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Second impact syndrome; the risks

Second impact syndrome is rare.  But this provides little comfort to the families of athletes who have died as a result of this unpredictable cascade of terrible events that takes their child's life.  In part, it is the mystery and unknown vulnerability shared by all athletes that combines to create palpable fear, particularly for those involved in contact sports. 

Statistics

The numbers are small.  From 1980-1993 the National Center for Catastrophic Sports Injury Research in Chapel Hill, NC, identified 35 probable cases of second impact syndrome among American high school and college football players.1  

High school football estimates include:

- over 1.2 million high school student-athletes play football each year

- 47,000 to 67,000 will suffer concussions,2 although a number are unreported

- between 2005-2008 almost 16% returned to play the same day after losing consciousness5

- 40% returned to the game before their symptoms had fully healed

- more than half of athletes hide symptoms from medical personnel5

And therein lies the problem.

Definition and risks

As the name implies, second impact syndrome occurs when someone suffers a second injury to their brain before a previous injury has fully healed.  After the secondary impact, which may not be of great force, the brain loses its ability to auto-regulate intracranial and cerebral perfusion pressures, resulting in rapid, uncontrolled swelling. Death has been reported to occur in a matter of two to five minutes, usually without time to stabilize or transport an athlete from the playing field to the ED.

Prevention

Knowing when a concussion has fully healed is the art and science of trained medical professionals who have years of experience diagnosing and managing sport-related concussions. 

Returning to play before a concussion has completely healed sets the stage for a catastrophic injury.  Medical professionals trained in the diagnosis and management of concussion guide each individual’s recovery process to minimize the risks associated with additional brain injuries.  Athletes may be cleared to return to full activity - practice and/or games - when physical and cognitive symptoms have resolved and a gradual return-to-play schedule has successfully been completed.  Pioneering neurosurgeon from Boston University, Dr. Robert Cantu, provided SportsConcussions.org with updated return-to-play guidelines in October 2010.

Most athletes who continue to play with headaches or other symptoms will not suffer second impact syndrome.  But who will be affected and who will not, is unpredictable.


References:

1. Cantu RC. Second impact syndrome. Clin Sports Med. 1998;17:37–44. [PubMed]

2. The Problem with Football: How to Make it Safer   Time magazine  Jan. 28, 2010

3. Boden BP, Tacchetti RL, Cantu RC, Knowles SB, Mueller FO. Catastrophic head injuries in high school and college football players. Am J Sports Med. 2007;35:1075–1081. [PubMed]

4. Cifu D, Steinmetz BD, Drake DF. Repetitive head injury syndrome. [Accessed August 29, 2008];eMedicine. 2008 March 24; Available at: http://www.emedicine.com/sports/TOPIC113.HTM.

 5. CNN "Big Hits, Broken Dreams" dr. Sanjay Gupta  Jan. 29, 2012

 

 

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