Call for concussion registry

AN Australian expert has echoed a US call for a national registry of sports-related concussions, saying that a local database should cover all sports-related injuries.

Professor Caroline Finch, director of the Australian Centre for Research into Injury in Sport and its Prevention, based at Monash University, said a national registry of all sports injuries would be a valuable resource in guiding the future development of protocols and prevention strategies.

Such an initiative could also provide data to help address concerns about the long-term impacts of concussion, including chronic traumatic encephalopathy (CTE), said Professor Finch, who is a spokesperson for Sports Medicine Australia.

“There is a lot of debate coming from America about CTE. Because we don’t have [sufficient] data [about concussion] we are really in a situation where there is considerable misinformation and people are concerned about the potential for long-term brain damage”, Professor Finch said. “There is some low-level evidence that might support that, but without any national database, we have no strong evidence to say one way or the other.”

Professor Finch was commenting on a US position paper, published in Neurology, exploring the legal and ethical implications of the management of sports-related concussion. The authors recommended the establishment of a national concussion registry and baseline cognitive testing of US athletes. (1)

They said such an approach would enable the monitoring of concussion rates and the implementation of prevention strategies, including game rule modifications.

An accompanying editorial said it was a “refreshing reminder” of the need for continued education and research on sports-related concussion. (2)

Professor Finch told MJA InSight a registry marrying data collected by sports clubs, health professionals and hospitals was also crucial given the rise of hospital-treated sports-related injuries among children aged up to 15 years, as identified in a study published by her group earlier this month. (3)

Associate Professor Paul McCrory, neurologist and sports physician at the University of Melbourne’s Florey Institute of Neuroscience and Mental Health, said while the concept of a national concussion registry might be an “aspirational goal”, in reality most sports-related concussions occurred at the community level where injury was less likely to be detected.
    
“It’s a catch-22 that where the registry is most needed is where the data is hardest to catch”, he said.

Professor McCrory, a coauthor with Professor Finch on an MJA study that found Victorian hospitalisations for sports-related concussions had increased by more than 60% over 9 years, said concussions managed in hospital were just a fraction of the concussions that occurred. (4)

“There are probably 10 times as many concussions that go unreported to doctors as ones that are diagnosed”, he said.

Education of both athletes and GPs — who tended to be on the sidelines at junior- and community-level sporting competitions — was critical to detecting and improving the management of these cases, Professor McCrory said.

“The more knowledge and education the better, there’s no question that needs to be improved,” he said.

Professor Finch pointed to recent research by her group that showed low levels of knowledge of concussion management guidelines and protocols among a small sample of GPs. (5)

She told MJA InSight education needed to extend beyond the medical profession to sports clubs.

“This is a dual-sector problem”, she said. “Sports clubs’ coaches and officials [must] mandate that if someone gets a knock to the head or if someone has suspected concussion, they’re not allowed [to return to the field] until they have seen a doctor.”

Professor McCrory said by displaying best clinical practice at the elite level, junior and community leagues were more likely to follow suit.

“Encouraging people to report their symptoms or go to the doctor if they have an injury is key”, he said. “Using athletes as role models can be quite useful in getting that educational message across.”

Professor McCrory said many Australian sporting codes had developed sophisticated codes of conduct and ethical guidelines to address issues of conflict of interest for sports physicians, who were often employed by the sports club, and player safety.

Recent initiatives such as “no return to play on the day” and making video recordings available to doctors on the sidelines were revolutionising sideline sports medicine, he said.

1. Neurology 2014; Online 9 July
2. Neurology 2014; Online 9 July
3. BMJ Open 2014; Online 2 July
4. MJA 2013; 198: 427-430
5. Am J Lifestyle Med 2014; Online 19 June