02/25/2014

Washington State’s Zackery Lystedt law is helping to educate high school athletics coaches about concussions, but new research finds that 69 percent of student athletes that were surveyed still played with concussion symptoms.

High school athletics coaches in Washington State are now receiving substantial concussion education and are demonstrating good knowledge about concussions, but little impact is being felt on the proportion of athletes playing with concussive symptoms, according to two studies published this month in the American Journal of Sports Medicine.

The first study, released February 7, surveyed 270 coaches from a random sample of public high school football, girls’ soccer, and boys’ soccer in Washington State. Nearly all answered concussion knowledge questions correctly and the majority said they felt very comfortable deciding whether an athlete needed further concussion evaluation.

However, among the 778 athletes surveyed in a second study released today, 40 percent reported that their coach was not aware of their concussion, and 69 percent of the athletes reported they played with concussion symptoms.

Only one third of athletes who had experienced symptoms consistent with concussions reported receiving a concussion diagnosis.

Washington’s law is named for Zackery Lystedt who in 2006 suffered a brain injury following his return to a middle school football game after sustaining a concussion. He and his family, along with medical personnel, lobbied the state extensively for a law to protect young athletes in all sports from returning to play too soon.

“Six years after the passage of the nation’s first concussion law, educating coaches about concussions does not appear to be strongly associated with the coaches’ awareness of concussions.  Too many  athletes are still playing with concussion symptoms,” explained the studies’ principal investigator Frederick Rivara, MD, MPH, professor and vice chair of the Department of Pediatrics, and division chief for General Pediatrics at the University of Washington.

The studies also identify a crucial gap in knowledge for parents and athletes. Under the law, parents and athletes are required to sign a form alerting them to the dangers of concussions. The majority of coaches reported that they provided athletes with at least some instruction on concussions, including reading materials, videos or websites, but nearly one-third reported not providing athletes with any additional information.

For parents, the education they received from coaches was even less: Nearly 60 percent of coaches reported not providing parents with any additional concussion education, other than asking them to sign the legally required form.

“Given that concussions are difficult to diagnose, and often require either an athlete or a parent to report symptoms, educating these groups is an essential part of preventing athletes from playing with symptoms and risking a second potentially serious brain injury,” Rivara said.

“The Lystedt law was designed to improve identification of athletes with concussion and thus prevent athletes from continuing to play with concussive symptoms, risking further injury. Perhaps someday we can design laws that prevent concussion, but this would likely require different methodology, such as rule changes,” explained study author Sara P. Chrisman, MD, MPH, acting assistant professor in the Department of Anesthesiology and Pain Medicine Department of Adolescent Medicine Seattle Children's Hospital.

Now that Mississippi has passed a youth concussion law, all U.S. states have a law aimed at preventing youth brain injuries in sports.

To learn more about the law in Washington and its requirements, as well as the laws across the country, visit http://lawatlas.org/preview?dataset=sc-reboot.

The articles, “The Effect of Coach Education on Reporting of Concussions Among High School Athletes After Passage of a Concussion Law” and “Implementation of Concussion Legislation and Extent of Concussion education for Athletes, Parents, and Coaches in Washington State,” are available online through the journal: http://ajs.sagepub.com/.