Michael J. Stuart
KOLOA, Hawaii — A speaker at Orthopedics Today Hawaii said there is a need for a validated, rapid, objective, diagnostic test to better diagnose concussions, especially in youth athletes.
“It’s a very important issue because all our youth are participating in sports,” Michael J. Stuart, MD, said during his presentation. “Probably more than half of concussions go unreported. We have no good objective means of diagnosing them”
He said a diagnosis for concussion can be delayed because athletes may feel normal and the signs and symptoms are not apparent. Stuart said it is important to notice the visible signs of concussion and that even with education, this is a major hurdle as signs are not always apparent.
“If someone gets up and falls down and gets up and falls down, take them out of the game,” Stuart said.
Stuart noted coaches for youth sports should be primarily responsible for determining whether an athlete has a concussion and to remove the player from the game. He noted health care providers are not always at every sports game, so it is up to coaches, teammates, team physicians and parents.
The concussion recognition tool can be used by nonmedical personnel to look for the red flags and signs of concussion. Stuart said the tool should be provided to all parents, players and coaches. Those in the medical profession can use the sport concussion assessment tool (SCAT 5), but he recommends it be used sparingly.
“I don’t think you need to put players through SCAT 5 if you saw worrisome mechanisms of injury, [the player] staggered off field and don’t know where they are,” he said. “It’s pretty obvious. Athletes will ignore or avoid the problem. Symptoms may be delayed.”
He recommended physicians use the King-Devick Test.
“If a takes a player too long to read the numbers compared to their baseline, they’re out [of the game],” Stuart said.
He said physicians need to have graduated return-to-sport and return-to-school strategies. Confounding factors may delay decisions for return to play. Physicians need to be aware of their state laws, provider requirements and clearance laws. Concussion prevention is important, Stuart said, and some protocols include education, teaching techniques, sportsmanship, rule enforcement and changes, limiting contact in practice, improved protective equipment and neck strengthening.
“Prevention is something we work hard on,” Stuart said. “The answer is not to get rid of youth sports, but to work harder to make them safe.”– by Monica Jaramillo
Stuart MJ. Concussions in sports: What you need to know. Presented at: Orthopedics Today Hawaii; Jan. 12-16, 2020; Koloa, Hawaii.
Disclosure: Stuart reports no relevant financial disclosures.