Concussion Prevention, Care Are Key Targets for Research

Few healthcare issues reach the presidential podium and ESPN headlines, but the topic of sports-related concussions in youth scored both, gaining momentum as a national priority.

President Obama hosted the first-ever White House Healthy Kids & Safe Sports Concussion Summit May 29, where key stakeholders gathered to promote new efforts that will increase research to expand knowledge of concussions and create a culture of safety that supports children in disclosing symptoms and optimizing their recovery.

“We want our kids participating in sports,” Obama told the audience. “I’d be much more troubled if young people were shying away from sports. As parents, though, we want to keep them safe, and that means we have to have better information.”

A concussion is a mild traumatic brain injury caused by a blow or jolt to the head or body that causes the brain to shake. Annually, young people make nearly 250,000 visits to emergency rooms in the U.S. to be treated for brain injuries from sports and recreation, according to the Centers for Disease Control and Prevention. Some concussion symptoms may appear immediately after the injury, while others may not show up for several days. They can include headache, nausea, dizziness, sleep problems, difficulty concentrating, and moodiness.

Pediatric sports medicine specialist Christina Master, MD, and President and Chief Operating Officer Madeline Bell of The Children’s Hospital of Philadelphia were in attendance at the summit as it was announced that CHOP will begin development of a comprehensive pediatric and adolescent concussion registry. It will provide a database of information about concussion cases to inform scientific research to improve care.

The registry is a result of a Department of Pediatrics Chair’s Initiative project at CHOP called Minds Matter that involved a multidisciplinary team who set out to create tools to standardize and streamline concussion diagnosis and management across the CHOP Care Network so that primary care providers could handle the majority of concussion cases more efficiently and seamlessly.

“We incorporated a SmartSet feature into CHOP’s electronic medical record that gives providers standardized and evidence-based guidance on how to clinically evaluate and manage concussions,” said Kristy B. Arbogast, PhD, director of engineering for CHOP’s Center for Injury Research and Prevention, who led the Minds Matter team along with Dr. Master. “We coupled that with in-person training, and the response has been great. We believe kids are getting much better care.”

The clinical demand for concussion care throughout the CHOP system remains high, with a total of about 12,800 concussion visits in 2013 alone. Consequently, the need for pediatric research is great. Dr. Arbogast contributed to an Institute of Medicine report in 2013 that revealed many gaps in researchers’ understanding of the causes and consequences of sports-related concussions.

“A lot of what we think we know about concussion and prevention, if you pull the curtain back, the fundamental data supporting those ideas aren’t there,” Dr. Arbogast said.

In his remarks at the summit, Obama announced several public-private partnerships to support new concussion research. For example, the National College Athletics Association (NCAA) and the Department of Defense are jointly launching a $30 million effort to fund a comprehensive clinical study of concussion and head impact exposure. And the National Institutes of Health is using funding from the National Football League to begin a longitudinal research effort to detect, characterize, and measure the chronic effects of repetitive concussions.

With so many entities willing to take the ball and run to improve concussion diagnosis, management and prevention, the fundamental science in changing quickly, Dr. Arbogast said. Finding the best way to translate that research into evidence-based advocacy will be the next challenge that she hopes to tackle in her new role as a member of the National Council on Youth Sports Safety.

David Satcher, MD, former U.S. Surgeon General, and Eliot Sorel, MD, a global health expert from George Washington University School of Public Health and Health Services, convened a multidisciplinary panel of experts to form the national council. They invited Dr. Arbogast, the NCAA’s chief medical officer, Safe Kids Worldwide’s chief executive officer, and two former professional football players, among others.

“Its mission is to raise awareness and apply an integrative approach to create a culture of prevention and reduce the number of injuries that children sustain in sports,” Dr. Arbogast said. “We want to think about youth sports in a way that children can gain the benefits of physical activity, leadership, and character development while ensuring that they are as safe as possible while they play.”

During their inaugural meeting in February, the council identified several sports safety concerns — concussion, overuse injury, heat illness, and sudden cardiac death — and decided that their first goal would be to take aim at changing the culture around concussion. Workgroups hold virtual strategy meetings on a monthly basis, and they anticipate that their efforts will culminate in a best practices tour in 2015.

Council members will visit about 10 localities and host town-hall like events that will feature innovative practices and approaches to concussion prevention, diagnosis, treatment, and management. While the spotlight will be on sharing knowledge, they anticipate some sports players will lend their star power to help change society’s norms. Athletes, parents, coaches, school professionals and healthcare providers must realize that, “shake it off” is not an acceptable response to concussion; it is a brain injury that deserves serious attention.

“I like being part of an entity that is tasked with shaping the national tone on this issue,” Dr. Arbogast said. “And I am excited about the opportunities to possibly highlight some of the phenomenal clinical care CHOP sports medicine, primary care, and trauma doctors are providing for kids with concussions and to show that CHOP is a thought leader on this issue.”