October is usually a busy month for concussions with fall sports in full swing. This October was also busy for concussions in a different way, with three important meetings focusing on the topic.
In mid-October, the National Institutes of Health (NIH) convened a Pediatric Concussion Workshop, gathering an interdisciplinary group of researchers, clinicians and stakeholders together in Bethesda, MD to discuss the current state of the evidence in our understanding of pediatric concussion, particularly in those younger than high school age. It was an honor to present along with Bill Meehan and Kevin Guskiewicz among other experts at this workshop.
Topics addressed included unique aspects relating to concussion in children with regard to injury mechanisms, location of care and recovery time, methods of diagnosis, and approaches to management, as well as the particular impact on children’s lives, including school, sports and recreation. In addition to highlighting the gaps in knowledge, participants brainstormed in breakout sessions regarding lines of possible future research. This NIH workshop represented an important step forward in furthering our understanding of concussion in children. The video of this conference is available for viewing.
Less than two weeks later, the Committee on Sports Medicine and Fitness of the American Academy of Pediatrics convened their session at the annual AAP National Conference in San Francisco. There was a full agenda covering the entire spectrum of issues in sports for children, including the problems with the professionalization of youth sports and early specialization. The research session included posters, as well as platform presentations on topics ranging from concussion to novel methods of using technology to assess risk for injury.
On the concussion front, the Committee showcased its tremendous breadth with presentations on results from clinical research from the US and abroad regarding the role of in-office exercise testing in determining readiness for return to play by Dr. Gordon Browne from Australia, to the potential utility of functional near infrared spectroscopy in concussion assessment by Eileen Storey from our research group at Children’s Hospital of Philadelphia.
To close out the month, last, but certainly not least, the Concussion in Sport Group convened their now quadrennial meeting in the historic city of Berlin, gathering together multidisciplinary experts from around the world to refine the Consensus Guidelines on Concussion in Sport which are used around the world by clinicians, researchers and educators to inform their clinical care, innovative research and earnest advocacy on behalf of athletes in this important area of wellness. Also involved in the process were over 200 researchers who presented their work at the meeting in either the poster or oral sessions. US sports medicine was well-represented by Margot Putukian, Kevin Guskiewicz, John Leddy and Bill Meehan among others.
A tremendous amount of work was done in advance of the meeting by the organizing and scientific committees and team of experts. Twelve work groups were tasked with reviewing the evidence to date, addressing specific questions relevant to improving our understanding of concussion in sport. Questions included identifying the best means of assessing a concussion in an athlete on the sideline, updates on advances in our understanding of the underlying pathophysiology and biomechanics, similarities and differences in concussion in children, and potential therapeutic approaches to concussion, both acute and prolonged.
The systematic review process was presented in a transparent fashion along with summary findings, with discussions about implications for future practice. The topics were opened up for comment by the 400-plus attendees, and participants were encouraged to contribute ideas, thoughts, and feedback for the consensus committee to consider when revising the final guidelines. Healthy and vigorous conversations ensued, and many perspectives were shared. The committee of experts spent an additional two days in intense work on the revision of the guidelines, and we can look forward to their publication, along with their extensive systematic reviews, in the early half of next year.
The content of this post first appeared in Dr. Master's guest blogger article for the Clinical Sports Medicine Blog on November 2, 2016.
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