The document discusses youth sports concussions, including known information and unknown areas that require further research. It summarizes current Centers for Disease Control and Prevention (CDC) activities focused on understanding concussion burden and changing youth sports culture. Key known facts are provided about athletes, coaches, parents, and healthcare providers. Many unknowns remain around concussion prevalence, prevention strategies, identification and response. Research priorities include evaluating intervention effectiveness and understanding long-term outcomes. The document concludes that while knowledge has increased, gaps remain in behaviors and more data is needed to keep young athletes safe.

1. Grant Baldwin, PhD, MPH
Youth Sports Concussion
RESEARCH PRIORITIES

2. “There are known knowns.
These are things we know
that we know.
There are known unknowns.
That is to say, there are
things that we know we don't
know.
But there are also unknown
unknowns. There are things
we don't know we don't
know.”
Donald Rumsfeld

3. Overview
 Highlights of current CDC
activities
 Knowns and unknowns
about concussion
 Research priorities

5. White House Healthy Kids & Safe Sports
Concussion Summit - May 2014

6. KEY FEATURES REQUESTED
National level
Representative
Coverage of ages 5 to 21
High level of detail (e.g.,
preexisting conditions,
concussion history, use of
protective equipment, signs
and symptoms of a
concussion)
Pre-event
Event
Post-event
Clinical Presentation
Captures concussions outside of healthcare setting
Captures concussions outside of organized sports
OTHER KEY CONSIDERATIONS
Capture TBI more broadly (beyond
sports concussions)
Ability to produce state-level
estimates
Measures of exposure

8. Heads Up Key Accomplishments
 Developed relationships with 85+
organizations and dozens of key
experts.
 Created over 50 products.
 Distributed more than 6 million
print resources.
 Trained 3 million+ coaches.
 Connected with close to 40 million
Americans on social media.
 215 million+ media impressions
through print media and TV PSAs.

9. Pediatric Mild TBI Guidelines
 Importance of appropriate diagnosis
of children and teens with mild TBI.
 Need for evidence-based guidelines
to help U.S. clinicians treating
children and teens.
 Workgroup established with over 40
experts.
 6 clinical questions, over 12,000
abstracts and 1,700 full-text articles
reviewed.
 Expected in 2016.

12. KNOWNS: Athletes
 Most athletes have heard about concussion.1
 Young athletes may be unable to identify if
their symptoms are caused by a concussion
or another condition.2-3
 Athletes are more likely to report a
concussion in practice.4
 Over 50% of athletes report that their coach
did not know they had a concussion.3
 Few athletes stop playing entirely if they
experienced concussion symptoms.5-6

13. KNOWNS: Coaches
 Coaches feel it is their
responsibility to recognize a
possible concussion and remove
an athlete from play.7
 Coaches may have difficulty
identifying some concussion signs
and symptoms, such as vision
problems and sensitivity to light
and noise. 7, 8-9

14. KNOWNS: Coaches
 Athletes who receive positive
messages from their coach and
were praised for symptom reporting
are more likely to report their
concussion symptoms.10
 Coaches are less likely to remove a
young athlete from play when it is a
championship game.11

15. KNOWNS: Parents
 Parents do not always recognize post-
concussive symptoms in their children when
they appear.18
 Mothers are more likely to strongly agree
than fathers that concussions are critical
issue.1
 Parents play a key role in influencing their
children’s behavior – including concussion
reporting.19
 Parents serve as role models for safety
behaviors – including helmet wearing.20

16. KNOWNS: Health Care Providers
 Health care providers do not feel they have
adequate knowledge or training of concussion
management - such as RTP protocols.11-13
 Although guidelines exist, knowledge of and
adherence to them is low among some
specialties.13-15
 Current medical education often does not
include an evidence-based curriculum on
concussion and few health care providers
receive CME about it.16-17

17. KNOWNS: School Professionals
 Limited research and evidence on the effective
“Return to Learn” strategies.21-22
 Current research focuses on the importance of
a multidisciplinary and team-based approach
to facilitate students returning to the
classroom.21, 23

18. UNKNOWNS: Burden
 How many sports and recreation-related concussions occur among
youth each year?
 Is the number and rate of sports and recreation-related
concussions changing over time?
 What percent of those occur outside of organized, school-based
sports - the source of much of our knowledge right now?
 What percent are seen by a healthcare provider and where are
they being seen? How is this changing over time?

19. UNKNOWNS: Burden
 What barriers and facilitators influence athletes’ reporting of
concussions and how can accurate reporting be improved?
 What is the reliability of self-reported concussions among different
population groups and among sports participants of different
ages? How reliable is parent/caregiver reporting?
 Are there any novel approaches that can improve the reliability
and quality of information reported? How can new technologies
be leveraged?

20. UNKNOWNS: Prevention
 What are the impact of rules changes, changes in training
practices, and changes in the sporting environment on the
incidence or severity of concussions?
 What coaching strategies - like changes in playing technique or use
of protective equipment – are most useful? How can these efforts
be brought to scale?
 How can we best influence parents’ and coaches’ attitudes about
concussion and ensure athletes feel empowered to report a
concussion?

21. UNKNOWNS: Prevention
 What behavioral intervention strategies can be developed and
tested that change the culture of sports?
 Which primary prevention strategies to reduce concussions are
most effective with various stakeholders - players, coaches, teams,
leagues, school staff and families?
 How do public policies and other environmental factors influence
knowledge, attitudes, and behaviors regarding concussion
prevention?
 What are the costs of various TBI prevention strategies and which
are most cost effective?

22. UNKNOWNS: Identification
 What barriers and facilitators influence athletes’ reporting of
concussions in sports?
 How can education and awareness campaigns – like CDC Heads-Up
– best complement environmental change to reduce concussions?
 What role can teammates, coaches, and parents/caregivers serve
on increasing concussion reporting and care-seeking behavior?
 How effective are trainings at promoting positive reporting
behaviors among athletes?
 What strategies mitigate the barriers to concussion reporting and
facilitate a positive, safety-focused environment?

23. UNKNOWNS: Response
 What is the efficacy of state, community, and organizational
policies– including return to play and return to learn laws and
policies?
 What are the best practices for assisting young athletes with
return to learn and effective approaches to improve school
professionals’ knowledge, attitudes, and behaviors regarding
concussion?
 What are the barriers – like cost and staffing - to implementing a
return to learn process and how can they be overcome?

24. UNKNOWNS: Response
 How effective are pediatric guidelines at improving recognition and
management of mild TBI? Do they enhance clinical decision making?
 What is the feasibility and utility of using clinical decision support
tools like Electronic Health Records to improve diagnosis and
management of TBI?
 What are the range of long-term health and educational outcomes
for children?
 What risk and protective factors positively impact the trajectory of
these outcomes?

25. Unknown Unknowns
http://www.cdc.gov/injury/

26. Conclusions
 CDC ACTIVITIES: Focused on understanding
the burden, changing the culture of youth
sports, and providing clinicians with
guidance and decision support tools.
 KNOWNS: Significant progress in
knowledge about concussion. Gaps remain
in attitudes and behaviors across audiences
to keep young athletes safe on the field and
in the classroom.
 UNKNOWNS: Need for better
understanding of the burden, the
effectiveness of existing interventions,
strategies to change culture, and long term
outcomes.
 UNKNOWN UNKNOWNS: ?

27. For more information please contact Centers for
Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333
Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-
6348
E-mail: cdcinfo@cdc.gov Web: www.cdc.gov
The findings and conclusions in this report are those of the authors and do not
necessarily represent the official position of the Centers for Disease Control
and Prevention.
Special thanks to Kelly Sarmiento and Matt Breiding for their assistance with
this presentation

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31. SPORT CONCUSSION
SUMMIT
September 24, 2015#uminjuryctr