Kenneth Goldblatt | October 20, 2018 | Personal Injury

Emergency room visits by children and adolescents for brain injuries jumped more than 60 percent over an eight-year period, according to a report released Thursday by the Centers for Disease Control and Prevention, which said the increase was believed to be a result of increased awareness of concussions and other head injuries.

The report said emergency rooms recorded an increase of visits from 153,375 in 2001 to 248,418 in 2009 among those 19 years old and younger because of traumatic brain injuries sustained in recreational activities. According to the study, the sports most likely to lead to the injuries are bicycling, football, playground activities, basketball and soccer.

“We believe that one reason for the increase in emergency department visits among children and adolescents may be a result of the growing awareness among parents and coaches, and the public as a whole, about the need for individuals with a suspected T.B.I. to be seen by a health care professional,” said Dr. Linda C. Degutis, director of the C.D.C.’s National Center for Injury Prevention and Control.

Concussions and their debilitating effects have been receiving increased attention, particularly in the N.F.L., which has taken steps to reduce the number of head injuries to players after years of distancing itself from research about the lasting impact of such injuries. The N.H.L. was also slow to adjust its rules to address the issue and was set to open its season Thursday with one of its best players, Sidney Crosby of Pittsburgh, sidelined because of the lasting effects of a concussion.

The issue has also become a flashpoint in youth sports. According to a recent report by the National Center for Catastrophic Sport Injury Research, more than 500,000 concussions are sustained by the 4.4 million children who play tackle football.

According to Dr. Julie Gilchrist, one of the C.D.C. study’s authors, the emergency room data is the first to quantify that the effort to educate coaches, parents and children about concussions is taking hold.

“We would like to see the numbers go down because we hope we have gotten better at preventing them, but we knew the numbers would have to go up before they start to come down because awareness has to go up first,” Gilchrist said.

Dr. Robert Cantu, co-director of Boston University’s Center for the Study of Traumatic Encephalopathy, also says the publicity surrounding concussions is having a significant impact. “I view the numbers as encouraging,” he said. “Some people will say that the numbers go up because the number of concussions is going up, but I don’t believe it is.”

Although Gilchrist said a rise in concussions is possible because even youth athletes are getting bigger and faster, she said that if that were the reason for the increase, the numbers of children admitted to the hospital for head injuries would also increase. But those numbers have remained relatively constant.

Still, Cantu said the biggest danger area is the amount of concussions that go undiagnosed, leading to potentially more debilitating and even fatal second-impact injuries. He said in football and hockey the number of actual concussions is six or seven times higher than the number diagnosed. Those numbers in hockey stem from research done in Canada in which physicians watched and counted the number of likely concussions sustained in games and practices in youth leagues.

It is why Cantu, who is writing a book about concussions at the youth level, believes children under 14 should not play collision sports until they are made safer.

“They should not play collision sports as they are currently played,” he said. “Listen, I love sports. I’m not trying to get rid of sports. I’m trying to get rid of head trauma in sports, particularly at the youth level.”

Collision sports were not at the root of all head injuries in the C.D.C. study. The report said that children under 10 are most likely to visit the emergency room for head injuries sustained on a playground or while bicycling. The injuries among males ages 10 to 19 are most likely from football, followed by bicycling. From ages 15 to 19, football causes by far the most concussions (30.3 percent). Soccer, basketball or bicycling are the most likely culprits for females ages 10 to 19.

Gilchrist said it was not possible to use the numbers to assess the risks of any particular activity because participation numbers are not part of the study. “Those activities may have the most concussions simply because they are so common,” she said.

She also said future research hoped to pin down head injuries that are treated by primary care physicians and other doctors, not just ones that land in emergency rooms, to get a better handle on just how many concussions are being sustained and how they are treated.

The C.D.C. has worked to increase awareness of the dangers of concussions with its Heads Up initiative, which began in 2003. It includes a section on its Web site dedicated to educating parents on the subject. It warns that even if an injury does not appear to be serious, it can have lasting repercussions, if left untreated, that affect memory, behavior, learning and emotional development.

And while the numbers signal progress, experts agree it is only a start.

“We are never going to get all of them, but we have to get a lot better,” Cantu said. “Not all the fault lies with the people on the sidelines. The kids have been to blame, too, playing through symptoms and not reporting. That’s why we have to educate them about the dangers of playing through them.”

Cantu said 32 states had passed legislation mandating concussion education for young athletes, parents and coaches.