The New York Times reported last week that the NFL and USA Football had publicized inaccurate statistics about the efficacy of a training program called Heads Up Football in preventing concussions in youth football players. Officials at USA Football had to concede that they did not review the data from the study carefully and did not realize that the positive data they were publicizing contradicted data from the same study published one year ago that showed negative results for the Heads Up Football program.
This is bad news for football, which has seen a steep drop in youth participation in recent years because of safety concerns. More and more research is coming out demonstrating a risk of chronic traumatic encephalopathy (CTE) among patients with a history of concussions. Parents are increasingly wary of allowing their children to play contact sports where a few concussions as a kid put them at risk of severe neurological complications decades later.
Even if all contact sports were banned, however—an unrealistic and unappealing (for a sports fan) scenario—we will not completely eliminate the risk of CTE. While the focus has been on sports-related concussions, this does not reflect the reality that many concussions occur outside of sports.
In my own primary care clinic over the past few months alone, I have seen patients with concussions from all sorts of causes: a man who had been in a car crash and had headaches and a foggy feeling for weeks afterward; a young woman who was the victim of domestic violence and came in with nausea and dizziness; an elderly man who had fallen and hit his head; a young man with weeks of headaches after a rowdy graduation celebration went awry.
Concussions like these that occur outside of sports often go undiagnosed. In the emergency department, when a patient comes in after a car crash or a bad fall, we almost reflexively do a CT scan of the head. If this scan does not show bleeding in the brain, we “clear” the patient and send them out with far too little counseling. This approach is good for detecting trauma that can be deadly in hours to days, but completely fails to address concussions. CT and MRI scans cannot detect concussions—the diagnosis is based on symptoms and physical exam. Because of how we approach head injury patients, we miss many cases of concussion and do not provide patients with crucial information on recovering from these injuries.
A search of the academic literature on concussion reveals that most of it is focused on sports-related injuries. Just a handful of papers directly address concussions in the adult primary care setting. Emergency and internal medicine physicians are not given adequate training on how to identify and manage concussions in patients outside a sports context, and as a result, patients are being underdiagnosed and undertreated.
The good news is that much of the research targeting sports-related concussions can also be applied to other causes of concussion. BioDirection, a Boston company developing a rapid blood test to help in the diagnosis of concussion on the playing field, could adapt its technology to help make quick diagnoses in the emergency department. And Astrocyte, a Cambridge, MA-based company, is developing a drug it hopes will protect neurons from damage after trauma.
Concussions are unfortunately common both in sports and outside of sports, and they are a big and growing public health concern. If we are able to identify concussions more reliably outside the sports setting, we can minimize the damage from these injuries. As more people are correctly diagnosed, the scale of this problem will become clearer. I hope that by exposing the problem of concussions outside sports, it will help push more funding toward addressing this important issue.
Alex Harding is a resident physician in the primary care track of Internal Medicine at Massachusetts General Hospital. He has no financial interests to disclose. Follow @alexharding7