The Burden of Concussion in British Columbia


Concussion and mild traumatic brain injury (mTBI) – used synonymously in the literature – have received enormous attention in recent years, both in the media as well as the scientific literature. The Centers for Disease Control has estimated that 1.6 to 3.8 million cases of sport-related concussions occur annually in the United States. Sport and recreational activities contribute to about 21 percent of all traumatic brain injuries among children in the US. This means that nearly 80 percent of head injuries are not sports-related.

A concussion can occur to anyone from a variety of causes, such as hitting your head while falling down a flight of stairs, falling off a slide in a playground, or running into a door frame. Concussions are caused by a direct blow to the head or other body part resulting in a rotational movement of the brain within the skull. Concussion can occur with or without loss of consciousness and symptoms can be subtle, including headache, confusion, nausea or dizziness, and may not appear for hours or days. Recommended treatment includes both physical and mental rest.

If an individual returns to activity too soon and a second concussion is sustained before recovering from the first, a condition known as second-impact syndrome (SIS) may occur: a swelling of the brain that can result in brain damage causing severe disability or even death. Furthermore, an individual is 3-times more likely to sustain a second concussion while in recovery from a concussion.

The short- and long-term effects of concussion can vary from person to person and can greatly affect quality of life. A significant percentage of professional hockey and football players, as well as high school athletes, with previously reported concussions or other head-related injury were found to have reported an impact on their social and professional lives including difficulties at work, attending school, playing sports and other simple activities such as riding stationary bicycles or lifting weights. This implies that the long-term effects of concussion are often not recognized early enough to prevent post-concussion syndrome and permanent brain damage.

Although concussion has not been recognized as a potentially life threatening condition in the past, SIS is the most catastrophic and lethal brain injury resulting from sport-related trauma.

Concussion is among the most devastating of catastrophic injuries, with twice the death rate of injuries overall. Evidence exists that children and adolescents take longer than adults to recover following a concussion, and can permanently change the way a child or youth talks, walks, learns, works and interacts with others. Therefore, concussion management and appropriate return to activity is crucial, particularly in the pediatric and adolescent populations.

Active and timely rehabilitation is essential for concussion patients who remain symptomatic longer than a six week period. This may include physiotherapy, occupational therapy, educational support, neuropsychology and in some case neuropsychiatry. Coordination by integrated team of professionals is required to tailor a unique rehabilitation plan for each patient.

Concussions impact the lives of children and youth at all levels and therefore having a provincial program in place with immediate access is crucial to their quality of life and future.

The purpose of this report is to describe the burden of concussion in BC, for the general population, with a focus on children and youth ages 0 to 19 years. This will be accomplished by describing mortality and hospitalization data at the provincial level, as well as emergency department visits at participating sites within Vancouver Coastal Health (VHC), Fraser Health (FH), and the BC Children’s Hospital (BCCH) located in Vancouver within the Provincial Health Services Authority.

This report will be used to facilitate discussion around the need for a concussion program for children and youth in BC.

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