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Vanderbilt Sports Medicine Prevention of Concussion: What Works, What Doesnt and Whats Next April 30, 2013 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation Assistant Professor of Pediatrics Medical Director, Program for Injury Prevention in Youth Sports (PIPYS) Vanderbilt University Medical Center Team Physician Vanderbilt & Belmont Universities Nashville Sounds & Nashville Predators VSCC & Rawlings Concussion Education Program

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Vanderbilt Sports Medicine Disclosures NO commercial relationships Research & Educational funding NIH U54 Institutional Clinical & Translational Science Award

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Vanderbilt Sports Medicine Objectives Review basic principles of injury prevention Discuss best evidence available for prevention of sports concussion Empower you to create a safer sporting environment and culture for youth athletes

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Vanderbilt Sports Medicine Injury Prevention 101

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Vanderbilt Sports Medicine Categories of Prevention Primary Preventing the injury from happening Secondary Reducing a possible injurys severity Tertiary Working for the best outcome after an injury

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Vanderbilt Sports Medicine Injury Prevention is a Team Sport

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Vanderbilt Sports Medicine Emery CA et al. CJSM, 2006. Safety cannot be delegated, it is a shared responsibility of Parents Coaches Youth athletes Safety advocates Athletic trainers Schools Health professionals

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Vanderbilt Sports Medicine Clinical CareResearch Approaches To Prevention

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Vanderbilt Sports Medicine Three More Es Evaluation Economic incentives Empowerment

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Vanderbilt Sports Medicine Strategies for Concussion Prevention

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Vanderbilt Sports Medicine Concussion Prevention: Equipment Football Helmets Mouth Guards Head Gear

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Vanderbilt Sports Medicine Football Helmet Ratings: STAR Evaluation System 5 Stars Riddell 360 Rawlings Quantum Plus Riddell Revolution Speed 4 Stars Schutt ION 4D Schutt DNA Pro + Rawlings Impulse Xenith X1 Ridell Revolution Rawlings Quantum Riddell Revolution IQ 3 Stars Schutt Air XP Xenith X2 2 Stars Schutt Air Advantage 1 Star Riddell VSR4 0 Stars Adams A2000 Pro Elite Virginia Tech National Impact Database. May 2012. Reduction in concussion risk

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Vanderbilt Sports Medicine Mouth Guards Effects of mouth guards on dental injuries and concussion in college basketball. Labella et al. MSSE, 2002. (LOE 2) Findings: No difference in concussion rate Significantly lower rate of dental trauma

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Vanderbilt Sports Medicine Head Gear in Soccer Withnall et al. BJSM, 2005. Three equipment types tested No attenuation of mechanical forces due to heading ball 33% reduction in acceleration forces from direct head-to-head contact Further evidence needed for effect on injury or concussion prevention

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Vanderbilt Sports Medicine Navarro RR. Curr Sports Med Reports, 2011.

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Vanderbilt Sports Medicine Summary of Helmet Benefits in Sports McIntosh AS et al. BJSM, 2011.

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Vanderbilt Sports Medicine Headgear Fitting Important across sports A well maintained, properly fitted helmet required to provide advertised level of protection to athlete Serious head injury (not concussion) Frequently inspect equipment for wear and tear including cracks, defects and loss of proper fit Hands-on demonstration Rawlings

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Vanderbilt Sports Medicine CDCs Heads Up Initiative Goal: Improve prevention, recognition, and response to concussion among young athletes Courtesy: Julie Gilchrist, MD, FAAP CDR, US Public Health Service Division of Unintentional Injury Prevention

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Vanderbilt Sports Medicine Heads Up: Concussion in Youth Sports 2007 26 member partnership Target = volunteers, parents Content: Audience ready & appropriate Fact sheets for coaches, parents, and athletes Clipboard Magnet Poster Concussion quiz Targeting Youth Sports

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Vanderbilt Sports Medicine Evaluation: Youth Sports Toolkit Changed knowledge, attitudes, behavior 63% viewed concussion more seriously 77% reported more skill in indentifying potential concussions 72% educated others: athletes, parents, other coaches CDC Unpublished Data

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Vanderbilt Sports Medicine 2005, 2010 14 organization collaboration Target = coaches Content: Personal story video Guide for coaches Wallet card Clipboard sticker Posters Fact sheets for parents and athletes Targeting High School Sports Heads Up: Concussion in High School Sports

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Vanderbilt Sports Medicine Youth Sports Coaches New Online Trainings for Coaches High School Coaches Football Coaches (Developed 2010) > 200,000 completed sessions

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Vanderbilt Sports Medicine 2010 Based on national needs assessment 31 organization collaboration Target = school personnel/officials Content: Fact sheets Symptom checklist Magnet Poster Laminated card Concussion in Schools (K-12) Heads Up to Schools: Know Your Concussion ABCs Prevention, Recognition, ResponseRECOVERY 3 months = 230,000 copies

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Vanderbilt Sports Medicine Heads Up: Brain Injury in Your Practice Targeting Primary Care Physicians 2003, 2007 15 agency cooperative Content: Diagnosis, management & referral recommendations ACE symptom evaluation tool ACE Care Plan Concussion in Sports palm card Patient education materials

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Vanderbilt Sports Medicine 2008 clinical guidelines Pocket card for clinicians Wallet card for patients Patient discharge handout Integrated into electronic discharge and clinician education systems Targeting Emergency Care Providers Acute Care Setting: Updated Mild Traumatic Brain Injury Guidelines for Adults Implementation > 85% US ERs Coming attractions Pediatric MTBI guidelines!!!

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Vanderbilt Sports Medicine Sport-Specific Information More to come Extensive collaboration National sports governing bodies Football, lacrosse, volleyball, hockey, soccer, baseball, softball, rugby, field hockey NCAA Educational resources Policy change Tournament PSAs NFL/NFLPA Locker room posters Youth version Postseason/Times Square PSAs Extensive collaboration National sports governing bodies Football, lacrosse, volleyball, hockey, soccer, baseball, softball, rugby, field hockey NCAA Educational resources Policy change Tournament PSAs NFL/NFLPA Locker room posters Youth version Postseason/Times Square PSAs

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Vanderbilt Sports Medicine Obtaining Copies of the Materials All materials are available at NO COST at: www.cdc.gov/Concussion.

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Vanderbilt Sports Medicine Educational Programs & Rule Changes Adherence to rules & limit illegal play 6.4% of overall injuries in 9 HS sports were related to rules transgressions (98,066 injuries/yr) Collins CL et al. Inj Prev, 2008. (RIO) Teaching proper fundamentals & technique Tackle with head up (head/neck trauma) Heading in soccer (developmental readiness) Educational & Awareness campaigns Improved knowledge & attitudes

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Vanderbilt Sports Medicine Emergency Action Plan (EAP) All organizations should have in place Detailed instructions for all contingencies and potential persons responding to an emergency Include concussion protocols (CAP) Include a map of the facilities Practice

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Vanderbilt Sports Medicine Concussion Prevention Efforts: Take Home Increased awareness of risk Use of preventive gear and behaviors Institute & adhere to preventive policies/rules Improved coaching of skills Strict officiating Enhanced recognition and response

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Vanderbilt Sports Medicine Program for Injury Prevention in Youth Sports (PIPYS) A Game Plan for Safety and Health in the Young Athlete

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Vanderbilt Sports Medicine Overview One of the first of its kind established in the nation (2011) Multidisciplinary partnership Dedicated solely to the pediatric and adolescent aged athlete Addressing all aspects of injury prevention and safety in youth sports Research, education, community outreach, social & political action, clinical care

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Vanderbilt Sports Medicine

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http://www.childrenshospital.vanderbilt.org/sportssafety www.vanderbiltsportsmedicine.com www.vanderbiltconcussion.com Thank You