New Post-Concussion Management Recommendations
By Gerri Elder
In New Jersey, a 16-year-old high school football player died on October 15, two days after suffering a brain hemorrhage while making a tackle during a junior varsity game.
The New York Times reported that Ryne Dougherty, a junior linebacker for Montclair High School, had sustained a concussion during practice on September 18. He had been cleared by doctors to return to the field approximately three weeks later, on October 6.
Dougherty had reportedly told a teammate that he still had post-concussion symptoms, specifically headaches, after being cleared by his family physician and a neurologist.
Judith Weiss, the school's interim principal, said she was not aware of any school officials who knew that Dougherty was still having post-concussion symptoms.
Post-concussion symptoms can include nausea, headaches, dizziness, sensitivity to light or cognitive problems. Established guidelines for concussion management require that athletes be free from these symptoms, both before and after physical exertion, before returning to athletic competition.
Studies have shown that sustaining another blow to the head before full recovery from a concussion can lead to second-impact syndrome. Second-impact syndrome is a condition in which arteries swell and pressure builds in the brain. This can often lead to the onset of a coma or death.
Montclair High School uses the ImPACT neurological-testing program. ImPACT is a computer-based protocol that can help determine if an athlete has recovered from a concussion. In the program, baseline cognitive testing is administered to gauge short-term memory, among other things. After an athlete sustains a concussion, the results of these baseline tests are compared to tests administered after the injury.
Unfortunately, not all of the athletes at Montclair High School had been administered baseline testing before the season began. Dougherty had not been tested.
Dougherty was the second teen football player to die in the past three months in New Jersey due to a brain injury. His was the third teen death this season in New Jersey after participating in football activities.
In the United States this year, at least four high school football players have died after suffering head injuries. The National Center for Catastrophic Sports Injury at the University of North Carolina reports that three high school football players in the United States died from head injuries in 2007.
When Dougherty was injured on October 13, he was immediately rushed to the trauma center at the Hackensack University Medical Center. It was determined that he was suffering a brain hemorrhage and surgery was performed to relieve the pressure on his brain. Unfortunately, the surgery did not save his life and he passed away two days later.
Longer Recovery Time Recommended after Concussions
The San Diego Union-Tribune recently reported that a new medical study of concussions urges a longer recovery time.
According to modern medical standards in managing concussions, athletes are generally allowed to return to the field within a week or two of their first concussion, as long as they pass medical screening and do not have post-concussion symptoms such as blurred vision.
However, a recently published review of concussion studies is advocating a more conservative approach to concussion management. According to the review, four weeks off after a player suffers a concussion is imperative.
The review was published in the Archives of Neurology in September. Dr. Lester Mayers wrote that the idea of a longer recovery time would probably provoke concern and resistance on all levels of sport, but given the prevalence of head injuries in sports and the numbers of young brains at risk, it is essential that a period of at least four weeks be taken for recovery after a concussion.
Mayers bases his opinion on a series of recent studies that indicate that "persistent cerebral dysfunction occurs for at least one month in many concussed athletes."
The review concludes that if the four-week post-concussion recovery period were widely accepted, it could potentially reduce repeat concussions and devastating longer-term symptoms.