Oklahoma State Department of Health - Management of Concussion in Sports

Management of Concussion in Sports

Heads Up: Concussion in Youth Sports

The Centers for Disease Control and Prevention has developed Heads Up: Concussion in Youth Sports, which includes useful tools and information to help coaches, parents, and athletes prevent, recognize, and respond to a concussion.

The tool kit contains practical, easy-to-use information including:

A fact sheet for coaches on concussion;
A fact sheet for athletes on concussion;
A fact sheet for parents on concussion;
A clipboard with concussion facts for coaches;
A magnet with concussion facts for coaches and parents;
A poster with concussion facts for coaches and sports administrators; and
A quiz for coaches, athletes, and parents to test their concussion knowledge.

To order or download this tool kit free-of-charge, go to: http://www.cdc.gov/ConcussionInYouthSports/. All materials are available in English and Spanish.

Management of Concussion in Sports

Grades of Concussion

Grade 1:

Transient confusion (inattention, inability to maintain a coherent stream of thought and carry out goal-directed movements)
No loss of consciousness
Concussion symptoms or mental status abnormalities on examination resolve in less than 15 minutes

Grade 2:

Transient confusion
No loss of consciousness
Concussion symptoms or mental status abnormalities (including amnesia) on examination last more than 15 minutes

Grade 3:

Any loss of consciousness
1. Brief (seconds)
2. Prolonged (minutes)

Management Recommendations

Grade 1:

Remove from contest
Examine immediately and at 5 minute intervals for the development of mental status abnormalities or post-concussive symptoms at rest and with exertion
May return to contest if mental status abnormalities or post-concussive symptoms clear within minutes

Grade 2:

Remove from contest and disallow return that day
Examine on-site frequently for signs of evolving intracranial pathology
A trained person should reexamine the athlete the following day
A physician should perform a neurologic examination to clear the athlete for return to play after 1 full asymptomatic week at rest and with exertion

Grade 3:

Transport the athlete from the field to the nearest emergency department by ambulance if still unconscious or if worrisome signs are detected (with cervical spine immobilized, if indicated)
A thorough neurologic evaluation should be performed emergently, including appropriate neuroimaging procedures when indicated
Hospital admission is indicated if any signs of pathology are detected, or if the mental status of the athlete remains abnormal

When to Return to Play

Grade of Concussion:	Return to Play only After Being Asymptomatic with Normal Neurologic Assessment at Rest and with Exercise:
Grade 1 Concussion	At least 15 minutes
Multiple Grade 1 Concussions	1 week
Grade 2 Concussion	1 week
Multiple Grade 2 Concussions	2 weeks
Grade 3 - Brief Loss of Consciousness (seconds)	1 week
Grade 3 - Prolonged Loss of Consciousness (minutes)	2 weeks
Multiple Grade 3 Concussions	1 month or longer, based on decision of evaluating physician

Features of Concussion Frequently Observed

Vacant stare (befuddled facial expression)
Delayed verbal and motor responses (slow to answer questions or follow instructions)
Confusion and inability to focus attention (easily distracted and unable to follow through with normal activities)
Disorientation (walking in the wrong direction; unaware of time, date and place)
Slurred or incoherent speech (making disjointed or incomprehensible statements)
Gross observable incoordination (stumbling, inability to walk tandem/straight line)
Emotions out of proportion to circumstances (distraught, crying for no apparent reason)
Memory deficits (exhibited by the athlete repeatedly asking the same question that has already been answered, or inability to memorize and recall 3 of 3 words or 3 of 3 objects in 5 minutes)
Any period of loss of consciousness (paralytic coma, unresponsiveness to arousal)

Sideline Evaluation

Mental Status Testing
Orientation:	Time, place, person, and situation (circumstances of injury).
Concentration:	Digits backward (i.e., 3-1-7, 4-6-8-2, 5-3-0-7-4). Months of the year in reverse order.
Memory:	Names of teams in prior contest. Recall of 3 words and 3 objects at 0 and 5 minutes. Recent newsworthy events. Details of the contest (plays, moves, strategies, etc.)
Exertional Provocative Tests 40 yard sprint 5 push-ups 5 sit-ups 5 knee-bends	Neurological Tests Strength Coordination Sensation
Any appearance of associated symptoms is abnormal, e.g. headaches, dizziness, nausea, unsteadiness, photophobia, blurred or double vision, emotional lability, or mental status changes. For more information about the management of Concussion in Sports Public Education Campaign, please call the American Academy of Neurology at (651) 695-1940 or the Brain Injury Association at (703) 761-0750. Quality Standards Subcommittee of the American Academy of Neurology. The Management of Concussion in Sports [practice parameter]. Neurology 1997;48:581-585.