The Institute of Medicine and the National Research Council today released a comprehensive report on sports-related concussions in youth, detailing factors associated with increased rates of the brain injury, the effectiveness of protective devices and new screening, diagnosis, treatment and management techniques, as well as the long-term consequences of concussions.

Two University of Pennsylvania faculty members are members of the IOM committee that authored the report, "Sports-Related Concussions in Youth: Improving the Science, Changing the Culture." They are Susan Margulies, the George H. Stephenson Professor in Bioengineering in the University of Pennsylvania’s School of Engineering and Applied Science, and Kristy Arbogast, the engineering core director of the Center for Injury Research and Prevention at the Children’s Hospital of Philadelphia and an associate professor in the Department of Pediatrics at Penn’s Perelman School of Medicine.

The report recommendations include establishing a national surveillance system to measure the incidence of concussion rates in youth and developing objective metrics for measuring whether concussions have occurred, as current practices rely on subjective signs and symptoms reported by young players. Further research into the long-term consequences of the concussions and injury thresholds and risk factors, such as previous head injuries, is also needed.

Beyond new research and treatment avenues, the committee also recommended changes for players, coaches and parents, including new age-appropriate rules and regulations for sports to prevent and respond to these injuries. The report’s final and most immediate recommendation was also to those involved in youth sports, asking them to “change the culture” around concussions and treat them as head injuries with the potential for serious consequences.

As the director of the Injury Biomechanics Lab, Margulies’ research focuses on the way the body’s tissues deal with the stresses and strains of everyday movement and the thresholds at which they can no longer return to normal function, resulting in injury. Earlier thinking on brain trauma suggested that children and adults responded to injuries in the same way, but by integrating biomechanical information derived from computational models and in vivo data, Margulies’ lab has shown that the injury mechanisms and responses vary with age. 

“Pre-adolescent children have different responses than adults to brain injuries, due to changes in tissue mechanical properties and thresholds for neural and vascular damage that occur as they grow,” Margulies said. “That’s why we need to pay increasing attention to how concussions impact young athletes, especially as we’ve seen in this report that and we have no real data on grade- or middle-school athletes and no objective metrics for measuring concussions across age groups.”     

Also in need of further research is the relationship between the linear and rotational accelerations at play during a head impact and the magnitude at which these head movements can potentially lead to a concussion.      

Kristy Arbogast, who studies pediatric biomechanics and effectiveness of safety devices, underscored one of the report’s key findings: that the lack of data on the relationship between these accelerations and concussion risk means that the ability of helmets to protect against that type of head injury is unknown.

“The committee found that helmets protect against skull fracture and more severe head injuries, but there is little evidence that protective equipment reduces the risk of concussion in young athletes,” Arbogast said. “Until we can quantify these concussion-causing accelerations across children of various ages, we cannot evaluate whether helmets help reduce these measures below a level that results in injury.”

The report was sponsored by Centers for Disease Control and Prevention, U.S. Department of Defense, U.S. Department of Education, Health Resources and Services Administration, National Athletic Trainers’ Association Research and Education Foundation, National Institutes of Health and CDC Foundation with support from the National Football League. 

The Institute of Medicine and the National Research Council are part of the National Academy of Sciences, a private, nonprofit institution that provides independent, evidence-based advice under an 1863 congressional charter.  The National Academy of Sciences, National Academy of Engineering, Institute of Medicine and National Research Council make up the National Academies.