Principle Investigator: Kevin M. Guskiewicz, Ph.D. Institution: University of North Carolina Title: A Prospective Study on Injury Assessment, Return to Play and Outcome Following Concussion in Athletes Abstract: Deciding when an athlete can safely return to participation following a concussion represents perhaps the most challenging task of any sports medicine clinician. Athletic trainers and team physicians are often forced to make such decisions while having little or no objective information on which to base their decision. It is difficult to determine the severity of the injury, especially when there is no loss of consciousness or amnesia. Research reports a high incidence of repeated head injury in sports, and suggests that serious sequelae likely increases with repeated head injury. The school athletes, including routine clinical examination, the Standardized Assessment of Concussion (SAC), the Balance Error Scoring System (BESS), a brief neurophychological test battery, and post-concussion symptom checklist. The relationship between injury assessment, management, return to play and outcome will be empirically addressed as part of the study. Sports medicine personnel from 20 high schools during the 1999-2000 and 2000-2001 academic years. The schools will be evenly divided into two groups: 1) Assessment Group, which will utilize the SAC, BESS, and neurophychological battery, in addition to completing the Concussion Index and Concussion Symptom Checklist as part of 8 post injury assessments; and 2) Reporting Group, which will only complete the Concussion Index and Concussion Symptom Checklist. Baseline screenings will also be compared to injured subjects across each postinjury assessment day. This study is expected to result in 1) validation of a safe, practical and cost effective method for assessing concussion and preventing the serious effects of subsequent head injuries in collegiate athletes; and 2) validation of a safe and practical concussion grading scale and return to play guideline based on symptom resolution and objective testing. Back

Principle Investigator: Barry J. Maron, Ph.D.

Institution: Minneapolis Hear Institute Foundation

Title: Renewal of United States Commotio Cordis Registry


Abstract: Over the last several years, the risks associated with participation in sports have come under great scrutiny in the public as well as medical community. It is known that some sudden cardiac deaths in young athletes on the athletic field are due to underlying (and usually unsuspected) cardiovascular disease, particularly hypertrophic cardiomyopathy. Recently, we have defined another cause of sudden death during sports participation in athletes without underlying cardiovascular disease. These are events (commonly referred to as commotio cordis) (3) in which a blunt blow to the chest, usually no extraordinary for the recreational or competitive sports activity involved, produces instantaneous collapse and cardiac arrest. Such catastrophes usually occur in young children and have been produced in a variety of ways — often by a projectile (e.g., baseball, hockey puck, lacrosse ball) but also by blunt person-to-person contact (e.g. bodily collisions of karate blows).

Many important issues remain unresolved with regard to blunt chest impact- induced cardiac arrest (commotio cordis) in children and young adults, including understanding of the broad clinical spectrum, mechanism of death (through analysis of arrhythmias documented following collapse), prevalence of events (obtained prospectively), determinants of survival, as well as the role of protective gear. These questions can be answered only through the detailed analysis and assembly of data from large numbers of victims. This is absolutely crucial to future efforts in this field since only a relatively small number of cases have been reported to date; for example, knowledge of the frequency of commotio cordis unavoidably impacts on policy decisions regarding the institution of protective chest padding in ice hockey and football, or development of specially designed (softer-than-normal) baseballs to afford greater impact safety. We believe that maintenance of the U.S. Commotio Cordis Registry will ultimately answer most of these questions. At present, we have assembled complete data on 75 sports but 7% were due to informal (non-adversarial) physical encounters outside the athletic arena; such latter tragedies usually result in criminal convictions. As a direct result of the support previously afforded by NOCSAE several papers and abstracts have been published characterizing commotio cordis and contributing to the visibility of this important problem in the lay and medical communities. It is our objective to create a self-sustaining registry regarding this clinical entity for publication in peer-reviewed journals. In addition, we intend to intensify our research for commotio cordis events occurring outside of sporting as well as the newly-described (and related) phenomenon of vertebral artery rupture leading to subarachnoid hemorrhage and sudden death produced by hockey puck blows to the neck.