New Study In Ontario Reveals That As Many as 20% of All Adolescents Say They Have Had A Concussion In Their Lifetime

TORONTO, June 25, 2013—One in five adolescents surveyed in Ontario said they have suffered a traumatic brain injury that left them unconscious for five minutes or required them to be hospitalized overnight, a statistic researchers in Toronto say is much higher than previously thought.

Sports such as ice hockey and soccer accounted for more than half the injuries, said Dr. Gabriela Ilie, lead author of the study and a post-doctoral fellow at St. Michael's Hospital.

Traumatic brain injuries, such as concussions, were reported more often by males than females, by those with lower school grades and by those who used alcohol or cannabis in the previous 12 months, she said.

The study was to be published Wednesday (June 26) in the Journal of the American Medical Association.

Dr. Ilie said this is one of the first studies of traumatic brain injury to focus only on adolescents and to include all of their self-reported TBIs. Most previous studies based their reporting only on hospital records. Concussion is the most common form of traumatic brain injury. The data used in the study were from the 2011 Ontario Student Drug Use and Health Survey (OSDUHS) developed by the Centre for Addiction and Mental Health.

The survey, one of the longest ongoing school surveys in the world, contains responses from almost 9,000 students from Grades 7-12 in publicly funded schools across Ontario. The OSDUHS began as a drug use survey, but is now a broader study of adolescent health and well-being. For the first time in 2011, questions about traumatic brain injury were added to the survey.

"The questions about TBI were added to the OSDUHS because there were no current data on prevalence in the adolescent population," said Dr. Robert Mann, a senior scientist at CAMH and director of the OSDUHS. "Early research has indicated that there may be links between TBIs and mental health and substance use during adolescence – we plan to study this in the near future."

The survey found that 20 per cent of adolescents in Ontario said they had had a traumatic brain injury in their lifetime. It found that 5.6 per cent of them had had such an injury in the past 12 months.

Dr. Ilie said this suggests the prevalence of TBI among young people is much higher than previously known, because many head injuries remain uncounted when they are not being reported to parents, teachers, sports coaches or health care workers. In Canada, 50 per cent of all injuries that kill and disable youth involve a TBI.

This new research found that 46.9 per cent of the TBIs reported by adolescent females occurred during sports (e.g., hockey, skate boarding); the figure was 63.5 per cent for males.

Students who reported drinking alcohol occasionally/frequently and those who reported using cannabis 10 or more times over the past 12 months had more than five times and more than three the odds, respectively, of acquiring a traumatic brain injury in the past 12 months than students who reported abstinence. The survey also showed that students who reported overall poor grades at school (below 60 per cent) had almost four times the odds of a lifetime acquired brain injury than students who reported grades at or above 90 per cent.

"Traumatic brain injury is preventable," said Dr. Ilie. "If we know who is more vulnerable, when and how these injuries are occurring, we can talk to students, coaches, and parents about it. We can take preventive action and find viable solutions to reduce their occurrence and long-term effects."

Brain injuries among adolescents are particularly concerning because their brains are still developing. There is growing evidence that people who have had one or more concussions are at greater risk of future concussions, and evidence that multiple brain injuries can result in lasting cognitive impairment, substance use, mental health and physical health harms.

Source: St. Michael's Hospital

The Legislation will not be reintroduced. Instead, the Ministry of Education has decided to introduce a new concussion protocol which is outlined in the Ontario Physical Health Education Association policy web site. CLICK HERE FOR MORE While much of the information is relevant and useful, there is still a lot of detail that should be added for local teachers and coaches to understand

We now have very reliable proof that tens of thousands of students attending elementary and secondary schools in Ontario may be walking around with mild traumatic brain injuries that place them at risk for life-altering consequences from multiple concussions.  The most revealing evidence was included in a special publication of the Ontario School Boards’ Insurance Exchange on concussions. The OSBIE provides insurance coverage for almost all school boards in Ontario . Each school is required to maintain incident reports to record the details of accidents and injuries that are experienced by students.

During 2011, a total of 634 incident reports were labeled as concussions or possible concussions. Of this, only 60%, or approximately 400 were sport-related. With approximately 1 million students enrolled in Grades 7 through 12 alone, the fact that only 400 sport-related injuries were labeled as concussions or possible concussions is great cause for concern.

Experts from the medical field tend to agree that the annual rate of concussions for sports like hockey, football and soccer typically range from 15 to 20%. With over 900 secondary schools in Ontario, many of which offer competitive hockey, football and soccer programs for both boys and girls, to see only 400 sport-related incident reports labeled concussions or possible concussions is a clear indication that this type of injury is being grossly under reported or unidentified.  Consider still that aside from injuries attributed to playing for school teams, students may also receive concussions during physical education classes, intramural sports and in pick-up games in the school yard or at home, to say nothing about the number of students who receive concussions while playing on a minor sport team.

Representatives from St. Michael’s College, an all-boy Grade 7 to 12 private school in Toronto , made a presentation about their concussion management program during the OuCH! Outcomes Following Concussion in Hockey 2012 Conference, which was held at St. Michael’s Hospital on September 8, 2012. It was pointed out that during the previous year they recorded 80 concussions out of the approximately 1000 boys who were enrolled in the school.

St. Michael’s College has such an effective program that very few concussions go undetected, but other than that, they are representative of most public and independent high schools throughout Ontario . If we projected their rate of concussions across the province, it means that we could expect up to 80,000 sport-related concussions out of the 1 million students we have enrolled in Grades 7 to 12 alone. And yet we had less than 400 recorded incidents during 2011.

Dr. Michael Czarnota, Ph. D., is the primary consulting neuropsychologist for most of the Major Junior leagues in Canada , including the OHL, the QMJHL, and the WHL. He is also involved in the same capacity with the CHL, the NOJHL, the EPHL and has worked with the Women’s Hockey Association and Hockey Canada . Dr. Czarnota is concerned that if we do not become more successful in identifying concussions when they first occur, there is great danger that student-athletes may suffer serious consequences from multiple concussions because of their increased vulnerability once the brain is in an injured state.

“To better understand what takes place in the brain when you receive a concussion, just think of what happens when you have a scab on your skin that forms from a small cut. If you leave the scab alone and allow it to heal, there shouldn’t be any remaining sign of the original injury. However, if you pick at the scab it may become larger or infected. Moreover, it will take longer for the wound to heal and there is a good chance that there will be a permanent scar left on the skin. The same thing happens to the brain with concussions. If you follow a rehabilitation program that includes physical and cognitive rest, there is a good chance that the injury will heal and you won’t have any long term symptoms. However, if you continue to play sports and end up subjecting the brain to excessive stimulation while the first concussion is healing, you may prolong the recovery period and you may also receive additional concussions which could end up leaving you with permanent long-term symptoms. The key is identifying the injury in the first place. ”

I am afraid that many school boards may be waiting for the legislation to be passed before they develop or revise their own formal concussion management programs in order to be in compliance with the new regulations that are expected. In the meantime, tens of thousands of students may be slipping through the cracks while classroom teachers, phys. ed. Instructors, school coaches and even parents are unaware that they are placing so many students in grave danger. If they don’t know their students are injured, then teachers cannot be expected to make the necessary accommodations in the classroom which will help with the recovery process and allow the student to cope with the academic program.  

It is suggested that School Boards should at least take time to review and evaluate the effectiveness of their existing concussion management programs in light of the report from OSBIE. We’ve already heard enough from the experts about the nature of traumatic brain injuries to be able to develop formal preparation, identification and rehabilitation protocols that will ensure the safety and well-being of our student-athletes. We just need the will to take the knowledge we already have and make the necessary enhancements once we identify the weaknesses of our current practices. This review, evaluation and revision of existing concussion management programs is something that should not be delayed.  Multiple concussions have unpredictable cumulative effects on cognitive, emotional and psychological functions and may leave a person with a life-time of memory and vision impairment, headaches, dizziness, and even cause serious mental health problems later on in life.

I would like to invite members of school boards and minor sport organizations to contact me by email at robertkirwan@concussionmanagementpartners.com, by phone at (705) 969-7215 or download our 287 page Program Development Guide and begin doing something positive and concrete to develop your own student-athlete concussion management program that will easily meet any requirements outlined in OPHEA and from possible pending legislation that may be coming from the Ministry at some point in the future. We can’t afford to wait any longer.

FOR A FULL PDF COPY OF THE ISSUE CLICK HERE

Enough Talking & Listening!
Now Is The Time For Action!

Collective Denial of Concussions Has Reached Dangerous Levels

Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012

Expert Facilitators Work With School Boards & Minor Sport Organizations

FOR MORE INFORMATION

by email at rkirwan@infocomcanada.com

or by phone at 705-969-7215

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