Germany’s Christoph Kramer is a World Cup Superstar. He’s also a symbol of an extremely flawed sports concussion policy. Kramer was knocked out and lost consciousness 17 minutes into the World Cup final match. Germany’s team doctor allowed him to play for another 15 minutes, finally allowing him to be removed from the game as he fell over.
“Unfortunately, this is not an isolated case,” says Michael J. O’Brien, MD, director of the sports concussion clinic at Boston Children’s Hospital. O’Brien cites Uruguay’s Álvaro Pereira. When Pereira was knocked out cold during a first-round match, the team doctor called him out. The doctor’s decision was overruled by Pereira and the coach.
“We need an agreed upon set of rules for handling players with symptoms of concussion. These rules need to be applied in all cases—whether it’s the World Cup Final or a pre-season scrimmage,” says O’Brien.
The professional athlete risks his health when he plays impaired or concussed, and also sends the wrong message to youth sports’ players and coaches. “Kids identify with professional athletes,” says O’Brien. “Aspiring soccer players try to emulate pros, even their risky behavior.”
A two-part solution
O’Brien and other experts recommend a complete shift in FIFA’s concussion policy. Suggestions include:
- providing time to assess players with suspected concussion (current player substitution rules require teams to play with one less athlete on the field while a doctor assesses the injured player, which creates a disincentive for sideline assessment)
- authorizing an independent physician, rather than a team physician, to remove a concussed player from the game
- implementing a standard, science-based protocol to sports concussion assessment and return to play
Parents and coaches can be part of the solution, too, says O’Brien. “We need a culture change. It’s important for parents, players and coaches to determine youth sports goals and set limits. Is the goal to stay healthy and have fun? Does possible victory merit pushing through injury and increasing risks to player’s health?”
Do you want to learn more about protecting players from head injury? Download Boston Children’s concussion prevention guide.
Seems like everywhere you turn, there’s new information about how dangerous head injuries can be. And because they can be so devastating, many doctors are quick to use computed tomography (CT) scans to check for serious injury when they see a young patient who has suffered a blow to the head. (Almost 50 percent of all children taken to U.S. emergency departments for head injury have a CT performed.) But according to a new study co-lead by Lise Nigrovic, MD, MPH, at Children’s Hospital Boston, these CT scans are used far more often than they need to be.
“Only a small percentage of children with blunt head trauma really have something serious going on,” she says. “If a child has suffered a serious injury and is at high risk for head trauma he needs to receive a CT right away. But if the child is at an intermediate risk he can be watched in the ED for a few hours and may not need a CT at all.”
To produce their images, CT scanners use small doses of ionized radiation. The patient’s level of exposure to that radiation is extremely low, but there is data indicating that even small exposure can lead to increased life time risk of cancer. Children may be especially susceptible to this exposure, because their developing tissue is particularly sensitive to the affects of radiation. (Read about the ways Children’s Hospital Boston ensures safety of its patients who receive specialized imaging.)
Based on this information, clinicians are left with a difficult question: How severe must a head trauma be for the benefits of a CT scan to outweigh the risk associated with its use?
“Probably less than one percent of the kids who come to emergency departments for head injury have serious enough head trauma to warrant a CT,” Nigrovic says. “But clinicians have the difficult challenge of figuring which patients do fall into that one percent. It’s not quite a needle in the haystack scenario, but it can be difficult.” …