Sports-related concussions and the Louisiana Youth Concussion Act
Concussion, also referred to as mild traumatic brain injury (TBI), is defined as a "complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces." Various symptoms may be observed in patients with concussions. All of these might not be evident at the time of the injury and be intermittent in their nature. It is estimated that 300,000 of the yearly TBIs in the United States are sports-related, the second leading cause for TBIs after motor vehicle accidents among people aged 15 to 24 years old. Due to some recently reported high profile injuries and deaths of sports personalities, sports-related concussion has seen increasing media and public interest in the last decade. We review the role of football in youth concussions and analyze the Nationwide Inpatient Sample from 2007 to 2009 to elucidate the outcome and costs associated with sports-related concussions of the youth in the United States. We also review the latest state legislative efforts to decrease the incidence of dangerous sports-related concussions in youth--the Louisiana Youth Concussion Act.
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ABSTRACT: El traumatismo encéfalo craneano (TEC) es una entidad compleja y heterogénea, que compromete principalmente a adultos jóvenes en etapas productivas de la vida, transformándose en un problema crítico de salud pública y socio-económico en todo el mundo. Los pacientes que sobreviven a un TEC como consecuencia presentan alteraciones funcionales secundarias a un trastorno cognitivo, motor y conductual, que generan una restricción a la participación en las actividades de la vida diaria y en su reintegro familiar, social y laboral competitivo, conduciendo a una sobrecarga en los cuidados de su entorno. La rehabilitación en el TEC debe ser temprana, multidisciplinaria, intensiva, centrada en el paciente y multidimensional, considerando los aspectos motores, cognitivos, cognitivo comunicativos, alteraciones de la deglución y conductuales como elementos centrales, teniendo como objetivo final el reintegro a la comunidad y eventualmente al mundo laboral competitivo.
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ABSTRACT: Sports-related concussions (SRC) and traumatic brain injury (TBI) represent a growing public health concern. We reviewed the literature regarding equestrian-related brain injury (ERBI), ranging from concussion to severe TBI.
A literature review was performed to address the epidemiology of SRC and TBI in equestrian-related sports. MEDLINE and PUBMED databases were searched to identify all studies pertaining to brain injury in equestrian-related sports. We included two broad types of brain injury using a distinction established in the literature: 1) TBI with functional impairment, including concussion, or mild TBI, with negative imaging findings; 2) TBI with structural impairment, with positive imaging and at least one of the following pathologies identified: subdural hemorrhage (SDH), epidural hemorrhage (EDH), subarachnoid hemorrhage (SAH), intraparenchymal hemorrhage (IPH), cerebral contusions, and skull fractures.
Our literature search yielded 199 results. We found 26 studies describing functional TBI and 25 mentioning structural TBI, and 8 including both. Of all modern sporting activities, equestrian sports were found to cause some of the highest rates of total bodily injury, severe brain injury, and mortality. Concussions comprise approximately 9.7-15% of all equestrian-related injuries brought to hospitals for evaluation. Structural TBI was rare, and documentation of these injuries was poor. While demographic risk factors like age and sex are minimally discussed in the literature, two studies identified a protective effect of increasing rider experience on all forms of bodily injury. However it remains unclear if increasing rider experience protects specifically against head injury. Finally, rates of helmet use in horseback riding remain dismally low - ranging from 9-25%, depending on the activity. These low rates have persisted over time, despite evidence in this literature that helmets lead to an absolute risk reduction for head injury of 40-50% in equestrian sports.
Equestrian-related functional and structural TBI, represents a significant public health burden. Rider and horse characteristics make the sport uniquely dangerous, as the athlete has limited control over an animal weighing over a thousand pounds. Helmet use rates remain very low despite clear evidence of risk reduction. Healthcare providers are strongly urged to lobby professional and governmental organizations for mandatory helmet use in all equestrian sports.
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