Bret Stetka, MD; Andrew N. Wilner, MD


April 17, 2013

In This Article


Concussion remains a clinical syndrome that depends on a clinical history of head injury or sudden force, typical symptoms, and findings on physical examination. The AAN guideline represents an important first step to highlight the importance of recognition and management of concussion in amateur and professional athletes. These guidelines provide a basis for a consistent approach to amateur and professional athletes with mild head injuries, which should facilitate daily management at the sidelines and ringside.

Although concussions in professional athletes receive most of the press, concussions in youth sports are actually more numerous. Coaches, parents, physicians, and schools will benefit from these practical guidelines in addressing the frequent occurrence of sports-related mild head injuries.

It seems that the AAN has chosen the term "licensed healthcare provider" in order to include all medical practitioners who participate in sports medicine, acknowledging that those likely to assess athletes may not necessarily be physicians. These may include certified athletic trainers, neurologists, neuropsychologists, neurosurgeons, orthopedists, physician assistants, pediatricians, sports medicine doctors, and others. The guideline also asserts that these LHCPs must be "trained in diagnosing and managing concussion," which emphasizes the need for proper training regardless of one's specialty or degree. Ultimately, the management of each athlete with a concussion must be individualized.

Many questions remain regarding the pathophysiology of concussion and the best approach to facilitate brain healing. For example, what exactly is the nature of the injury at the tissue and cellular level that accounts for a patient's symptoms? What is it about a first concussion that predisposes to a second? How much "healing" takes place after a concussion vs "rerouting" of signaling to compensate for the injury? Does rapid return to play after symptom resolution engage the brain and promote healing or is prolonged rest a better approach? Can helmet technology be improved to prevent concussions? Now that concussion is on everyone's radar, perhaps research efforts will receive additional impetus, and the answers to these and other important questions will be forthcoming sooner rather than later.