Second Impact Syndrome. Myth or reality?

Performance of the Baseline Sport Concussion Assessment Tool in Male and Female Spanish Amateur Rugby Players

Background/Objectives: The Sport Concussion Assessment Tool (SCAT) is a test used to screen for suspected concussions, with the results compared to baseline values. If current baseline values are unavailable, they can be compared to baseline values obtained from professional rugby players. The aim of this study was to evaluate the baseline SCAT values in Hispanic community rugby players of both sexes. This cohort study used an observational, prospective, and descriptive design. Methods: Participants: A total of 81 female (age: 23.3 ± 3.3 years) and 138 male (age: 23.7 ± 4.3 years) Spanish rugby players who participated in national-level competitions. Interventions (or assessment of risk factors of independent variables): The SCAT was administered as part of the pre-season medical testing, including symptoms endorsed, cognitive submode performance, and balance performance. Results: Most of the Spanish community rugby players presented some symptom in the SCAT (male = 75.4%; female = 91.4%). The number and severity of the symptoms reported by the male players were lower than those reported by the female players (p = 0.001). The time to complete the tandem gait test and balance test showed differences between sexes (p < 0.001). Conclusions: The baseline SCAT values of Spanish community rugby players differ from those of professional players, leading to the recommendation of conducting the SCAT for all players before the beginning of the season. If baseline evaluations cannot be performed, the results obtained could serve as a basis for developing reference values for community rugby in the Hispanic population. Recording the menstrual cycle phase during which the SCAT is performed may help improve its interpretation.

Pediatric Traumatic Brain Injury and Microvascular Blood-Brain Barrier Pathology

Importance

Pediatric traumatic brain injury (TBI) is a major cause of morbidity and mortality, with an increased risk of catastrophic outcome compared with adult TBI, including diffuse brain swelling and so-called second impact syndrome. Nevertheless, the biological substrates driving adverse outcomes in pediatric TBI remain poorly described.

Objective

To compare neuropathological evidence of brain swelling and blood-brain barrier (BBB) disruption after moderate or severe acute TBI in adult vs pediatric case material.

Design, Setting, and Participants

In this retrospective case series, cases of pediatric (aged 3-18 years) and adult (aged ≥19 years) TBI were accrued from January 1, 1979, to December 31, 2005, and underwent laboratory-based assessment of autopsy material from the Glasgow TBI Archive. Data analysis was performed from January 2019 to January 2024.

Exposures

Single moderate or severe TBI.

Main Outcomes and Measures

Evaluation of representative brain tissue sections stained for markers of endothelia (CD34) and BBB integrity (fibrinogen and immunoglobin G).

Results

Eighty-one pediatric patients (mean [SD] age, 12.1 [4.6] years; 50 [62%] male) and 62 adult patients (mean [SD] age, 38.7 [12.9] years; 35 [56%] male) were studied. At autopsy, when present, brain swelling was more often diffuse and bilateral among pediatric patients (64 of 81 cases [83%]) when compared with adult patients (21 of 62 [34%]) (P < .001). Histologic evidence of BBB disruption was common in material from both adult (57 of 62 [91%]) and pediatric (65 of 81 [80%]) (P = .06) patients. In pediatric patients, however, this was a predominantly microvascular, capillary-level pathology, which was a less common finding in adult case material (mean [SD], 84.7% [8.6%] vs 31.2% [7.7%]; P < .001).

Conclusions and Relevance

This autopsy case series of patients dying in the acute phase after single moderate or severe TBI provides neuropathological evidence of age-dependent differences in vascular pathology. Specifically, although BBB disruption in pediatric material was typically confined to microvascular, capillary-level vessels, in adult case material, BBB disruption more typically involved larger-diameter vessels. This observation of distinct microvascular pathology in pediatric acute TBI requires further investigation. In the meantime, this study presents an intriguing potential candidate pathology contributing to diffuse brain swelling in this age group.

Headpulse Biometric Measures Following Concussion in Young Adult Athletes

Importance

Concussions are common in sports. Return-to-play protocols can be enhanced by objective biometrics.

Objective

To characterize temporal changes of headpulse, a digital biometric, in athletes with sports-related concussion; to explore the association of unstructured physical activity with headpulse changes.

Design, Setting, and Participants

This cohort study included headpulse measurements from players in the highest level of amateur Australian Rules Football in South Australia. Analysis included feasibility and validation phases, with the feasibility cohort recruited between August 5, 2021, and September 10, 2021, and the validation cohort recruited between May 5, 2022, and September 3, 2022. Data were analyzed October 2022 through January 2023.

Interventions

Cranial accelerometry detected micromovements of the head following cardiac contraction (what we have described as "headpulse"). Headpulse was serially recorded for 1 month in concussed individuals.

Main Outcomes and Measures

Headpulse waveforms underwent frequency transformation analysis per prespecified algorithm. Result Z scores were calculated. Headpulse Z scores exceeding 2 (2 SDs from control means) met an abnormality threshold. Headpulse sensitivity, timing, and duration of change were determined.

Results

A total of 59 control and 43 concussed individuals (44 total concussions; 1 control also concussed, 1 concussed individual injured twice) provided headpulse measurements. The feasibility cohort (all male) included 17 control (median [IQR] age, 23 [19-28] years) and 15 concussed individuals (median [IQR] age, 21 [19-23] years). The validation cohort included 25 female (median [IQR] age, 21 [20-22] years) and 17 male (median [IQR] age, 26 [23-29] years) control individuals, and 8 female (median [IQR] age, 28 [20-31] years) and 20 male (median [IQR] age, 21 [19-23] years) concussed individuals. Headpulse reached abnormality threshold in 26 of 32 concussed individuals (81%; 9% on day 0, 50% by day 2, 90% by day 14). Headpulse alterations lasted 14 days longer than symptoms and were exacerbated by return-to-play or unsupervised physical activity.

Conclusions and Relevance

In this study of 101 amateur Australian Rules Football athletes, the digital headpulse biometric was evaluated in 44 sports-related concussions. Compared with controls, new headpulse changes occurred after concussion; this objective metric may complement return-to-play protocols.

Head Injuries and Emergencies in Sports

Head injuries are a common occurrence in sports and can involve injuries to the brain, skull, and superficial soft tissues. The most commonly discussed diagnosis is a concussion. Head and cervical spine injuries must be considered together at times, due to the overlapping nature of symptoms present during on-field evaluation. This article presents a range of head injuries, along with critical steps in evaluation and management.

Are You Ready for Some Football?

Football has become the most popular spectator sport in the United States today and attracts millions of players, both professional and amateur. This article discusses the risks of playing football. It is a contact sport and can result in a wide variety of injuries to the players. The rules of the game are based on adult participation; however, 2.8 million children participate in recreational tackle football every year. An understanding of the game and the risks associated with playing football is presented. The risks of the game are discussed with a focus on the prevention of injury. The most common injuries are presented, which include concussion and the major risk of traumatic brain injury. The importance of wearing appropriate protective gear and developing strategies to avoid head and neck injuries is presented. The role of parents and coaches is described, with tips on how to identify injuries and how to prevent them to guarantee the safety of players. Finally, the role of the nurse and other health care providers is discussed. This article presents an overview of the complexity of tackle football and strategies to keep the players safe.

Sporting activity after craniosynostosis surgery in children: a source of parental anxiety

PURPOSE

Craniosynostosis correction involves major skull surgery in infancy-a potential source of worry for parents when their treated children begin involvement in sports.

METHODS

Electronic multiple choice survey of parents of children who had undergone craniosynostosis surgery in infancy using 5-point Likert scales.

RESULTS

Fifty-nine completed surveys were obtained from parents of children who had undergone previous craniosynostosis surgery. Mean age of children was 7.8 years (range 3 months to 22 years), with 36 non-syndromic and 23 syndromic cases. The most common surgery was fronto-orbital remodelling (18). Fifty-two of 59 were involved in athletic activity. The most intense sport type was non-contact in 23, light contact in 20, heavy contact in 4 and combat in 5. Participation level was school mandatory in 12, school club in 17, non-school sport club in 21 and regional representative in 2. One child had been advised to avoid sport by an external physician. Mean anxiety (1-5 Likert) increased with sport intensity: non-contact 1.7, light contact 2.2, heavy contact 3.5 and combat 3.6. Twenty-nine of 59 parents had been given specific advice by the Craniofacial Team regarding athletic activity, 28 of which found useful. Three sport-related head injuries were reported, none of which required hospitalisation.

CONCLUSION

Little information exists regarding sports for children after craniosynostosis surgery. This study suggests that parental anxiety remains high, particularly for high impact/combat sports, and that parents would like more information from clinicians about the safety of post-operative sporting activities.

Concussions in Dancers and Other Performing Artists

Dancers and other performing artists are subject to head impacts that result in concussion-like symptoms. In spite of this, performing arts do not have access to the continual, focused emphasis on the diagnosis, management, and prevention of concussions that is commonplace in sports. Performing arts present a unique environment in which concussions occur and must be managed. This article outlines what is known about performing arts concussions, describes mechanisms of head impacts sustained by participants in dance and the related artforms of theater, circus, and film and television stunts, and offers concussion management guidelines for these artistic fields.