Clinical Decisions Commentary

New England Journal of Medicine, August 17, 2023

Clinical Vignette followed by Pro and Con Expert Commentary

What’s Interesting about this article?

  • The clinical case vignette involved a healthy 13-year-old boy with a normal physical exam and no history of concussions or heart problems. The father played football and enjoyed the camaraderie and competition but wonders if it is safe for his son to participate.
  • Recent news reports on high-profile cases of chronic traumatic encephalopathy following repeated football concussions has both parents and physicians concerned about the dangers of this sport in high school students.
  • The argument for participation states that there are multiple benefits of regular exercise and participation is sports, and that high-quality studies have found no association between participation in collision sports such as football and adverse changes in cognition or depression.
  • The argument against participation states that there is no accepted evidence of the risk of CTE in a 13-year-old playing football, but the risk is not zero. A decision to play involves a discussion of risk benefit trade-offs and risk tolerance with family and youth.

JournalDoc Comments:

  • Evaluation of risk should involve size and weight of boy, the position that he wants to play and head-to-head collision probability, and size and weight of competitors who will be playing opposite his position.
  • If parents and boy have low risk tolerance and other non-contact sport options are available (tennis, swimming), it is probably best not to play football.
  • If family and youth are willing to accept some degree of risk and post-concussion protocols are in place for the team, may be reasonable for youth to play and re-evaluate each year based on individual experience.

Link to article in PubMed

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