Concussion Management in Organized Sports

by Steve Holder on June 25, 2008

Almost every athlete knows what it means to “have your bell rung” or to “see stars.” These are the common expressions for a head injury that leaves a player momentarily disoriented. Disorientation following a head injury is one of the signs of concussion.

Each year in the U.S., millions of children and adults experience a concussion from involvement in organized sports. In football, baseball, basketball, and soccer alone, nearly 100,000 will visit a hospital emergency room as a result of a head injury. Serious concussions and multiple mild concussions can lead to lasting disability and can sometimes be fatal. (See Brain Injuries in Sports.)

Given the potential for serious brain injury in sports activities, the American Academy of Neurology (”AAN”) has issued guidelines specifically for concussion management in sports. These guidelines for coaches apply to sports at any level, from pee-wee to pro.

Concussion Symptoms

Managing a concussion first requires recognizing its symptoms. Any player exhibiting any of the following conditions should be evaluated on the sideline before being allowed to return to the game.

  • Confusion, disorientation
  • Headache, dizziness, nausea, vomiting
  • Uncoordinated or slow movement
  • Impaired thinking or memory
  • Slow or slurred speech
  • Blurred vision, double vision, or sensitivity to light
  • Ringing in the ears
  • Loss of memory of events immediately before or after the injury
  • Unconscious for any period of time

Evaluating the Concussion

Concussions can be mild or severe. Players can recover quickly from a mild concussion and the AAN guidelines allow the athlete to resume play after all concussion symptoms have cleared up. Any head injury other than the mildest concussion, however, requires a neurological examination and at least a 1-week or longer break from playing.

The following describes how to evaluate a concussion’s severity, with Grade 1 being the mildest.

  • Grade 1. Temporary disorientation, no loss of consciousness, all symptoms clear up in less than 15 minutes.
  • Grade 2. Temporary disorientation, no loss of consciousness, symptoms persist for 15 minutes or more.
  • Grade 3. Any loss of consciousness, whether for seconds or minutes.

If the player remains unconscious, have emergency medical personnel transport the player to the emergency room. Because of possible neck or spine injuries, do not remove protective gear and do not move the player. In case of vomiting, roll the athlete gently to one side being careful to keep the head and spine aligned.

If on the other hand the player loses consciousness only briefly, take the player to get a neurological evaluation.

Sideline Assessment

A mild, Grade 1 concussion is the most common, but it can be the most difficult to identify since the symptoms may be brief. Nonetheless, it’s important to recognize even a mild concussion because a second mild concussion can have serious implications.

When no loss of consciousness occurs, evaluate the player for other symptoms. To determine if a player is suffering from deteriorated mental or physical function, ask the player to:

  • Identify the date, day of the week, month, location, opponent (Orientation)
  • Recall what happened, previous opponents, recent events (Memory)
  • Count from 10 backwards; recite the months of the year in reverse order (Concentration)
  • Walk or run a short distance, perform calisthenics (Intact senses and motor function)

Evaluate the athlete every 5 minutes for improvement. If the symptoms all clear up within 15 minutes, the player can return to the competition. If the symptoms do not clear up in less than 15 minutes, the player has a Grade 2 concussion.

Sidelining the Player

A concussion greater than a Grade 1, or two or more concussions of any grade, require a player to get a neurological evaluation and take a minimum of one to two weeks away from the sport. The risk of permanent or fatal injury from repeated brain trauma is too serious to be taken casually.

Detailed guidelines for evaluation, treatment, and limitations on sports activities are available in the complete paper from the American Academy of Neurology, Practice Parameter: The Management of Concussion in Sports.

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