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Head injury is a major public health concern due to the high incidence and the accompanying morbidity and mortality. In the USA, head injuries are a contributing factor to one third (30.5%) of all injury-related deaths and result in 52 000 deaths, 275 000 hospitalisations and 1.4 million emergency department visits each year.1 While fully 75% of head injuries are classified as mild traumatic brain injury, frequently referred to as ‘concussions’, these injuries can have serious and prolonged health consequences.1
Concussions are caused by a physical blow or jolt to the head resulting in either forces applied directly to the head (eg, a pitcher being struck by a batted ball) or movement of the brain within the skull (eg, anterior–posterior deceleration or rotational forces experienced in motor vehicle crash). Such forces disrupt normal cellular processes in the brain. Concussions are seen in all age, gender and ethnic groups but, because they are commonly sustained during sports and recreational activities, they have frequently been described in children. The estimated incidence of sports-related concussions in the USA ranges from 300 000 to 3.8 million annually.2 Estimating incidence is difficult because sports-related concussions frequently go undetected due to a lack of recognition of symptoms or …
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