AAP Updates Sport-Related Concussion Recommendations

Lara C. Pullen, PhD

November 13, 2018

The American Academy of Pediatrics has released updated guidance on the diagnosis and management of sport-related concussion (SRC).

This first update in 8 years suggests that, although athletes need to take an immediate break from play after a concussion, they do not need to eliminate all physical and cognitive activity.

The guidance, by Mark E. Halstead, MD, director of the Sports Concussion Program at Washington University, St. Louis, Missouri, and colleagues was published online on November 12 in Pediatrics.

The pediatricians describe the evolution of thought from elimination of all activity in the days following a concussion to an emphasis on reduction of activity. They explain that a brisk walk can be considered an example of an appropriate post-SRC activity.

"Students shouldn't need to take a prolonged amount of time away from school, though they should work with teachers on lessening the academic workload. These are individual decisions that families should discuss and evaluate with their child's physician," explained Halstead in a news release. Moreover, the report notes that there is no research to indicate that the use of electronics such as computers, television, or video games, is harmful after concussion.

Research does suggest that effective management of SRC can shorten recovery time and possibly decrease the risk of long-term symptoms and complications. When appropriately managed, most pediatric athletes will recover within 4 weeks of injury.

Unfortunately, players who may have received an SRC are often encouraged to "tough it out without seeking help," said Halstead. The report cautions against giving this message to young athletes.

Instead, neurocognitive testing and other tools should be used to determine whether an athlete can return to play. Healthcare providers should also know their current state's laws regarding return to play after a concussion.

Although research is still limited with regards to the long-term effects of single or multiple concussions, athletes with a suspected SRC should be immediately removed from play and not resume until they have returned to their baseline level of symptoms and functioning.

Athletes who continue to have symptoms after an SRC should be evaluated for coexisting problems that may be contributing to the presentation. Not only is each concussion unique, but symptoms may overlap with other medical conditions.

If an athlete remains unconscious after a head injury, he or she should be treated as if they have a cervical spine injury.

SRCs remain a common occurrence in most sports at all levels. Each year physicians in the United States treat 1.1 million to 1.9 million children and teens for recreation- or sport-related concussion.

Middle school tackle football has the highest rate of SRC at 2.6 to 2.9 per 1000 athletic exposures. This is noteworthy because there is very little research on concussions in middle school and younger athletes. For girls, the riskiest sports are soccer, followed by lacrosse and field hockey.

The report calls for rule changes, education programs, and improvements in equipment design to reduce the risk for concussion.

The authors have disclosed no relevant financial relationships.

Pediatrics. Published online November 12, 2018. Full text

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