Brain concussion in young athletes: major pain points

About authors

1 Federal Research and Clinical Center for Sports Medicine and Rehabilitation of the Federal Medical Biological Agency, Moscow, Russia

2 Pirogov Russian National Research Medical University, Moscow, Russia

Correspondence should be addressed: Maria S. Tarasova
Raevskogo, 4, 121151, Moscow; ur.abmftrops@smavosarat

About paper

Funding: this review is part of the applied research study on the Clinical and prognostic significance of neurometabolic cascade for the development of delayed complications of hypoxic and traumatic brain injuries in athletes (Neurocascade-20, ID 76.35.41) conducted by the Federal Research and Clinical Center of Sports Medicine and Rehabilitation of FMBA under the State Assignment for years 2020–2021.

Author contribution: Klyuchnikov SO searched and analyzed the literature and contributed to writing the manuscript; Feshchenko VS contributed to writing the manuscript and edited the final version; Zholinsky AV edited the final version of the manuscript; Tarasova MS, Slivin AV, Efimov PV searched and analyzed the literature.

Received: 2021-07-20 Accepted: 2021-08-19 Published online: 2021-09-17
  1. McCrory P, Meeuwisse W, Dvorak J, et al. Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin. Br J Sports Med. 2016; 51 (11): 838–47.
  2. Giza CC, Hovda DA. The new neurometabolic cascade of concussion. Neurosurgery. 2014; 75 (suppl 4): S24–S33.
  3. Neelakantan M, Ryali B, Cabral MD, Harris A, McCarroll J, Patel DR. Academic Performance Following Sport-Related Concussions in Children and Adolescents: A Scoping Review. Int J Environ Res Public Health. 2020; 17: 7602.
  4. Davis GA, AndersonV, Babl FE, Gioia, GA, Giza CC, Meehan W, et al. What is the difference in concussion management in children as compared with adults? A systematic review. Br J Sports Med. 2017; 51: 949–57.
  5. Rivara FP, Tennyson R, Mills B, Browd SR, Emery CA, Gioi G, et al. Consensus Statement on Sports-Related Concussions in Youth Sports. JAMA Pediatr. 2020; 174 (1): 79–85.
  6. Bryan MA, Rowhani-Rahbar A, Comstock RD, Rivara F. Sportsand recreation-related concussions in US youth. Pediatrics. 2016; 138: e20154635.
  7. Zuckerman SL, Kerr ZY, Yengo-Kahn A, Wasserman E, Covassin T, Solomon GS. Epidemiology of sports-related concussion in NCAA athletes from 2009-2010 to 2013-2014: incidence, recurrence, and mechanisms. Am J Sports Med. 2015; 43: 2654–62.
  8. Cancelliere C, Coronado VG, Taylor CA, Xu L. Epidemiology of isolated versus nonisolated mild traumatic brain injury treated in emergency departments in the United States, 2006–2012: sociodemographic characteristics. J Head Trauma Rehabil. 2017; 32 (4): E37–E46.
  9. Kerr ZY, Yeargin S, Valovich McLeod TC, Nittoli VC, Mensch J, Dodge T, et al. Comprehensive coach education and practice contact restriction guidelines result in lower injury rates in youth American football. Orthopaedic Journal of Sports Medicine. 2015; 3 (7): 2325967115594578. DOI: 10.1177/2325967115594578. PMID: 26674011; PMCID: PMC4622331.
  10. Bompadre V, Jinguji TM, Yanez ND, Satchell EK, Gilbert K, Burton M, et al. Washington State's Lystedt law in concussion documentation in Seattle public high schools. Journal of Athletic Training. 2014; 49 (4): 486–92.
  11. Yang J, Comstock RD, Yi H, Harvey HH, Xun P. New and recurrent concussions in high-school athletes before and after traumatic brain injury laws, 2005–2016. American Journal of Public Health. 2017; e1–e7.
  12. Coronado VG, Haileyesus T, Cheng TA, Bell JM, HaarbauerKrupa J, Lionbarger MR, et al. Trends in sports- and recreation- related traumatic brain injuries treated in US emergency departments: the National Electronic Injury Surveillance SystemAll Injury Program (NEISS-AIP) 2001–2012. J Head Trauma Rehabil. 2015; 30 (3): 185–97.
  13. Carroll LJ, Cassidy JD, Holm L, Kraus J, Coronado VG. Methodological issues and research recommendations for mild traumatic brain injury: the WHO collaborating centre task force on mild traumatic brain injury. J Rehabil Med. 2004; S (43): 113–25.
  14. Babikian T, Satz P, Zaucha K, Light R, Lewis RS, Asarnow RF. The UCLA longitudinal study of neurocognitive outcomes following mild pediatric traumatic brain injury. J Int Neuropsychol Soc. 2011; 17 (5): 886–95.
  15. Resch J, Driscoll A, McCaffrey N, Brown C, Ferrara MS, Macciocchi S, et al. ImPact test-retest reliability: reliably unreliable? J Athl Train. 2013; 48 (4): 506–11.
  16. Bruce J, Echemendia R, Meeuwisse W, Comper P, Sisco A. 1 year test-retest reliability of ImPACT in professional ice hockey players. Clin Neuropsychol. 2014; 28 (1): 14–25.
  17. Prasad MR, Swank PR, Ewing-Cobbs L. Long-term school outcomes of children and adolescents with traumatic brain injury. J Head Trauma Rehabil. 2017; 32: E24–E32.
  18. Alexander DG, Shuttleworth-Edwards AB, Kidd M, Malcolm CM. Mild traumatic brain injuries in early adolescent rugby players: Long-term neurocognitive and academic outcomes. Brain Injury. 2015; 29: 1113–25.
  19. Gusev EI, Skvorcova VI. Ishemija golovnogo mozga. M.: Medicina, 2001; 328 c. Russian.
  20. Ommaya AK, Gennarelli TA. Cerebral concussion and traumatic unconsciousness. Correlation of experimental and clinical observations of blunt head injuries. Brain. 1974; 97 (4): 633–54.
  21. Buzzini SR, Guskiewicz KM. Sport-related concussion in the young athlete. Curr Opin Pediatr. 2006; 18 (4): 376–82.
  22. Rumjancev AG, Dreval ON, Feniksov VM. Sindrom «Shaken Baby» : diagnostika, lechenie, profilaktika. Voprosy prakticheskoj pediatrii. 2007; 2 (2): 23–29. Russian.
  23. Adam JO, Jai S, Kshitij M. Parenchymal brain injuries in abusive head trauma. Pediatr Radiol. 2021; Feb 27.
  24. Emery C, Kang J, Shrier I, Goulet C, Hagel B, Benson B, et al. Risk of injury associated with bodychecking experience among youth hockey players. Can Med Assoc J. 2011; 183: 1249–56.
  25. Hollis SJ, Stevenson MR, McIntosh AS. Incidence, Risk, and Protective Factors of Mild Traumatic Brain Injury in a Cohort of Australian Nonprofessional Male Rugby Players. Am J Sports Med. 2009; Dec; 37 (12): 2328–33.
  26. Halstead ME, Walter KD, Moffatt K, Council on sports medicine and fitness. Sport-Related Concussion in Children and Adolescents. Pediatrics December. 2018; 142 (6): e20183074.
  27. Virji-Babul N, Borich MR, Makan N, Moore T, Frew K, Emery CA, et al. Diffusion tensor imaging of sports-related concussion in adolescents. Pediatr Neurol. 2013; 48 (1): 24–29.
  28. Feldman HM, Yeatman JD, Lee ES, Barde LH, Gaman-Bean S. Diffusion tensor imaging: a review for pediatric researchers and clinicians. J Dev Behav Pediatr. 2010; 31 (4): 346–56.
  29. Van BL, Ghesquière P, Lagae L, De SB. Arithmetic difficulties in children with mild traumatic brain injury at the subacute stage of recovery. Dev Med Child Neurol. 2015; 57 (11): 1042–8.
  30. Gasparovic C, Yeo R, Mannell M, Ling J, Elgie R, Phillips J, et al. Neurometabolite concentrations in gray and white matter in mild traumaticbrain injury: an 1H–magnetic resonance spectroscopy study. J Neurotrauma. 2009; 26 (10): 1635–43.
  31. Yeo RA, Phillips JP, Jung RE, Brown AJ, Campbell RC, Brooks WM. Magnetic resonance spectroscopy detects brain injury and predicts cognitive functioning in children with brain injuries. J Neurotrauma. 2006; 23 (10): 1427–35.
  32. Vagnozzi R, Signoretti S, Floris R, Marziali S, Manara M, Amorini AM, et al. Decrease in N-acetylaspartate following concussion may be coupled to decrease in creatine. J Head Trauma Rehabil. 2013; 28 (4): 284–92.
  33. Babikian T, Freier MC, Ashwal S, Riggs ML, Burley T, Holshouser BA. MR spectroscopy: predicting long-term neuropsychological outcome following pediatric TBI. J Magn Reson Imaging. 2006; 2 (4): 801–11.
  34. McCrea M, Meier T, Huber D, Ptito A, Bigler E, Debert CT, jet al. Role of advanced neuroimaging, fluid biomarkers and genetic testing in the assessment of sport-related concussion: a systematic review. Br J Sports Med. 2017; 51 (12): 919–29.
  35. Halstead ME, Walter KD. Clinical report—sport-related concussion in children and adolescents. Pediatrics. 2010; 126 (3): 597–615.
  36. Dambinova SA, Shikuev AV, Weissman JD, Mullins CD. AMPAR Peptide Values in Blood of Nonathletes and Club Sport Athletes With Concussions. Military Medicine. 2013; 178 (3): 285–90.
  37. Dambinova KT, Aliev EV, Bondarenko GV, Ponomarev AA,Skoromec AP, Skoromec TA, i dr. Biomarkery ishemii golovnogo mozga kak novyj metod dokazatel'stva jeffektivnosti nejrocitoprotektorov. Zhurnal nevrologii i psihiatrii im. S. S. Korsakova. 2017; 117 (5): 62–67. Russian.
  38. Len TK, Neary JP, Asmundson GJG, Goodman DG, Bjornson B, Bhambhani YN. Cerebrovascular reactivity impairment after sport-induced concussion. Med Sci Sports Exerc. 2011; 43 (12): 2241–8.
  39. Maugans TA, Farley C, Altave M, Leach J, Cecil KM. Pediatric sports-related concussion produces cerebral blood flow alterations. Pediatrics. 2012; 129 (1): 28–37.
  40. Wang Y, West JD, Bailey JN, Westfall DR, Xiao H, Arnold TW, et al. Decreased cerebral blood flow in chronic pediatric mild TBI: an MRI perfusion study. Dev Neuropsychol. 2015; 40 (1): 40–44.
  41. Moore DR, Pindus DM, Raine LB, Drollette ES, Scudder MR, Ellemberg D, et al. The persistent influence of concussion on attention, executive control, and neuroelectric function in preadolescent children. Int J Psychophysiol. 2016; 99: 85–95.
  42. Moor RD, Jacob JK, Ellemberg D. The long-term outcomes of sport-related concussion in pediatric populations. Int J Psychophysiol. 2018; 132 (Pt A): 14–24.
  43. Baillargeon A, Lassonde M, Leclerc S, Ellemberg D. Neuropsychological and neurophysiological assessment of sport concussion in children, adolescents and adults. Brain Inj. 2012; 26 (3): 211–20.
  44. Nelson LD, Guskiewicz KM, Barr WB, Hammeke TA, Randolph C, Ahn KW, aet al. Age differences in recovery after sport-related concussion: a comparison of high school and collegiate athletes. J Athl Train. 2016; 51 (2): 142–52.
  45. Hessen E, Nestvold K, Anderson V. Neuropsychological function 23 years after mild traumatic brain injury: a comparison of outcome after pediatri and adult head injuries. Brain Inj. 2007; 21 (9): 963–79.
  46. Babcock L, Byczkowski T, Wade SL, Ho M, Mookerjee S, Bazarian JJ. Predicting postconcussion syndrome after mild traumatic brain injury in children andadolescents who present to the emergency department. JAMA Pediatr. 2013; 167 (2): 156–61.
  47. Baillargeon A, Lassonde M, Leclerc S, Ellemberg D. Neuropsychological and neurophysiological assessment of sport concussion in children, adolescents and adults. Brain Inj. 2012; 26 (3): 211–20.
  48. Prins ML, Giza CC, Repeat traumatic brain injury in the developing brain. Int J Dev Neurosci. 2012; 30 (3): 185–90.
  49. Moore RD, Pindus DM, Drolette ES, Scudder MR, Raine LB, Hillman CH. The persistent influence of pediatric concussion on attention and cognitive control during flanker performance. Biol Psychol. 2015; 109: 93–102.
  50. Gessel LM, Fields SK, Collins CL, Dick RW, Comstock RD. Concussions among United States high school and collegiate athletes. J Athl Train. 2007; 42 (4): 495–503.
  51. Covassin T, Moran R, Elbin RJ. Sex differences in reported concussion injury rates and time loss from participation: an update of the National Collegiate Athletic Association Injury Surveillance Program from 2004–2005 through 2008–2009. J Athl Train. Large study summarizing sex differences in concussion rates and recovery after SRC in collegiate athletes. 2016; 51: 189–94.
  52. Ono KE, Burns TG, Bearden DJ, McManus SM, King H, Reisner A. Sex-based differences as a predictor of recovery trajectories in young athletes after a sports-related concussion. Am J Sports Med. 2016; 44 (3): 748–52.
  53. Tanveer SR, Zecavati N, Delasobera EB, Oyegbile TO. Gender differences in concussion and post-injury cognitive findings in an older and younger pediatric population. Pediatr Neurol. 2017; 70: 40–49.
  54. Caccese JB, Kaminski TW. Minimizing head acceleration in soccer: a review of the literature. Sports Medicine. 2016; 46 (11): 1591–604.
  55. Wallace J, Covassin T, Beidler E. Sex differences in high school athletes’ knowledge of sport-related concussion symptoms and reporting behaviors. J Athl Train. 2017; 52: 682–8.