Concussions are STILL a hot topic and not just because Will Smith is playing the lead role of Bennet Omalu, MD in the movie Concussion. Concussions are a looming concern at every sporting event where contact is common, parents are trying to decide when and where their children should participate in sports, and researchers are scurrying to better understand every aspect of this injury and how to treat it. My usual review of the news confirms these observations yet again – ranging from the mix of sad outcomes as a result of multiple concussions to those trying to enact new processes and technology to give the medical community the tools to better recognize and treat these injuries. Sometimes there’s so many different components to this entire concussion crisis, it’s hard to know where to start. All that being said, I do believe that we have people out there making small discoveries that will ultimately lead us all to the breakthroughs we’re looking for – in recognition and diagnosis, management and understanding the long-term prognosis of these injuries.
I came across something today that prompted me to look more closely injury surveillance for youth (5 yr. – 21 yr.) in all types of sports, not just organized high school or college ones. There are still many unanswered questions regarding concussions, including sufficient actionable epidemiology data that can be utilized for better clinical decision-making. Many states included an injury surveillance requirement as part of their sports-related concussion legislation, but at this point the state data is not aggregated into any sort of national surveillance system. To review your states concussion legislation and learn about your state’s concussion surveillance system (if mandated) check out: http://www.ncsl.org/ and enter “concussion and [state]” in the search box.
The idea of a national concussion injury surveillance system seems to be such an important move it was the first recommendation by the IOM in 2013 as part of Sports Related Concussions in Youth: Improving the Science, Changing the Culture. Implementing a national injury surveillance system provides more complete epidemiological data. This data not only allows us to better understand incidence and risk, but it helps judge the effectiveness of current prevention strategies and implement new ones to address disparities. Our goal is always to prevent concussions and limit the likelihood of the injury, but do we have data to support current strategies or develop new ones?
The most commonly cited injury surveillance systems cited when discussing concussion include:
- Reporting Injuries Online (RIO) - captures high school athletes participating in organized sports
- National College Athletic Association (NCAA) Injury Surveillance System - captures injuries in college athletes
- U.S. Consumer Product Safety Commission's National Electronic Injury Surveillance System - captures injuries reported to designated emergency department’s that involve sports equipment (helmets, bats, pads, etc.)
While each of these systems can tell us about a specific subset of athletes, it doesn’t capture all potential concussions that can occur as a result of sports participation. These systems do not capture concussions in athletes younger than 14 years old, those who participate in private organized sports or participate in recreational sports.
How do we capture all the necessary data to obtain the robust epidemiological data health care providers seek? Currently the limited data provided has gaps as mentioned above and may not be easily generalizable either. A national concussion surveillance system could be part of the solution. The momentum to develop such a system seems to be picking up steam. There appear to be some projects in the works that could get us there.
The Centers for Disease Control (CDC) just published, Report to Congress on Traumatic Brain Injury Epidemiology and Rehabilitation Recommendations for Addressing Critical Gaps that reiterates the need for a national surveillance system along with several other recommendations. The 2016 budget request also includes $5 million to complete a telephone survey intended to improve the available concussion epidemiological data regarding very young athletes and unreported concussion by contacting and surveying patients by phone.
Congress is scheduled to take up the topic of concussions yet again via the House Energy and Commerce Committee in 2016. The committee chairman, Fred Upton, promises a “broad review” of concussions. I wonder aloud whether this review could lead to the development of a national injury surveillance system for concussions for all young people who participate in sports, whether recreational, private league or organized school sports (high school or college). Fred Upton did not mention injury surveillance as a specific topic to be addressed, but it’s one of the many parts of the concussion puzzle I hope will be addressed.
Whether it’s the CDC or Congress or some other project that collects the epidemiological data necessary to begin to fully understand concussion, collecting this data will help begin to address the gaps in the medical communities understanding of concussions. Beyond encouraging athletes and parents to report concussions in order to receive appropriate care, the medical community must be able to collect and share data to ensure concussion patients are receiving the best evidence-based care possible.