COMMENTARY

Sports Concussion: Now There Are Guidelines

Sandra Adamson Fryhofer, MD

Disclosures

August 30, 2013

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Guidelines on Concussion

Hello. I'm Dr. Sandra Fryhofer, and welcome to Medicine Matters. The topic is concussions and the new evidence-based guidelines on its evaluation and management, from the American Academy of Neurology and published in the journal Neurology.[1] Here is why it matters.

Each year, as many as 3.8 million people in the United States suffer a sports-related concussion. Many of these individuals don't seek immediate medical attention. The new guidelines reviewed studies dating back to 1955. The first (and probably the most important) rule is that if concussion is suspected, take the player out immediately. And if in doubt, the best advice is to sit it out.

Concussion is defined as a biomechanically induced alteration of the brain function, typically affecting memory and orientation. It's a clinical diagnosis. Blackout or loss of consciousness is not required and it occurs in less than 10% of cases. The first 10 days after concussion are especially critical, which is also the time in which athletes are at a greater risk of having another concussion.

The guidelines debunk the so-called second-impact syndrome concept due to lack of evidence; this is that a second impact could cause cerebral edema and death. They do, however, explain that athletes recovering from a concussion have both a slower reaction time and a slower cognition processing time, which may leave them more vulnerable to another unexpected hit.

These new guidelines also place emphasis on individual management. The concussion severity is no longer classified at the time of the event, and there is no general safe timeline for return to play. The timing of return to play depends on the individual, the symptoms, and how quickly those symptoms resolve. Athletes should not return to play until all symptoms have resolved and until cleared by a healthcare professional well versed and trained in concussion diagnosis and management. Younger people generally take longer to recover than those in college.

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