By Kathryn Doyle
NEW YORK (Reuters Health) - More than half of high school athletes with concussions play despite their symptoms, and often their coaches aren't aware of the injury, according to a new study.
Most U.S. states have passed laws intended to prevent high school athletes from having a concussion go unrecognized and risking further danger by continuing to play, but legislation may not be enough, the researchers say.
Concussion symptoms include memory problems, headache, irritability or sleeping more than usual, according to the Centers for Disease Control and Prevention (CDC), and playing with these symptoms can lengthen recovery time.
"I think that currently the big problem is that kids hide their symptoms," said Dr. Frederick P. Rivara , who led the study at Harborview Injury Prevention and Research Center at the University of Washington in Seattle.
"The laws and attention to concussion have made coaches much more aware of the issues and I do believe that most coaches want to do the right thing," Rivara told Reuters Health. Playing with symptoms increases the risk of a more serious brain injury, he said.
His team's study included male high school football players and female soccer players in Washington state during the 2012 season. At the beginning of the season, team coaches filled out questionnaires designed to assess their personal details and experience and their level of education with regard to concussions.
Athletes also filled out baseline questionnaires about their history of head injuries at the beginning of the season, and researchers contacted them and their parents weekly throughout the season to report the number of practices, games, head injuries and potential concussion symptoms.
Over one season, 11 percent of soccer players and 10 percent of football players sustained a concussion, based on the symptoms they reported.
According to the survey of 778 athletes, 69 percent of those with concussions reported playing with symptoms and 40 percent reported that their coach was not aware of their concussion.
"It's disappointing that so many young athletes with apparent concussions choose not to report their symptoms to coaches or even parents, but they are often highly motivated to avoid being removed from play," Keith O. Yeates, a pediatric traumatic brain injury researcher at Nationwide Children's Hospital in Columbus, Ohio, said.
"They may also downplay or not realize the risks associated with concussions," said Yeates, who was not involved in the new study.
Each year, U.S. emergency rooms treat more than 100,000 sports-related concussions in kids age 19 and under, according to the CDC.
Rivara expected to see more concussions in football than in soccer, and was surprised at how common concussions seemed to be overall. But the previous studies that found more concussions in football were largely based on athletic trainer reports, and not athlete reports, he and his coauthors note.
Whether coaches had been educated in concussion symptoms and management did not seem to affect how likely their concussed players were to continue participating on the team, the authors report in the American Journal of Sports Medicine.
Washington was the first state to pass comprehensive concussion legislation aimed at high school athletes, the researchers write. The state's Zackery Lystedt Law, enacted in 2009, mandates coach education on concussions, and that parents sign an information sheet about concussions before kids can participate in the sport.
In addition, the researchers note, the law requires "removal of the athlete from practice or play at the time of a suspected concussion, and written clearance by a licensed health care provider trained in the evaluation and management of concussions before the athlete can return to practice or play."
To get more concussed players off the field, "we should focus on educating not only coaches but athletes and parents as well as to the symptoms and dangers of concussion," Yeates said. "We also need research to determine which educational strategies work, and better tools for identifying concussions on the sidelines," he said.
"Educating coaches is important but it may not be enough," Rivara said.
"One thing that needs to be done is to address the culture of sport, of winning at all costs, of 'manning up' and playing despite symptoms," he said.
SOURCE: http://bit.ly/1niEvIS American Journal of Sports Medicine, online February 25, 2014.