Many studies focusing on organ damage during competition focus on short-term, immediate damage due to blunt-force trauma with a limited time window, and minimal long-term followup to control for the possibility of lasting symptoms or lingering health problems as a result. (Cantu, 2003) Thus, there is still considerable need to examine and quantify a risk of death that would otherwise be dismissed; and to characterize this threat through a variety of statistics.
Second-impact syndrome (SIS), a term originating in 1984, is described by a Dr. David Cifu and other colleagues as a "situation in which an individual sustains a second head injury before the symptoms from the first head injury have resolved." (Cifu, 2010) The second trauma for an athlete is likely to occur days to weeks following the first, in high risk sports. Loss of consciousness (syncope) is not necessary for dangerous complications to set in. (Bey, 2009) an impact which may seem of little consequence at first, wherein the athlete may seem to be only momentarily dazed can have a profound effect. But the effects of this second impact may result in cerebral edema/swelling and herniation, creating a slow bleed within the skull. This hidden crisis can trigger a seemingly healthy athlete to suffer fainting and fatality within minutes. (Bey, 2009) Dr. Cifu reports a mere 17 cases of confirmed SIS (Secondary Injury System) that have been dignified with descriptions in the medical literature. Much work still remains to describe the true pathophysiology and medical risks of SIS. (Cifu, 2010) Although Bey and colleagues have identified 35 apparent cases of the condition over a course of 13 years of examinations of football players. (American) Although similar corroborating injuries are not universally reported, even among higher-risk sports; such as Australian football which claims eight times the frequency of concussions as the American game. (Bey, 2009) Certain young athletes may not comprehend or recognize the warning signs of concussions or may believe that minor injuries do not constitute a risk sufficient to stop them from playing. A medically-reviewed guide in the New York Times as well as Mayo Clinic sources have compiled a list of early warning signs to assist with recognition of the dangers and symptoms, which can range from mild to severe. (New York Times, 2011) They can include: 1. Altered consciousness, feelings of drowsiness, difficulty in awakening, or similar deficits. 2. Confusion, ‘spaced-out' feeling, clouded thinking. 3. Headache. 4. Loss of consciousness 5. Amnesia, either retrograde or anterograde concerning of events before the injury or immediately after it. 6. Nausea and/or vomiting. 7. Visual hallucinations; such as flashing lights. 8. Fugue states or "lost time". (New York Times, 2011) 9. Ringing in the ears is another possibility according to Mayo Clinic sources. (Mayoclinic.com 2011) In many cases, minor concussions - while dangerous will still allow time for the patient to receive medical attention. But secondary insults are still a risk. Before SIS becomes a factor medical intervention should be a possibility. (Mutlu et al. 2003) Worth noting are certain warning signs that indicate immediate danger in regards of emergency symptoms of a concussive injury. Young athletes or indeed anyone suffering head injuries should seek immediate medical assistance at the onset of: 1.) Changes in level of alertness and