Concussions around the globe

Brandenburg Gate, Berlin

How do you get from Bethesda, MD to San Francisco to Berlin all in a month, during the busiest time of your year?

I don’t know — but my good friend Christina Master does.

Dr. Chistina Master is an esteemed colleague from Children’s Hospital, Philadelphia (CHOP), whom I am privileged to see at some medical conferences we both frequent, including the American Medical Society for Sports Medicine (AMSSM) and Pediatric Research in Sports Medicine (PRISM) meetings.   She is an associate professor of clinical pediatrics at the Perelman School of Medicine at the University of Pennsylvania, a prolific researcher, and a busy clinician with a focus on pediatric sports medicine.

She is also an avid runner and, it seems, world traveler.  A definite ‘must follow’ on Twitter if you want to stay up to date on pediatric sports medicine (or just enjoy her many photos of the beautiful trails on which she runs, or the great dining spots she hits on her travels). #OnTheMove may be the hashtag that best describes her!

Not being able to attend any one of the three fantastic meetings she hit this October, I asked her to share with the CJSM readership her reflections on the current state of concussion understanding from around the globe.  What follows are her first hand reports from the proceedings of the National Institutes of Health (NIH) Pediatric Concussion Workshop (Bethesda), the American Academy of Pediatrics (AAP) Council on Sports Medicine & Fitness meeting (San Francisco), and the “Concussion in Sports Group” (Berlin)

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Dr. Christina Master (2nd from left) with some friends from CHOP

October is usually a busy month for concussions with all the fall sports in full swing. This October was also busy for concussions in a different way, with three important meetings focusing on the topic.  In mid October, the NIH convened a Pediatric Concussion Workshop, gathering an interdisciplinary group of researchers, clinicians and stakeholders together in Bethesda, MD to discuss the current state of the evidence in our understanding of pediatric concussion, particularly in those younger than high school.  It was an honor to present along with Bill Meehan and Kevin Guskiewicz among other experts at this workshop.  Topics addressed included unique aspects relating to concussion in children with regard to injury mechanisms, location of care and recovery time, methods of diagnosis and approaches to management, as well as the particular impact on children’s lives, including school, sports and recreation.  In addition to highlighting the gaps in knowledge, participants brainstormed in breakout sessions regarding lines of possible future research. This workshop represented an important step forward in furthering our understanding of concussion in children.  The video of this conference is available for viewing.

Golden Gate Bridge, San Francisco

Less than two weeks later, the Committee on Sports Medicine and Fitness of the American Academy of Pediatrics convened their session at the annual AAP National Conference in San Francisco.  There was a full agenda covering the entire spectrum of issues in sports for children including the problems with the professionalization of youth sports and early specialization.  The research session included posters as well as platform presentations on topics ranging from concussion to novel methods of using technology to assess risk for injury.  On the concussion front, the Committee showcased its tremendous breadth with presentations on results from clinical research from the US and abroad regarding the role of in-office exercise testing in determining readiness for return to play by Dr. Gordon Browne from Australia, to the potential utility of functional near infrared spectroscopy in concussion assessment by Eileen Storey from our research group at The Children’s Hospital of Philadelphia.

To close out the month, last, but certainly not least, the Concussion in Sport Group convened their now quadrennial meeting in the historic city of Berlin, gathering together multidisciplinary experts from around the world to refine the Consensus Guidelines on Concussion in Sport which are used the world round by clinicians, researchers and educators to inform their clinical care, innovative research and earnest advocacy on behalf of athletes in this important area of athlete wellness.  Also involved in the process were over 200 researchers who presented their work at the meeting in either the poster or oral sessions.  US sports medicine was well-represented by Margot Putukian, Kevin Guskiewicz, John Leddy and Bill Meehan among others.

A tremendous amount of work was done in advance of the meeting by the organizing and scientific committees and team of experts. Twelve work groups were tasked with reviewing the evidence to date, addressing specific questions relevant to improving our understanding of concussion in sport.  Questions ranged from identifying the best means of assessing a concussion in an athlete on the sideline, updates on advances in our understanding of the underlying pathophysiology and biomechanics, similarities and differences in concussion in children and potential therapeutic approaches to concussion, both acute and prolonged.  The systematic review process was presented in a transparent fashion along with summary findings, with discussions about implications for future practice.  The topics were opened up for comment by all attendees, more than 400 plus, and participants were encouraged to contribute ideas, thoughts, and feedback for the consensus committee to consider when revising the final guidelines.  Healthy and vigorous conversations ensued and many perspectives were shared.  The committee of experts spent an additional two days in intense work on the revision of the guidelines and we can look forward to their publication, along with their extensive systematic reviews, in the early half of next year.

This comprehensive effort summarizing our current understanding of concussion in sport will, no doubt, prove to be a substantial contribution to our field and will help all of our efforts to move our understanding forward for the future.

One of the many running trails Dr. Master enjoyed in October!

Whew!  There’s the whirlwind summary of a jam packed month, but don’t get me wrong – it was not all work and no play – #workhardplayhard – the opportunities to reconnect with old friends and make new ones at each meeting hold promise for the future as we all work together to better understand concussion and improve the care and outcomes for our athletes.  The locales for each meeting afforded myriad opportunities to #optoutdoors during this wonderful season of autumn color.  Runs with colleagues on beautiful Rock Creek Trail in Maryland, taking in incredible views from Lands End Trail in San Francisco and exploring the natural and historical beauty of the Tiergarten and Spreeweg in autumn in Berlin just simply can’t be beat. See everyone in the spring! #ilovemyjob

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Thanks so much Christina!  Definitely looking forward to seeing you at PRISM (Dallas — January) and AMSSM (San Diego — May).