Over the past few years, newspaper headlines containing the word “concussion” have become disturbingly common. Much of the time, coverage has focused on professional athletes. But concussion—which can occur when force is applied to the head, with or without impact—affects people of all ages. Among 15- to 24-year-olds, sports are second only to motor vehicle accidents as the leading cause of concussion, according to the Centers for Disease Control and Prevention. More than one million athletes experience a concussion each year in the United States.
In response, the American Academy of Neurology (AAN) has released an evidence-based guideline for evaluating athletes with concussion. This new guideline, which replaces the 1997 AAN guideline on the same topic, has been endorsed by a broad range of athletic, medical, and patient groups, including the National Football League Players Association, the Child Neurology Society, the National Association of Emergency Medical Service Physicians, the National Association of School Psychologists, the National Athletic Trainers Association, and the Neurocritical Care Society.
“Among the most important recommendations the AAN is making is that any athlete suspected of experiencing a concussion immediately be removed from play,” says co-lead guideline author Christopher C. Giza, M.D., with the David Geffen School of Medicine and Mattel Children's Hospital at UCLA and a member of the AAN. “We are recommending that concussion be assessed in each athlete individually. There is no set timeline for safe return to play.”
Extra caution should be taken with athletes of high school age and younger, as evidence shows that they take longer to recover from a concussion than college athletes.
“If in doubt, sit it out,” said lead study author Jeffrey S. Kutcher, M.D., a sports neurologist with the University of Michigan Medical School in Ann Arbor and a member of the AAN. “Being seen by a trained professional is extremely important after a concussion. If headaches or other symptoms return with the start of exercise, stop the activity and consult a doctor. You only get one brain; treat it well.”
However, while an athlete should immediately be removed from play following a concussion, there is insufficient evidence supporting absolute rest, according to the authors.
The guideline was developed by reviewing all available evidence related to concussion in sports published between 1955 and June 2012. In recognition that scientific study and clinical care for sports concussions involves multiple medical specialties, a broad range of expertise was incorporated in the author panel. The authors analyzed more than 9,000 scientific studies to develop the guideline, and at least two authors independently analyzed and graded each study on the strength of its evidence.
Visit http://bit.ly/SwSWbF for the complete collection of Neurology Now articles on concussion. The AAN's new app, Concussion Quick Check, can help coaches and athletic trainers quickly recognize the signs of concussion. Available for the iPad, iPhone, and Android devices, the app can be found in the iTunes store or the Google Play store. A mobile version is available at aan.com/concussion.—Mike Smolinsky