BLOG: What you need to know about college students and concussion
by John Breck, DO
Concussions are common among college students — and they do not occur only in males participating in organized sports.
My colleagues and I at the University of Colorado Boulder conducted a prospective study (Breck, et al.) of undergraduate students who sought care from the student health center over 3 academic school years (August 2015 to April 2018), as well as varsity athletes who were treated through the athletics department during 2 of those 3 years. During this time, there were 1,100 concussions reported in all, for an incidence of 132.4 concussions per 10,000 students. It is likely that the true incidence is even higher, as our study does not include students who did not seek care or those who may have sustained a concussion during summer break, away from school.
There were more non-sport-related concussions than sport-related ones. In the news media most of the focus on concussion is sports-related, but concussion experts know that head injuries happen in many other settings, ranging from slipping on ice to a car accident or hit to the head. College students are a high-risk population in general — and perhaps even more so in Colorado where higher-risk recreational activities like alpine skiing and mountain biking are common.
We found that concussion incidence peaked in August and was lowest in December. This may be due to differences in academic demand (lower at the start of the school year; higher at the end of the semester) and/or seasonal participation in outdoor recreation. We were not able to evaluate behavioral factors such as alcohol use in this study, but that is an interesting area for future research.
The incidence of concussion was higher for women than for men. We were not surprised by this distribution, as there is already a body of evidence that girls and women are more frequently diagnosed with concussion. This may be because females are more prone to head injury due to anatomic or biomechanical differences (such as neck strength) or it may simply reflect a greater awareness of and accuracy in describing symptoms.
Campus health centers around the country vary widely in staffing models, typical usage and services offered. We are fortunate to have a strong interdisciplinary concussion care team in Boulder that includes neurology, physical therapy, ophthalmology and optometry.
Oculomotor testing is always part of our concussion evaluation. It is one of the most accurate and objective forms of testing we use in the diagnosis of concussion, and persistent oculomotor symptoms are one of the most common reasons for specialist referral. These symptoms can be easily provoked and particularly troublesome for college students who are reliant on the ability to track and converge when reading a book or looking at a computer screen.
I encourage optometrists who treat college-age students to ask patients about head injuries, falls and accidents, regardless of their sports participation, and to test for and treat oculomotor symptoms (or refer for treatment).
The good news is that young people often respond very well to treatment and recover quickly. But college students are also at a stage in life when near demands are very high. It is critical that they get high quality, evidence-based care as soon as possible so they can return to learning in a safe way with as little disruption in their education as possible.
Reference: Breck J, et al. JAMA Netw Open. 2019;doi:10.1001/jamanetworkopen.2019.17626.
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John Breck, DO, is a sports medicine specialist and lead physician for the University of Colorado Boulder Medical Services. He is a graduate of the Michigan State College of Osteopathic Medicine and completed his residency and fellowship at the University of Michigan and the University of Florida, respectively. He is the coauthor of a recent paper on concussion in college students.
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