The management of concussion in sports is heavily influenced by the potential for rare but devastating head injuries. Determining the appropriate time for an athlete to return to play after a concussion can clearly be difficult. There is no gold standard test for measuring symptom severity or neurocognitive performance. Subtle neurological changes after mild head injury easily elude detection with standard neurodiagnostic tests such as CT, MRI, and electroencephalogram. There is little question that athletes frequently under-report symptoms in hopes of quickly re-entering the fray after a head injury. Neurocognitive testing using the Impact system is one potential (and hotly debated) solution worthy of critical evaluation. The broadcast fails to describe the quality of the evidence to support the neurocognitive testing; to quantify its potential benefits; to note its potential harms; to mention other potential solutions; to describe the costs in time and money; and to note that a researcher interviewed is a part owner of the company that owns and licenses the Impact system. Perhaps most importantly, the broadcast does not address two overriding questions: What is the clinical significance of the subtle changes detected by neurodiagnostic testing? And is there evidence to suggest that such testing protects athletes from the death and disability it has set out to prevent? Neurocognitive testing may demonstrate caring on the part of the athletes' schools and reduce the likelihood of successful law suits after injury, but the broadcast presents no evidence that the students themselves will benefit.
There is no mention of the costs associated with using the Impact system or other neurocognitive tests, in either dollars or time (e.g. training, testing, and interpretation). The story does not attempt to compare costs of this system with other systems that might help a physician determine when an athlete should return to play.
There is no attempt to quantify the benefit of the Impact system in terms of either relative risk or absolute risk reduction.
The broadcast does not mention potential harms of using the Impact system. Testing could cause an athlete needless anxiety. Unnecessarily withholding an athlete from play increases inactivity and the risk of depression. It is unclear who owns the sensitive information and how it is protected. And it is unclear whether the recommendation to wear headgear might make head-to-head collisions more dangerous for other players.
The broadcast relates the story of a young female soccer player who has suffered a concussion and must sit on the bench until her doctor believes it is safe for her to return to play. The report does not describe the nature of the evidence to support neurocognitive testing. It also does not provide evidence of whether the Impact system can protect athletes against the long-term disability or death that such systems were designed to prevent. Nor does it present evidence to support the suggestion that headgear is protective. One recent report found that soccer headgear showed little ability to attenuate the impact of a soccer ball during simulated heading.
The story cites data on the high incidence of concussions in young athletes. Although the CDC estimates that more than 300,000 sports-related concussions occur annually in the U.S. [http://www.cdc.gov/MMWR/preview/mmwrhtml/mm5538a1.htm], the broadcast’s claim that one in five high school athletes will suffer a concussion appears to be a gross exaggeration. Without a clear definition of concussion, it is meaningless. A new report from the National Federation of State High School Association estimates that about 7.2 million students participate in high school athletics in the U.S. [http://www.nfhs.org/web/2006/09/participation_in_high_school_sports_increases_again_confirms_nf.aspx] Of these, an estimated 1.2 million—or about one in five—will suffer an injury of some kind. Of those that suffer an injury, a distinct minority will suffer a concussion. A 2004 study of high school athletics in North Carolina found that about 15% of high school football players suffered a concussion during one season. Other research shows that about one in five college football players has a concussion each season.
The broadcast hints at the danger of repeat concussions, but does not mention the low prevalence of the most feared and devastating outcomes, the so-called post-concussive and second-impact syndromes. Though there is some evidence that young athletes with two or more previous concussions have subtle but prolonged neuropsychological problems, the story fails to say whether most concussions resolve without incident or long-term effects.
The broadcast includes interviews with an independent expert who describes the potential problems posed by premature return to play. However, it fails to mention that the other expert interviewed, Michael Collins, PhD, is a part owner in the company that developed and licenses the Impact system.
The broadcast fails to note alternative methods of determining when an athlete can safely return to play after a concussion, including inexpensive low-tech aids and clinical judgment. There is considerable debate in the sports medicine community on this point. The broadcast also does not elaborate on the potential disadvantages of the Impact system or on the potential advantages of its alternatives (traditional and electronic).
The report describes the widespread availability of the Impact system in the U.S., but fails to describe how an athlete would gain access to such neurocognitive testing systems.
The Impact system has been available for many years. Indeed, some 1500 athletic teams reportedly employ the system, according to the broadcast. Research suggesting that children's brains may be more vulnerable to injury than adults' brains has also been around for years. The broadcast does not report the news that likely stimulated the report–findings of a case control study of the Impact system by Michael Collins, PhD that were recently announced in a press release and published in the American Journal of Sports Medicine.
There is no obvious use of text from the press release.