Concussion Management in Children and Adults: Is There a Difference?

This critical review analyzes the differences in concussion management between children and adults. It covers the impact of concussion on athletes, prevention strategies, and knowledge about concussion management.

Running head: British Journal Sports Medicine 1
Critical Review
According to British Journal Sports Medicine

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Question: “Concussion management in children compared to adults: is there a difference?”
Introduction
Concussion occurs when a powerful motion of the head results in a transient alternation of
mental status of physiological function of the brain. It has been found that the rates of hospital
admission and ED visits for head injuries are higher in child population in comparison of among
adults. Mild Traumatic brain injuries (TBIs), involving concussive injuries which comprises
approximately 90% of all child and adolescent TBI. There are some common diseases have been
found in a concussive injury such as nuisance, faintness, nausea, excessive exhaustion and
destruction in attention and processing speed which is considered as common. These issues or
disease can be resolved easily within 7-10 days and in case of children and adolescent it can be
resolved within 4-7 days. Post concussive symptoms are likely to obstruct skill critical for giving
best in day to day activities (Lovell and Fazio, 2008). It has been analyzed that due to these
injuries number of young people enhancing deficits out coming in an inability to involve
efficiently in social as well as academic activities. In children and young people, post concussive
symptoms influence between 6% and 35% of young people until 3 months post concussion and it
can be reduced to 1% by 1 year. Children and adults with concussion may have a prolonged
recovery. After 3 months post injury, children and adolescent majorly 0 to 18 years with
concussion are symptomatic compared with 0.5% of controls.
Concussion management in sports activity
Sports have become a vital and it plays a great role of in the life as it keeps healthy,
wealthy and active. It provides so many benefits to the health such as control blood sugar, blood
pressure, stress levels, lower hyper tension; improve blood circulation and efficient functioning

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of the heart. There are numerous sports in all over the world in which various athlete participate
to represent their country (McLeod and Gioia, 2010). Now a day’s government has started to
encourage student and athlete to participate in Olympics to represent the country because it
enhances the dignity of the particular country. Every coin has two aspects and in case of
participating in sports, athlete may get injured. There are archery, badminton, basketball, beach
volleyball, kayak, climbing, wrestling, baseball and many more. Talavage, et. al., (2014), argued
that Concussion is a brain injury caused by the below to a head or can be considered as the
violent shaking of the body and the head. It may influence the brain function. However, the
effects of concussion are generally normal and provide outcomes in the form of headache and
issues with concentration, memory issues and balance. The concussion is usually caused by a
lower to the head. It is vital to keep focus on the prevention of injury (Small, Naughton and
Matthews, 2008). Prevention can be categorized into medical screening of athletes, stretching,
proactive, suitable equipment, sports psychology, sports psychology, adequate recovery and
nutrition and fluids for sport. The main symptoms of concussion (a temporary misbalance in the
function of brain as a result of trauma) are headache, dizziness, memory disturbance, seeing stars
and balance issue. It has been found that there are so many athletes in the world who has faced
the issue of this trauma and met with a major accident. Some of them are died that is why it is
vital for the government of the country to trained athlete in an efficient manner so that they can
prevent themselves from hazardous situation.
Critical review on concussion management
It has been evaluated by the Reddy and Collins, (2009), that sudden death in young viable
athletes is highly visible incident with extensive influence on the physicians and lay
communities. The scale of this issue regarding public has become a source of controversy. The

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methods and result has been drawn from various methodologies and methods. To guesstimate the
approx number of sudden death in US competitive athletes, it has been assembled a huge register
over a 27 year period utilizing for the recognition of systematic and the tracking strategies. It has
been found by this strategy that more than 1800 athletes died sudden whose age between 19 and
5 years, were recognized throughout the US from 1980 to 2006 in 38 diverse sports. There are
some examples which is highlighted the sudden death of the athlete due to concussion. It defines
that the symptom of cognitive resolve gradually rate than substantial symptoms with issues in
attention, executive skills and processing speed up to 3 months post-injury. There are so many
theories but it is not possible to every theory to measure the issue regarding brain injury (Lynall,
et. al., 2013). Many studies can be utilized pen and papers to evaluate the neurobehavioral
measures which are not prepared for sequential utilize to identify the consistent challenges in the
presentation. The symptoms of behavioral and somatic that is headache can be examined with
the help of rating scales with revival overall same to that reported on direct cognitive assessment.
On the other hand it has been argued by Harriss and Atkinson, (2009), that recent studies belief
in to recognize clinical predictors of persisting post concussive symptoms searching are defining
the difference in the definition of concussion along with the constitutes persisting symptoms and
heterogeneous. It has been analyzed that the players who are ready to play in the similar season
after diagnosing concussion had a huge chance of greater risk of time loss injury. An extensive
fraction of players informed repetition of symptoms to meet the test of neurocognitive test score.
Examples of athletes
It has been critically analyzed that concussion can hamper the life of the athletes, there
are some illustrations of athletes with different sports which will be helpful to understand the
impact of concussion on the playing life of athletes.

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Soccer
Male players can get the attention in soccer but it cannot be understood that they are the only
ones suffering devastating head injuries. Cindy Parlow Cone is two time U.S. Olympic gold
medalist who had suffered her first soccer-related concussion in 2001.
Football
Lamar Campbell is the former of Detroit Lions Player who says that there were two things
behind his decision to give his brain to Boston’s Centre for the study of Traumatic
Encephalopathy after his death. One of them is the suicide of former linebacker Junior Seau and
the other one is young son of Campbell, in that case he determines to follow the cleats of his dad.
Hockey
Eric Lindros is the retired hockey star who has suffered from concussion in the age of 17 and he
was worried about being tagged “concussion-prone”. The career of him is ended at the age of 20
after two serious concussion in 1995.
There are some examples of those athletes who has lost their precious life and become a
victim of unexpected death. Pheidippides was a Greek soldier and conditioned runner who ran
from Marathon to Athens to publicize military victory over Persia. At last time, He delivered his
last message after that collapsed and died (DiFiori, et. al., 2014). Daniel Yorath was a well
known football player who had just been appointed by the UK team Leeds United., it has been
found that the Daniel died due to hypertropic cardiomyopathy at the same time as playing
football with his father in the home garden. Reggie Lewis is another example of sudden death
while playing, he was Boston Celtic’s star and he was the sixth captain, at the time of died, he
was only 27 years old and died while shooting basket. Sergei Grinvok was died at age of 28; he

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was the gold medalist in the sport and well known personality. He was died in the time of
training at an ice rink in United States of America. There was an autopsy done which reflected
that he had arteries of 70 year old man and he never mentioned about chest pain. It has been
cleared due to above examples that there are numerous examples of sudden death of athlete
which recommend some factors so that other athlete can prevent their life due to health issues
(Sallis, 2009). It is vital for the athlete to get checkup time to time so that they could get to know
about the internal injury and disease to prevent them at right time. The sudden death of the
athlete is an overwhelming strategy because they represent the country by showing their playing
skills against for another country. There are so many effort should be made to enhance the
awareness of the cardiovascular risk linked with sport and to execute inclusive screening
strategies to eradicate those risks.
Millions of people are involving in the sports and practice for sport on daily basis,
following the wise saying which is “A sound mind in a healthy body”. Competitive athletes are
covered under the healthiest group in the society and called as heroes. It has been found that the
sudden death of athlete are rare while playing on the field, but its incidence is usually broadly
reported in the media because the wide range of young and apparently healthy individuals may
get influenced due to sudden death of athlete (O'Donovan, et. al., 2010). The unexpected death of
a young athlete is always considered as the tragic incidents which spoil the families along with
the other young competitors. It has been evaluated that the actual rate of sudden death of young
athletes while playing on the field which defines the uncertainty of competitive sports but overall
is low. It has been estimated with the help of retrospective analysis that the occurrence of the
athletes in the US high school and college is less than 1 in comparison of 100,000 participants
per year and in the context of Italy it has been evaluated that the rate of athlete is less than 3 per

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100,000 athletes till age of 35 years. It is necessary to the athlete to keep focus on the protective
equipment so that the chances of protection from sudden death can be done.
Knowledge about concussion management
Concussion management is effective approach which is executed by the NCAA sport
Science Institute and leading scientific and sports medicine organizations for the department of
athlete and sport staff of medicine to utilize as they execute concussion analysis and the practices
of management on their property. Best practices cover the concussion management plan which is
available on the website so that everyone could get knowledge about the concussion
management plan (Paoloni, et. al., 2009). In the context of recognition and diagnosis of
concussion, students-athlete who is feeling the sign and behaviour of concussion with a sport
related concussion must be decreased and removed gradually from this practice or competition
and referred to a perfect physician who has experienced in concussion management. A sport
linked concussion diagnosed of student-athlete must not be permitted to return to play in the field
or practice as well and should be inoperative from the activity of the athletic for the reminder of
the day. It has been argued by Heptig, (2016), that post concussion management is considered as
the foundation of sport related concussion which is a part of individualized treatment plan which
covers the initial physical and relative cognitive rest. It has been analyzed that the preliminary
management of sport-related concussion is dependent on the medical assessment individually,
modifying factors and the involving the history of concussion. These management involves some
factors which will be discussed but is not incomplete to that is clinical assessment at the time of
hurt which defines that the swift evaluation of concussion during injury is essential and there can
be various tools to evaluate the brief concussion such as standardized assessment of concussion
tool 3 which is also known as SCAT 3which is able to compare with baseline evaluation. Along

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with the contribution of post concussion management in the assessment of head injury and
cervical spine injury during injury is crucial and considered as warranted. It also includes the
transportation to the nearest hospital if the symptoms of repetitive emesis, worsening mental
status or the sign of the neurological are found. Sport related activity is considered as the
challenging activity for the young as well as children, unlike other injuries, in the time of return
to play activity. It has been found that the student- athlete who are usually participated in the
sports activity and does not take participate in the sports due to concussion disease and get
stressed emotionally. It is essential that the providers of health care should be remained attentive
to the symptoms and sign of misery and other response regarding affecting that can be brought
the situation of challenge following concussive injury. The care provider of student-athlete
should validate the diagnosis instead of pretending that the student athlete has expanded
concussion symptoms. These symptoms can be represented post-concussion syndrome, migraine,
sleep dysfunction or mood disorder or headache disorder such as depression and anxiety. It has
been cleared that there is no difference in the concussion management in children compared to
adults.
Figure 1: Match event responsible for concussion

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Source: (Alentorn-Geli, et. al., 2009).
The above mentioned image described that descriptive statistics has been utilized to
analyze the data regarding player symptoms, time to return to play, recovery time and the clinical
pathway through by the graduated return to play protocol. The above graph reflected that the rate
of incidents for any incident or accident were than measured for players that were analyzed with
a concussion before they were pre-injured and following revisit to play from post injury that is
concussion. The calculation is being done of matching incidents rates for injury who did not
inform a concussion (Carter, et. al., 2011).
Figure 2: proportion of players exhibiting symptoms
Source: (Maron, et. al., 2009).

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The above mentioned has been taken from article which describes the symptoms of players due
to concussion. The above mentioned feeling shows the post injury. It has been found from study
that the most common symptom of concussion is headache which has been presented in 95 that is
85% cases. The score of balance error recently following the incident is considered higher than
baseline which has been found in 79% cases. Loss of consciousness is being observed in 26
cases that are 22% while 16% are linked with amnesia. It has been analyzed that the only 4 cases
are interlinked with loss of consciousness and amnesia (Thomas, et. al., 2011).
Figure 3: Sudden death in young competitive athlete
Source: (Maron, Doerer, Haas, Tierney and Mueller, 2009).
Sudden death is brought the scenario of shocking around the environment of players. It
has been found through above image that the rate of sudden death is increasing. Although, death

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of someone is not in someone’s hand but precaution can lead them in save zone where, life can
be saved. That is why it is vital to give proper training regarding health and game zone. As per
Caine, Maffulli and Caine, (2008), sudden death events can occur due to cardiovascular causes.
It has been analyzed that the public appearance has to pay for sudden deaths in young athletes
which may be inconsistent to the real several amount of theses sudden death events. This can be
covered the comprehensible agreed the noticeable good health of contestant in the competitive
sports activities usually apparent as free of such insightful risks. It has been found that the
present findings may lead health issues into more realistic criteria. Inclusive data has been used
in this research to collect the data which include a individually wide range of sports and death
are not restricted to incidence on the agile zone itself, at a broad range, the number of death due
to concussion informed here is considerably less than that notified in organization with various
risk of existing in the age group of athlete for instance cancer, homicides, cystic fibrosis and
leukemia.
Involvement of government in concussion management
It has been found that the concussion in sport constantly to be a highly publicized and
highlighted topic which is being discussed by various national media and sports practioners. The
government has taken various steps regarding the health of athlete and the emergency
department visits for 14 to 19 years old because of concussion which has taken place in the
world in triple form 1997 to 2007. That group of emergency department of diagnosis of
concussion at that time frame in which 30 to 60 percent were sports related. It is essential to
identify that several of youth concussion is likely far in higher range in comparison of statistics
due to under reporting of signs in the population and the associated challenges with recognizing
this syndrome. The process of management of the youth athlete with a concussion is considered

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as the multi process. The key components of it are assessment, identification, and resolution of
medical symptom and return to sport (Marijon, et. al., 2011). It is crucial to have the better
understanding about the syndrome because it assists in emergency care. It is drawn a conclusion
of a direct blow to the head, face or chin by moving the stable object. On the other hand indirect
the forces of biomechanical as a conclusion of declaration or rotational forces of the skull are
also contributory factors. It is the biggest challenge to identify the concussion as the seriousness
of the syndrome is not always seeable with the visualization of the injury. It has been seen many
times that the brain of the young athlete might be more susceptible to injury in comparison of
adult brain because of immature issue development. Furthermore, it has been evaluated that the
less than ten percent of those athletes who are suffering from concussion experience loss of
consciousness (Kapron, et. al., 2011).

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Conclusion
It has been concluded that the Concussion is a brain injury caused by the below to a head
or can be considered as the violent shaking of the body and the head. It may influence the brain
function. There are so many people assume that they are not the victim of concussion if they
have not lost consciousness. The concussion rate has twice in the last decade and it has been
evaluated that there are between 1.6 and 3.8 million sports regarding concussion in every year.
However, the effects of concussion are generally normal and provide outcomes in the form of
headache and issues with concentration, memory issues and balance. Concussion management
plays a vital role to provide the guidance to prevent from concussion to the children as well as
young athlete. It majorly focus on five step that is recognize and avoid the triggers, triggers
references those activity which contributes to enhance the symptoms of concussion. In second
step, concussion management is focus on get some sleep because the recovery of brain is faster
during sleep. In third step, concussion management focuses on resting of brain. It has been
analyzed that processing of information can be harder for the person who is concussed. After that
it is vital to provide the rest to the body. The entire essay has focused on various elements
regarding sudden death of athlete and recommendations have been given to prevent this event.

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