov/ncipc

    Brain Injury Association of America
    This organization provides information and resources to improve the quality of life for individuals with brain injuries. www.biausa.org

    CDC does not endorse the articles, products, or guidelines of other organizations or individuals referenced in these materials. CDC provides this information to raise awareness about the magnitude of concussion in high school sports as a public health issue and to offer a scientific overview of the topic.



    Centers for Disease Control and Prevention gratefully acknowledges the following organizations for their participation in this project:

    American Academy of Pediatrics
    American Association for Health Education
    American College of Sports Medicine
    American School Health Association
    Association of State and Territorial Health Officials
    Brain Injury Association of America
    Institute for Preventative Sports Medicine
    National Association for Sport and Physical Education
    National Athletic Trainers’ Association
    National Federation of State High School Associations
    National Safety Council
    North American Brain Injury Society
    University of Pittsburgh Medical Center Sports Medicine Concussion Program
    U.S. Department of Education


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