Concussion: Why Nurses Need to Understand This Hidden Injury

Ann Worley


Pediatr Nurs. 2019;45(5):235-243. 

In This Article

Sports and Recreational Concussions

Benefits of sports to children are undeniable, yet most people would acknowledge the inherent risks of concussions. The CDC (2017b) reported that in 2012, an estimated 329,290 children age 19 years and under presented in EDs in the United States for sports and recreational concussion (SRC) injuries. An estimated 50% of SRCs go unreported, so the actual numbers might be greater (Harmon et al., 2013). Causes for under reporting include failure to recognize a concussion, lack of knowledge, dismissal as a minor injury, and failure of players themselves to report an injury for fear of being removed from play. Based on a report by the Institute of Medicine (as cited by the CDC, 2015a), 69% of 800 high school athletes with suspected concussion continued to play with symptoms.

The American Academy of Neurology (AAN) (2013) reported that the risk for pediatric concussions is highest in the sports of football and rugby, followed by hockey and soccer. For women and girls, the greatest risk appears to be in soccer and basketball (AAN, 2013). Although study evidence indicates that 69% of concussed pediatric athletes were male (CDC, 2016d), girls are reported to have a higher rate of concussion than boys in similar sports (Goldsmith & Ver Hage, 2011; Halstead & Walter, 2010). The cause for this finding is unknown, although speculation points to weaker neck muscles and smaller head masses in females. Males, on the other hand, may play more aggressively and be more reluctant to report their injuries (Halstead &Walter, 2010). Although concussions may occur in all sports, those that involve contact and collision plays, not surprisingly, have the highest incidence (Goldsmith & Ver Hage, 2011). In fact, a Canadian study by Emery and colleagues (2010), concluded that children playing in sports that allowed body checking and knocking another player down had 300% more injuries, including mild and severe concussions, than those playing noncontact sports. A concerning fact reported by McBride (2012) suggested that youth football players can generate head impacts as violent as those that cause concussions in adults.