Updated Expert Guidelines on Risks for and Management of Sports Concussion
There is no known treatment that speeds recovery or postconcussion impairment; monitoring to full recovery is critical.
Management of the millions of athletes who experience sports-related concussion annually is controversial. The American Academy of Neurology convened a panel of experts to review relevant literature published since 1955 and update the 1997 clinical practice guideline. The full guideline and supplementary materials are available at http://www.aan.com/go/practice/concussion.
The following highlights of the update are helpful to primary care clinicians who care for athletes with concussion on the field or in the office setting:
Concussion risk is greater for female athletes than for male athletes participating in the same sport (e.g., soccer and basketball).
Concussion risk is greater in American football and Australian rugby than in other sports.
Head protection probably decreases risk, but no specific type of headgear can be recommended.
Standardized assessment tools (e.g., Post-Concussion Symptom Scale and Standardized Assessment of Concussion) are relatively accurate in identifying concussion and useful for monitoring resolution of symptoms. These tools are not diagnostic and should only be used as an adjunct to traditional clinical evaluation.
Neuroimaging is not needed unless evidence exists of more severe trauma, clinical deterioration, loss of consciousness, post-traumatic amnesia, or focal neurologic deficits.
The critical objective in caring for concussed athletes is to monitor each athlete to complete resolution of symptoms before allowing them to return to play or practice. High-school age and younger athletes might require more conservative care and longer time to return to play. Prior grading systems have not proven useful; individual monitoring to full recovery off all medication, with graded physical activity to full participation, is the most important clinical objective. There is no known treatment that speeds recovery or prevents long-term impairment. Prior concussion predicts future concussions, and that plus prolonged recovery may predict long-term sequelae.
