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Jacquelyn Deichman

In 2009 Washington became the first state to pass a law requiring that young athletes be cleared by a healthcare provider to return to play after a concussion. In the next few years all states passed similar laws as awareness of the danger of sports-related concussions grew. 

But have those laws been effective?

Using one measurement, the answer is no, said Jacquelyn Deichman, a nursing student at Washington State University who researched adolescent concussions for her WSU Honors College thesis.

To gauge the laws’ effect, she looked at “leave without being seen” rates for sports- and recreation-related adolescent concussions in U.S. emergency rooms. That measurement is just what it sounds like: patients who check in at an ER but leave without being evaluated by a healthcare provider.

She used data collected by the National Electronic Injury Surveillance System and diagnosis and disposition codes, and separated the results into organized and non-organized sports.

The result: “We see these leave without being seen rates keep rising,” Deichman said.

There are lots of reasons people leave an ER without being seen, including long wait times, the lateness of the hour, and the weather.

Deichman theorized that some parents take their kids to the ER based on their symptoms, but decide later the symptoms are mild enough that they can leave.

What’s more, 40 percent of young athletes fail to report their symptoms, either because they don’t recognize them as symptoms of concussion or because they don’t want to be removed from play.

“Concussions are a huge problem to begin with,” Deichman said. Some 1.1 million to 1.9 million kids and young adults sustain a sports- or recreation-related concussion each year. The number of patients who leave a hospital or clinic without being seen is much smaller, but they’re considered high-risk because an untreated concussion could become dangerous or even life-threatening if the patient has another head injury.

Deichman said more education and standardized education are possible solutions.

“We need to be teaching athletes and their parents that it’s important to report their symptoms, it’s important to be removed from play,” she said. “They need to know the risks of continuing to play with concussions.”

Many “return to play” laws require states to give information on concussion symptoms to athletes and their parents, but the Centers for Disease Control and Prevention give only general guidelines on what information should be included.

In addition, “Athletes do not necessarily have to acknowledge their role in reporting concussion symptoms like athletes in the NCAA have to,” Deichman said, and only about half of states require athletes and parents to be informed of the risks of continuing to play after a head injury.

Deichman recommends that information on the symptoms and risks of concussions be standardized nationwide. “It could influence parents’ decision to wait in a busy emergency department,” she said.

–Addy Hatch, WSU News