Head and Neck Injuries

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Chapter 680 Head and Neck Injuries

Gregory L. Landry

Head Injury

The Centers for Disease Control and Prevention estimate that ~300,000 sports-related concussions occur annually in the USA. Concussions occur in >62,000 high school athletes each year, with football accounting for 63% of cases. Multiple myths exist regarding concussions, which pediatricians need to dispel (Table 680-1). Mild brain injury can occur with or without a loss of consciousness (LOC). The majority of concussions occurring in sports are not associated with LOC, and currently a concussion is any decrement in neurologic or cognitive function after a traumatic event (Table 680-2) (Chapter 63). Low-risk factors are noted in Table 680-3.

Table 680-1 IMPORTANT FACTS REGARDING CONCUSSIONS AND CHILDREN

• High school athletes are more vulnerable to concussions than older athletes and can take longer to recover.

• Failure to properly manage a concussion can lead to long-term cumulative consequences.

• Loss of consciousness is not an appropriate marker for the presence or absence of concussion.

• High school athletes are 3 times more likely to experience a second concussion if concussed once during a season

• More than 5% of high school athletes are concussed each year while participating in collision sports.

Adapted from Theye F, Mueller KA: “Heads up”: concussions in high school sports, Clin Med Res 2(3):165–171, 2004.

Table 680-2 CONCUSSION SIGNS AND SYMPTOMS

CONCUSSION SYMPTOMS

Headache or “pressure” in head

Nausea or vomiting

Balance problems or dizziness

Double or blurry vision

Sensitivity to light

Sensitivity to noise

Feeling sluggish, hazy, foggy, or groggy

Concentration or memory problems

Does not “feel right” or is “feeling down”

CONCUSSION SIGNS

Appears dazed or stunned

Is confused about assignment or position

Forgets an instruction

Is unsure of game, score, or opponent

Answers questions slowly

Loses consciousness (even briefly)

Shows mood, behavior, or personality changes

Can’t recall events before hit or fall (retrograde amnesia)

Can’t recall events after hit or fall (antegrade amnesia)

Adapted from the Centers for Disease Control Heads Up Concussion Campaign; From Grady MF, Goodman A: Concussion in the adolescent athlete, Curr Prob Pediatr Adolesc Health Care 40:153–169, 2010.

Table 680-3 LOW-RISK CHARACTERISTICS FOR CLINICALLY IMPORTANT BRAIN INJURIES

Normal mental status

No loss of consciousness

Nonsevere injury mechanism

No signs of basilar skull fracture

No severe headache

From Grady MF, Goodman A: Concussion in the adolescent athlete, Curr Prob Pediatr Adolesc Health Care 40:153–169, 2010.

Sports concussion is a complex pathophysiologic process affecting the brain, induced by traumatic biomechanical forces. Definition, evaluation, and treatment have evolved significantly since the 1970s. Grading scales were published to evaluate concussion severity, although controversy remained due to multiple guidelines. In November 2008, the 3rd International Symposium on Concussion in Sport confirmed that injury-grading scales should no longer be used. The participants also abandoned the simple vs complex classification suggested in the 2nd symposium in 2005. Instead, individual response should guide evaluation and return-to-play decisions. When a concussion is suspected, the athlete should be removed from the activity and medically evaluated. Regular monitoring over the initial few hours following injury is important. The group suggested use of an assessment tool called SCAT (Sport Concussion Assessment Tool) to assist the clinician in assessing the athlete.

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