Concussion and Traumatic Brain Injury Prevention Program

Increasingly, Connecticut residents are taking part in sports and recreational activities. Unfortunately, some of these activities can lead to serious head injuries unless precautions are taken.

The federal Centers for Disease Control and Prevention (CDC) estimate that at least 7 million sports and recreation-related injuries occur in the United States each year. More than half of these injuries occur among children, youth and young adults aged 5 to 24 years.

According to results from the 2017 Connecticut School Health Survey, administered by the Connecticut Department of Public Health (CT DPH) and the state Department of Education, 16.8% of high school students reported concussions from injuries and had to seek medical treatment while playing sports, exercising or being physically active during the previous year.

Traumatic Brain Injury

The CDC identifies traumatic brain injury (TBI) as a major cause of death and disability in the United States. TBIs contribute to about 30% of all injury deaths. Every day, 153 people in the United States die from injuries that include TBI. Those who survive a TBI can face effects that last a few days, or the rest of their lives. Effects of TBI can include impaired thinking or memory, movement, sensation (e.g., vision or hearing), or emotional functioning (e.g., personality changes, depression). These issues not only affect individuals but can have lasting effects on families and communities.

What is a TBI?

A TBI is caused when a bump, blow, or jolt to the head disrupts the normal function of the brain. However, not all blows or jolts to the head will result in a TBI. The severity of a TBI may range from “mild” (i.e., a brief change in mental status or consciousness) to “severe” (i.e., an extended period of unconsciousness or memory loss after the injury). Most TBIs that occur each year are mild, commonly called concussions.

What are the Leading Causes of TBI?

National:

According to CDC data from 2013, the leading cause of TBI was attributed to falls. Falls accounted for 47% of all TBI-related ED visits, hospitalizations, and deaths in the United States. Falls also disproportionately affect the youngest and oldest age groups:

The second leading cause of TBI was being struck by or against an object. These types of impacts accounted for approximately 15% of TBI-related ED visits, hospitalizations, and deaths in the United States.

The third leading cause of TBI, found across all age groups, was motor vehicle crashes. Motor vehicle crashes were responsible for numerous ED visits, hospitalizations, and deaths (14%).

Referencing 2013 national data for TBI-related deaths, intentional self-harm as the second leading cause (33%), followed by motor vehicle crashes were the third leading cause (19%).

Connecticut:

Similarly, 2008-2013 Connecticut data indicates the similar leading causes of TBI-related ED visits and hospitalizations:

54% of TBI-related ED visits were attributed to being struck by or against an object
52% of TBI-related ED visits were falls
42% of TBI-related ED visits were caused by motor vehicle crashes
53% of males and 66% of females had increased TBI-related hospitalization rates after age 75
- TBI-related hospitalization charges in 2013 averaged $9,749 daily

Also in Connecticut, the number one cause of TBI-related deaths were due to falls (55%), while motor vehicle crashes were the fourth leading cause (10%). The highest rates for TBI-related deaths were attributed to:

falls after the age of 75 (82%)
suicides between the ages of 30-84 (82%)
other/unspecified injuries after the age of 75 (82%)

Links

CDC website on traumatic brain injury & concussion

Concussions

A more common type of TBI, concussions, are caused by a blow or jolt to the head or body that results in rapid movement to the head that disrupts the function of the brain. The severity of a concussion may range from “mild”, i.e. a brief change in mental status or consciousness, to “severe”, i.e. an extended period of unconsciousness or amnesia after the injury. All concussions are serious even though many do not result in loss of consciousness. Parents, coaches and athletes should learn the signs and symptoms of a concussion and seek medical attention right away. In Connecticut, from 2007 to 2013 there were 22,047 hospital in-patient discharges and about 40,096 emergency department encounters. The emergency department costs totaled over $138 million.

State Health Officials encourage safe participation in sports and recreational activities as an important part of a healthy, physically active lifestyle at any age. The CT DPH recommends taking the following steps when taking part in sports and recreational activities to help keep you safe and prevent injury:

Use appropriate protective gear, such as helmets, wrist guards, and knee and elbow pads for all sports activities;
- Helmets do not prevent concussions but can help protect from a serious brain or head injury and skull fracture.
- Helmets should fit properly and be well maintained, age appropriate, worn consistently and correctly, and be appropriately certified for use.
- Reducing exposure to head impacts, and increasing coach training, and rule changes are important in reducing concussion risk.
Make sure that playground equipment is installed over shock absorbing surfaces;
Learn and practice the skills relevant for each sport or activity;
Follow safety rules for each sport or recreational activity; and
Adults should model safe behavior for children, including wearing helmets and following the rules.

Three Stages to Minimize a Concussion

What do you need to know about Concussions

Most people with a concussion recover well from symptoms experienced at the time of the injury. But for some people, symptoms can last for days, weeks, or longer. In general, recovery may be slower among older adults, young children, and teens. Those who have had a concussion in the past are also at risk of having another one. Some people may also find that it takes longer to recover if they have another concussion. (CDC, Injury Prevention & Control: Traumatic Brain Injury).

Some of the Signs and Symptoms of Concussions

When to Seek Immediate Medical Attention

Danger Signs in Adults

In rare cases, a person with a concussion may form a dangerous blood clot that crowds the brain against the skull. Contact your health care professional or emergency department right away if you experience these danger signs after a bump, blow, or jolt to your head or body:

Headache that gets worse and does not go away.
Weakness, numbness or decreased coordination.
Repeated vomiting or nausea.
Slurred speech.

The people checking on you should take you to an emergency department right away if you:

Look very drowsy or cannot wake up.
Have one pupil (the black part in the middle of the eye) larger than the other.
Have convulsions or seizures.
Cannot recognize people or places.
Are getting more and more confused, restless, or agitated.
Have unusual behavior.
Lose consciousness.

Danger Signs in Children

Take your child to the emergency department right away if they received a bump, blow, or jolt to the head or body, and:

Have any of the danger signs for adults listed above.
Will not stop crying and are inconsolable.
Will not nurse or eat.

Connecticut Concussion Statistics for Students, Pre-K through Grade 12

The Connecticut Health Services Program Information Survey Report Concussion Analysis indicated an overall decline in concussion reports from the 2015-2016 school year to the 2017-2018 school year. These reports include concussion diagnoses and reported missed school days. The top three contributing activities have remained the same annually.

During the 2015-2016 school year, there were 3,551 females and 3,645 male students diagnosed with a concussion. The top three activities contributing to the concussion diagnosis are interscholastic school athletics (32.0%), activities outside of school (25.7%), and non-school related sports (17.5%). These concussion diagnoses resulted in a total of 6,213 missed school days.

During the 2016-2017 school year, there were 3,362 females and 3,435 male students diagnosed with a concussion. The top three activities contributing to the concussion diagnosis are interscholastic school athletics (30.6%), activities outside of school (26.8%), and non-school related sports (15.8%). These concussion diagnoses resulted in a total of 5,575 missed school days.

During the 2017-2018 school year, there were 3,113 females and 3,116 male students diagnosed with a concussion. The top three activities contributing to the concussion diagnosis are interscholastic school athletics (30.7%), activities outside of school (26.8%), and non-school related sports (16.5%). These concussion diagnoses resulted in a total of 5,374 missed school days.