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Saturday, May 25, 2013
Concussion: State Laws Ignore Science
From MedPage Today:
State lawmakers are moving quickly to enact traumatic brain injury legislation aimed at protecting young athletes, but those laws are often a step ahead of the available science, researchers reported.
During a 4-year period from January 2009 through December 2011 44 states and Washington, DC enacted traumatic brain injury laws, reported Hosea H. Harvey, JD, PhD, at Temple University Beasley School of Law in Philadelphia.
"Youth sports traumatic brain injury laws have generally taken a one-size-fits-all approach," Harvey wrote online in the American Journal of Public Health. "The laws do not incorporate scientific consensus that youth concussions vary on the basis of age, the type of sport, and whether the athlete is male or female."
Additionally, "there is no agreed-upon traumatic brain injury diagnostic metric, and there are no uniform national traumatic brain injury reporting protocols."
In 2009 lawmakers in Washington state started the trend with a law named after Zackery Lystedt, a 13-year-old who was permanently disabled following a head injury sustained in a football game in 2006. That law mandates that youths showing signs of traumatic brain injury be examined and cleared by a licensed healthcare provider.
The majority of states used the "Lystedt Law" as a template when writing their own laws, Harvey wrote. Every consequent state law copied Lystedt, Harvey wrote, which requires no fewer than 24 hours of no play after a young athlete is sidelined. But research has not established the optimal duration a player should stay out, he wrote.
Only 16 states have liability limits, or exculpatory provisions, within their traumatic brain injury laws, while 29 do not, Harvey noted. Those limits provide legal immunity where health professionals might otherwise be sued by athletes and families, he stated.
Commenting about the legislation, Reed Estes, MD, of the University of Alabama at Birmingham, also noted that state laws focus on secondary hits rather than prevention.
"They go out after that concussion, sustain another hit or similar blow, and then that can be a more serious issue with potentially some future implications or some permanent deficits," Estes said.
Harvey pointed to the lack of longitudinal cohort studies assessing long-term health outcomes.
"It is impossible to precisely determine the causal relationship, if any, between youth-sports injuries and subsequent early onset dementia that has been observed in former professional athletes," he wrote.
Estes called for consensus among the states.
"One of the problems is there's so much variability in who covers the liability for the different healthcare practitioners that are making these clearance decisions," he said. "Is there a mandated or uniform education policy for the parents, the coaches, the athletes to provide a nationwide guideline or consensus for that?"
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