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Concussion in Professional Football: Players Returning to the Same GamePart 7

Pellman, Elliot J. M.D.; Viano, David C. Dr. med., Ph.D.; Casson, Ira R. M.D.; Arfken, Cynthia Ph.D.; Feuer, Henry M.D.

doi: 10.1227/01.NEU.0000150180.16552.8D

OBJECTIVE: A 6-year study was conducted to determine the signs, symptoms, and outcome of players who were concussed and either returned immediately or were rested and returned to the same game in the National Football League (NFL).

METHODS: From 1996 to 2001, concussions were recorded by NFL teams by use of a special standardized reporting form filled out by team physicians. Signs and symptoms were grouped by general symptoms, somatic complaints, cranial nerve effects, cognition problems, memory problems, and unconsciousness. Action taken after concussion was recorded for 887 patients.

RESULTS: There were 135 players (15.2%) who returned immediately and 304 (34.3%) who rested and returned to the same game after concussion. There were few differences by player position or team activity about the injury or action taken. However, the mean number of signs and symptoms progressively increased from those who returned immediately (1.52), rested and returned to play (2.07), were removed from play (3.51), or were hospitalized (6.55). Immediate recall problems (odds ratio [OR], 1.93; confidence interval [CI], 1.26–2.94), memory problems (OR, 1.52; CI, 1.06–2.19), and the number of signs and symptoms (OR, 1.39; CI, 1.25–1.55) were predictive of removal from play or hospitalization. There was no statistical association between return to play in the same game and a subsequent concussion or a more serious concussion involving 7+ days out.

CONCLUSION: Players who are concussed and return to the same game have fewer initial signs and symptoms than those removed from play. Return to play does not involve a significant risk of a second injury either in the same game or during the season. The current decision-making of NFL team physicians seems appropriate for return to the game after a concussion, when the player has become asymptomatic and does not have memory or cognitive problems.

Mild Traumatic Brain Injury Committee, National Football League, New York, and ProHEALTH Care Associates, LLP, Lake Success, New York (Pellman, Viano, Casson, Feuer)

ProBiomechanics LLC, Bloomfield Hills, Michigan (Viano)

Department of Neurology, Long Island Jewish Medical Center, New Hyde Park; Department of Neurology, New York University Medical Center, New York; and Department of Neurology, Albert Einstein College of Medicine, Bronx, New York (Casson)

Department of Psychiatry and Behavioral Neurosciences, Center for Healthcare Effectiveness Research, Wayne State University, Detroit, Michigan (Arfken)

Indianapolis Neurosurgical Group, Indianapolis, Indiana (Feuer)

Reprint requests: David C. Viano, Dr. med., Ph.D., ProBiomechanics LLC, 265 Warrington Road, Bloomfield Hills, MI 48304-2952. Email:

Received, June 12, 2004.

Accepted, October 29, 2004.

Copyright © by the Congress of Neurological Surgeons