CMAJ News

Physicians must be brought up to speed on concussion risks

anadian physicians have often been uninformed about the C long-term consequences of concussions suffered in sport, a spe - cialist in athletic injuries argues. There’s a desperate need to educate physicians about the consequences of concussions, Dr. Jaime Kissick, former head physician for the Senators hockey club and a specialist in athlete concussions at the Ottawa Sport Medi - cine Centre in Ontario told a special seminar on concussions in hockey held at Scotiabank Place in December 2011. Physicians are in the dark about concussions as much as everyone else, he said. “One of the very real chal - lenges we have is educating the med - ical profession. We are working hard at trying to educate them about the impor - tance of concussion diagnosis, manage - t l e ment, and return-to-play plans.” f n e s i

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mount on the negative long-term conse - n A / s quences of head injuries, panelists at the r e t u session said that doctors and sports e R organizations across the globe are As a result of the publicity accorded to hockey superstar ’s prolonged scrambling to raise awareness and funds absence from the game, the sport may have little option but to take the injury more needed to establish policies and proce - seriously. dures required to address the problem. As a result of the publicity accorded United States, “225 000 new patients Aubry said. But 30% of those players to hockey superstar Sidney Crosby’s are showing effects of long-term head score abnormally on neuropsychologi - prolonged absence from the game as a injury. This isn’t necessarily just mild cal tests, he added. “This means cogni - result of concussion, and growing indi - headaches, but chronic depression, sub - tive recovery may follow the resolution cations that there are severe, long-term stance abuse, and dementia as well.” of symptoms. And we should probably effects from head injuries, the sport has Changes to hockey rules haven’t be keeping our athletes out that much had little option but to take the injury been rapidly implemented as evidence longer.” more seriously, added Dr. Mark Aubry, of such consequences has emerged. But Despite the evidence of high risk chief medical officer for Hockey the panelists argued that part of the rea - involved in returning to play too early, Canada. “We’re getting more severe in son for the delay is that people were (NHL) physi - our return-to-play guidelines because unaware of the long-term consequences cians are still in disagreement about we’re learning more about the injury. of head injuries. when players should be allowed to suit We’re realizing it doesn’t heal that fast, “It’s an invisible injury,” Kissick up, Aubry added. and what may appear mild, may be noted, adding that “the way we treat There’s a desperate need to educate more severe and prolonged than you concussions today is certainly a lot dif - players, physicians, parents and others think.” ferent than how we treated them years in the hockey community about the The severity of those consequences ago. It was a problem that existed consequences of concussions, the pan - is becoming ever more apparent, said before, but people didn’t understand elists said. Dr. Kristian Goulet, medical director at because we didn’t have the education.” To that end, the Canadian Medical the Eastern Ontario Concussion Clinic Part of that problem has been that Association and the Canadian Acad - and the Pediatric Sports Medicine players’ symptoms recede and they are emy of Sport and Exercise Medicine Clinic of Ottawa. Every year in the often eager to get back out on to the ice, cohosted a workshop for physicians

© 2012 Canadian Medical Association or its licensors CMAJ, February 7, 2012, 184(2) E113 News in December 2011 which brought Canada has been one of the agents of to play in the same game, and similar together representatives from major change. laws are pending in 23 other states, national physician groups as a part of Association rules adopted this season Aubry said. bid to collaboratively develop guide - have “zero tolerance” for hits above the Revisions to international concus - lines to optimize the care of concussed shoulder, he said. “Every head hit has a sion guidelines are also needed, the pan - patients, Kissick said.“It’s a way to put consequence and should be punished, elists argued. The current guidelines everybody’s resources together. The regardless of whether it’s accidental or were developed in 2008, when the Third plan is to come up with some very not. There’s no grey area, we need to International Conference on Concussion good learning modules for Canadian respect players’ heads.” in Sport developed the Consensus State - physicians.” The groups are seeking also recommended that teams organize ment on Concussion in Sport , which funding from the NHL Players’ Asso - preseason seminars on concussions to lays out evidence-based guidelines for ciation to help develop the treatment better inform players, parents, trainers physicians, trainers and other health guidelines. and coaches about concussion risks. care professionals on how to treat con - While critics charge that hockey offi - While the association also recom - cussed patients (http://sportconcussions cials and aficionados have been slow to mends that concussed players get a .com/html/Zurich%20Statement.pdf). embrace such changes as bans on fight - “return-to-play note” from their doctor An update is expected to be released ing and intentional head hits, or to before getting back on the ice, Cana - after a conference to be held in Zurich, impose new equipment requirements dian oversight of the game appears to Switzerland in November 2012. — such as extra padding for helmets or be lagging behind the US. Some 17 Jordan Fallis, Ottawa, Ont. softer body padding, Aubry argued at the states have passed laws protecting con - Scotiabank Place session that Hockey cussed student athletes from returning CMAJ 2011. DOI:10.1503/cmaj.109-4080

E114 CMAJ, February 7, 2012, 184(2)