Context: Underreporting of mild traumatic brain injuries, or MTBIs, in high school athletics is a serious concern today. More specifically, the brain is more susceptible to serious injury after an initial MTBI, which can result in second impact syndrome. Second impact syndrome may occur when an athlete returns to play too soon after an initial MTBl and receives another trauma to the head. There have been at least 17 adolescent deaths related to second impact syndrome in recent years. Current return-to-play guidelines are often based upon a subjective assessment of return to normalcy which may be too liberal.
Objective: To determine if a computerized neuropsychological testing program can be used in the routine screening for MTBIs with high school football players, to ascertain if MTBls, are truly underreported among highschool athletes what length of time is needed for full recovery, and what return-to-play guidelines are . adequate to protect them from second impact syndrome. '
Design: This study utilized high school football players and ImPACT, a computer-based demographic; symptom and neuropsychological test program which assesses cognitive functioning levels. Each athlete was, tested pre-season for baseline functioning and then screen,ed after a 4-day period of hitting practice for a possible MTBl, If a MTBI occurred, either self-reported or discovered by ImPACT,the individual was then tested at 48 hours, 4 days, and2 weeks for serial evaluation of cognitive improvement overtime compared to the individuals', baseline data.
Setting: This study was completed at Central Catholic High School in Portland, Oregon.
Subjects: 84 varsity level football players ranging from 15-18 in age.
Results: Of the 84 players tested, 3 were found to have sustained a MTBl to some,degree. One of the players self-reported his injuries, while the other two did not and the associated cognitive dysfunction was discovered by screening with ImPACT© after three days of hitting practice. This means that 2.5% of the players sustained a MTBI and did not report .it. All three subjects showed a trend of a significant,decline in cognitive functioning at 48 hours, Whi9h showed improvement by 4 days, and two of the, subjects. showed essentially complete resolution by 2 weeks.
Conclusions: A computerized neuropsychological testing program seems to be a promising sensitive and objective screening tool for MTBIs in high school football players after engaging in activities that could possibly result in a MTBI. The time needed for full recovery from a MTBl seems to vary for each individual and a set timeframe for return-to-play is useless. Management needs to he individually based to include proper medical care and serial neuropsychological testing to assess , when the athlete has fully recovered, reducing his risk for second impact syndrome. The , ImPACT©program needs to be redesigned to improve randomization for repeated testing to minimize any practice effect.
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