Youth concussion study helps orient prevention programs

By Paul Mayne
April 24, 2014

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When it comes to the causes of concussions in children and adolescents, it’s all about four Ws for Douglas Fraser.

“The real goal was to see who was getting injured – who, what, where and under what circumstances,” said Fraser, a professor in the departments of Paediatrics, Physiology & Pharmacology and Clinical Neurological Sciences at Western’s Schulich School of Medicine & Dentistry. “Once you answer those questions, then you can implement targeted injury prevention programs.”


Along with Western’s Department of Surgery adjunct research professor Tanya Charyk Stewart and Geography professor Jason Gilliland, Fraser tracked all youth under the age of 18 who came to London Health Sciences Centre (LHSC) emergency departments with a concussion between 2006-11.


Of the 2,112 cases, two-thirds (67 per cent) occurred in males, with a median age of 13. Nearly half of all concussions were sports-related (48 per cent) with more than a third of those being from hockey. Other causes included falls, being struck by a person or object, motor vehicle collisions, cyclists and assault.

The findings of the study, funded by Children’s Health Foundation, were published in the March issue of the Journal of Trauma and Acute Care Surgery

Of particular interest to Fraser, a scientist with the Children’s Health Research Institute at Lawson Health Research Institute, was the relationship between rural and urban youth.

Youth living in rural areas were more likely to sustain concussions from injuries involving motorized vehicles such as all-terrain vehicles and dirt bikes; youth living in urban areas, however, suffered concussions mostly as a result of sports. 

“The reality is every region is different. So, it’s really important to see, in your specific area, what is going on so you can target specific injury prevention programs,” Fraser said. “Based on the injury, and the postal code of the patient, we can start to map where these injuries occur, where they live. Once we know more about the injuries, we can go out with target injury prevention plans into these hotspots.”

Such data, Fraser added, could be a huge benefit to municipalities, sporting organizations and even local arenas.

“If you have a high number of hockey injuries in one arena, you may need to take a look at if it is the ice surface, is it the boards, is it the culture?” he said.

In the six-year period of the study, the number of reported concussions increased each year – 289 in 2007 to 488 in 2011, a 69 per cent jump.

That’s a good sign, Fraser said.

What was once considered a ‘ding’ that young athletes were often told to ‘shake it off,’ is now recognized for its potential serious and long-lasting effects, he added. Attitudes have changed drastically.

“There has been a lot of media attention over the last few years around players like (Eric) Lindros and (Sidney) Crosby. So, more people are becoming aware of the problem and coming forward,” Fraser said. “However, the other aspect is culture. There is still a huge issue with parents, and even the players, with the ‘you’re fine, get back on the ice’ thoughts. That’s slowly changing.”

Concussions are a particular concern for children and adolescents because their brains are still developing. They are more susceptible to the effects of a head injury. Fraser said young children tend to have weaker neck muscles, relative to a larger head, and their brain is actually heavier because of more water content.

So, when they have a violent shake, the brain moves around more.

Concussions can often be predictable, said Charyk Stewart, an injury epidemiologist and data specialist (trauma program) at LHSC/Children's Hospital.

“In sports, if you have been hit, then just get off the field immediately and stop play,” she said. “If you are experiencing any symptoms, be seen by a doctor.”

She added concussion symptoms will vary for each patient, but things such as headaches, dizziness or any kind of confusion may be an indicator of a potential head injury. For younger children who may not be able to verbalize their concussion symptoms, look for irritability, the inability to console the child or lack of eating, drinking or sleeping.

“If you kind of don’t feel right, or it looks like something is off, it’s best to play it safe and see a doctor,” she said.

The goal of this research is to create injury prevention programs targeted at those at high risk of sustaining a concussion.

“The basic message we’re trying to get out is whatever you’re doing – be it riding an ATV or playing hockey – follow the rules and regulations because they’re there to protect you,” Fraser said. “Use your safety devices and use them properly. If you get an injury, stop what you’re doing. If you have symptoms you’re concerned with, seek medical help.”


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