SPORTS-RELATED
CONCUSSIONS IN YOUTH

Improving the Science, Changing the Culture

Committee on Sports-Related Concussions in Youth

Board on Children, Youth, and Families

Robert Graham, Frederick P. Rivara, Morgan A. Ford,
and Carol Mason Spicer, Editors

         INSTITUTE OF MEDICINE AND
NATIONAL RESEARCH COUNCIL
                          OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS      500 Fifth Street, NW      Washington, DC 20001

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This study was supported by contracts between the National Academy of Sciences and the Centers for Disease Control and Prevention (CDC) (200-2011-38807); the CDC Foundation (Unnumbered Award) with support from the National Football League; the Department of Defense (HT0011-12-C-0023); the Department of Education (ED-OSE-12-P-0049); the Health Resources and Services Administration (HHSH250200976014I); the National Athletic Trainers’ Association Research and Education Foundation (0512SETGRANT); and the National Institutes of Health (HHSN263201200074I). Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project.

International Standard Book Number-13: 978-0-309-28800-2

International Standard Book Number-10: 0-309-28800-2

THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. C. D. Mote, Jr., is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. C. D. Mote, Jr., are chair and vice chair, respectively, of the National Research Council.

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COMMITTEE ON SPORTS-RELATED CONCUSSIONS IN YOUTH

ROBERT GRAHAM (Chair), Director, National Program Office, Aligning Forces for Quality, and Research Professor of Health Policy, School of Public Health and Health Services, George Washington University, Washington, DC

FREDERICK P. RIVARA (Vice Chair), Seattle Children’s Guild Endowed Chair in Pediatrics and Professor, Pediatrics, School of Medicine, University of Washington, Seattle

KRISTY B. ARBOGAST, Engineering Core Director, Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, and Associate Professor of Pediatrics, University of Pennsylvania

DAVID A. BRENT, Academic Chief, Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, and Professor of Psychiatry, Pediatrics, and Epidemiology, School of Medicine, University of Pittsburgh

B. J. CASEY, Sackler Professor of Developmental Psychobiology and Director, Sackler Institute for Developmental Psychobiology, Weill Medical College of Cornell University, New York, New York

TRACEY COVASSIN, Associate Professor of Kinesiology and Undergraduate Athletic Training Program Director, Michigan State University, Lansing

JOE DOYLE, former Regional Manager, American Development Model, Rocky Mountain and Pacific Districts, USA Hockey, Colorado Springs, Colorado

ERIC J. HUANG, Professor of Pathology and Neuropathology, Department of Pathology, School of Medicine, University of California, San Francisco

ARTHUR C. MAERLENDER, Director, Pediatric Neuropsychological Services, and Assistant Professor, Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire

SUSAN S. MARGULIES, George H. Stephenson Professor in Bioengineering, Department of Bioengineering, University of Pennsylvania, Philadelphia

DENNIS L. MOLFESE, Mildred Francis Thompson Professor and Director, Center for Brain, Biology, and Behavior, Department of Psychology, University of Nebraska, Lincoln

MAYUMI L. PRINS, Associate Professor in Residence and Director, Brain Injury Research Center Education Program, David Geffen School of Medicine, University of California, Los Angeles

NEHA P. RAUKAR, Assistant Professor of Emergency Medicine, and Director, Division of Sports Medicine, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island

NANCY R. TEMKIN, Professor, Departments of Biostatistics and Neurological Surgery, University of Washington, Seattle

KASISOMAYAJULA VISWANATH, Associate Professor of Social and Behavioral Sciences, Harvard School of Public Health, and Director, Health Communication Core, Dana-Farber/Harvard Cancer Center, Boston, Massachusetts

KEVIN D. WALTER, Associate Professor, Departments of Orthopaedic Surgery and Pediatrics, Medical College of Wisconsin, Milwaukee

JOSEPH L. WRIGHT, Senior Vice President, Community Affairs, Children’s National Medical Center, and Professor of Pediatrics (Vice Chair), Emergency Medicine and Health Policy, George Washington University, Washington, DC

Study Staff

MORGAN A. FORD, Study Director

CAROL MASON SPICER, Associate Program Officer

WENDY KEENAN, Program Associate (through April 2013)

SAMANTHA ROBOTHAM, Senior Program Assistant

PAMELLA ATAYI, Administrative Assistant

KIMBER BOGARD, Director, Board on Children, Youth, and Families

Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:

Gordon Bloom, McGill University

R. Dawn Comstock, University of Colorado, Denver

Joseph J. Trey Crisco, Brown University

John DiFiori, University of California, Los Angeles

Corey S. Goodman, venBio LLC

Michael V. Johnston, Johns Hopkins University

Matthew W. Kreuter, Washington University

Brad G. Kurowski, University of Cincinnati

Karen McAvoy, Rocky Mountain Youth Sports Medicine Institute

Tamara C. Valovich McLeod, A.T. Still University

Barclay Morrison, Columbia University

Cara Camiolo Reddy, University of Pittsburgh

Thomas L. Schwenk, University of Nevada

CAPT Jack W. Tsao, Uniformed Services University of the Health Sciences

Keith O. Yeates, Nationwide Children’s Hospital

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Bradford H. Gray, The Urban Institute, and Floyd E. Bloom, The Scripps Research Institute. Appointed by the National Research Council and the Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Acknowledgments

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Contents

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Boxes, Figures, and Tables

BOXES

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