Policy Corner: California Concussion Law Signed; CDC Update

Gov. Jerry Brown signed Assemblywoman Mary Hayashi’s concussion bill Oct. 4, making California the 31st state to enact legislation based on the Zackery Lystedt Law. With millions of youth athletes now better protected by these policies, attention turns toward implementation.

ACSM is working with numerous organizations, not only to pass youth concussion laws in every state, but to help school districts, youth sports organizations and health care providers put them into action. Most laws call for evaluation by “a licensed medical provider knowledgeable in the diagnosis and treatment of concussion,” which underscores the need for access to professionals with appropriate experience and training. Efforts under way include expanding opportunities for professional education and, eventually, credentialing for diagnosis and management of sports-related concussion.

The U.S. Centers for Disease Control remains the definitive source for evidence-based, cost-free information relating to the prevention, diagnosis and treatment of concussion. School districts and youth sports organizations CDC materials for concussion education required by concussion laws. Last week, the CDC announced plans to develop guidelines for traumatic brain injury in children and adolescents.

Do we need national guidelines on TBI for kids and teens?

Recently, you may have seen media reports on CDC’s expanding efforts to promote prevention, proper diagnosis and management of traumatic brain injury (TBI), including concussions, through the development of national guidelines for kids and teens. Most health care professionals agree that increased awareness of TBI risks along with implementing prevention strategies and appropriate response to this injury can reduce incidence, severity and long term negative health effects among kids and teens. So do we need to develop national TBI guidelines for kids and teens?

Diagnosis and management of TBI in kids and teens should be approached much differently than in adults. While some research shows a child’s developing brain can be resilient, it is also known to be more vulnerable to the chemical changes that occur following this injury. A TBI can have a serious effect on a young person, causing short- and long-term problems affecting his or her thinking, language, learning, behavior, and/or emotions. While most kids and teens with a TBI recover quickly and fully, some will have symptoms that last for days, or even weeks. A more serious TBI can last for months or longer. It can even be fatal.

So, the short answer is yes. We believe guidelines need to be created specifically for kids and teens that are based on the best research available. Guidelines also need to be comprehensive and address TBIs that occur on and off the sports field: including those injuries from falls, motor vehicle crashes, among other causes.

We plan to begin by exploring the current science, conducting a rigorous review of scientific literature, and bringing together a very multi-disciplinary group of experts from across the country. This panel will engage to ask questions and assess the current evidence base in existing literature to determine the ultimate product: guideline, consensus document, etc.

We are very early on in this process, so at this point, we have not made any decisions on the make-up of the panel/committee. However, our hope is that over the next 2-3 years to be able to build collaborative and uniform guidance on diagnosis and management of TBI for kids and teens that can be used in health care professional’s offices, emergency departments, and training rooms nationwide.

This is not a short-term project, and this is just one piece of the effort, to really make an impact to address TBI and keep kids and teens active and healthy.

So what can you do now?

Last week CDC released a new course called “Heads Up to Clinicians: Addressing Concussion in Sports among Kids and Teens.” Developed with support from the NFL and the CDC Foundation, the course demonstrates what happens to the brain after a concussion, walks health care professionals through the steps of diagnosing and managing concussion, and offers strategies for prevention. You should take this course or encourage your child’s health care professional to take this course.

Parents and others can take an active role by ensuring school professionals and coaches keep “Heads Up” materials on hand in the classroom, the school nurse’s office, and on playgrounds and sports fields.

The topic of concussion has pushed to the forefront of discussion in the media, among parents and coaches, in professional sports and in health care settings. This topic is not going away any time soon and the information surrounding it will continue to evolve and change. In the meantime, we can do more than just discuss it. We can make valuable changes that affect the lives of young people.

Richard C. Hunt, MD, FACEP
Division of Injury Response
National Center for Injury Prevention and Control
Centers for Disease Control and Prevention