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Concussion has been recognized as a clinical entity for more than 1000 years. Throughout the 20th century it was studied extensively in boxers,123 but it did not pique the interest of the general population because it is the accepted goal of the boxer to inflict such an injury on their opponent. In 2002, however, the possibility that repetitive concussions could result in chronic brain damage and a progressive neurologic disorder was raised by a postmortem evaluation of a retired player in the most popular sports institution in the United States, the National Football League.45 Since that time concussion has been a frequent topic of conversation in homes, schools, and on television and has become a major focus of sports programs in communities and schools at all levels.

In the Unites States, according to the Centers for Disease Control and Prevention, each year 1.7 million people present to a hospital emergency room with a traumatic brain injury (TBI), and 1.365 million are treated and released, indicating that their injuries are not severe. In adults the leading causes of head injury are falls and motor vehicle accidents, but in the 15- to 24-year age group sports are second only to motor vehicle accidents. It has been estimated that 1.6 to 3.8 million sports-related mild TBIs occur in athletes annually, but the exact number is unknown.6789 Despite the National Collegiate Athletic Association mandatory concussion education program for student athletes, an anonymous survey of a cohort of college athletes revealed that 43% of athletes who had suffered a concussion deliberately concealed their symptoms, indicating the degree to which underreporting may take place.10 It is essential that we are able to accurately and expeditiously diagnose a concussion, provide effective treatment, and develop strategies to prevent recurrent injuries.

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-William J. Mullally, MD

This article originally appeared in the August 2017 issue of The American Journal of Medicine.

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