Concussion in Athletes: Making Sense of the Guidelines

Laurie Scudder, DNP, NP; Allen Sills, MD


April 24, 2013

In This Article

Editor's Note:
The 4th International Conference on Concussion in Sport was held in Zurich, Switzerland, in November 2012. Bringing together an international panel of experts in the areas of neurology, psychology, sports medicine, rehabilitation, and kinesiology, the group released a Consensus Statement on Concussion in Sport in March 2013, which updates the previous 2008 statement. The document joins a number of other recently released guidelines including new guidelines on the evaluation and management of sports concussion released by the American Academy of Neurology (AAN) the same month. The American Medical Society for Sports Medicine Position Statement, Concussion in Sport, was released in January 2013. Another consensus statement on concussion, focusing on the role of the team physician and developed jointly by the American Academy of Family Physicians, the American Academy of Orthopaedic Surgeons, the American College of Sports Medicine, the American Medical Society for Sports Medicine, the American Orthopaedic Society for Sports Medicine, and the American Osteopathic Academy of Sports Medicine, dates from 2011. How does the clinician make sense of this plethora of recommendations? To try to answer this question, Medscape interviewed Allen Sills, MD, an author of the recent international consensus statement, Associate Professor of Neurological Surgery at Vanderbilt University, and a cofounder of the Vanderbilt Sports Concussion Center, to bring some clarity to the process of evaluating children and adults with concussion.

Concussion vs mTBI

Medscape: Could you begin by discussing the definition of concussion? The international consensus group makes a clear distinction between concussion and mild traumatic brain injury (mTBI), in contrast to other guidelines. What is the difference?

Dr. Sills: Concussion is a transient trauma-induced alteration in brain function, meaning that there is a start and stop time to the symptoms and that it is obviously associated with some discrete traumatic event with an alteration of brain function that can be manifested by many different symptoms. The term mTBI is much broader because it refers to a whole spectrum of injuries to the brain that can occur as a result of trauma, most of which are less likely to be sports-related, and it also encompasses a number of structural injuries to the brain that are associated with trauma. That is in contrast to a concussion, where traditional brain imaging is normal. Concussion is much more of a functional rather than a structural injury. The document implied, but did not state, that concussion involved negative imaging while mTBI involved positive findings on imaging.