Sports Concussions: New Guidelines Issued

Sept. 29, 2004 -- Tighter rules on team sports have cut injuries dramatically. To further protect athletes, a team of experts has issued a study and guidelines regarding concussions.

"As sports become more of a fixture in the lives of Americans, a burden of responsibility falls on the shoulders of the various organizations, coaches, parents, clinicians, officials, and researchers to provide an environment that minimizes the risk of injury," writes researcher Kevin M. Guskiewicz, PhD, with the University of North Carolina at Chapel Hill.

His report appears in this month's Journal of Athletic Training.

The guidelines from Guskiewicz's report are based on the latest studies, and are intended to provide trainers, coaches, doctors, and parents with recommendations on preventing and handling concussions.

Among the guidelines:

1. Defining Concussion

• The term "ding" should not be used to describe a sport-related concussion as it generally diminishes the seriousness of the injury. If an athlete shows signs of a concussion after contact to the head, the athlete has, at the very least, sustained a mild concussion.
• Signs of concussion include: changing levels of consciousness, balance problems, memory and concentration difficulties, headache, ringing in the ears, and nausea.

2. Making the Return-to-Play Decision

• With sports that have a high risk of concussion, athletes may need brain (cognitive) and balance (postural-stability) tests before playing to establish their baseline functioning. These cognitive screening tests are similar to minimental status exams, which measure immediate memory, orientation, concentration, and delayed recall.
• If an athlete is injured, the time of the initial injury should be recorded. The athlete should be monitored for injury symptoms afterward, and symptoms should be noted in writing.
• Officials should monitor the athlete's vital signs and level of consciousness every five minutes after a concussion, until condition improves. The athlete should also be monitored over the next few days, looking for signs of delayed injury as well as recovery.

3. Determining Seriousness of Concussion

• After an injury, cognitive and balance testing is recommended to determine injury severity and whether the athlete is ready to return to play.
• Once the athlete is symptom-free, another round of testing should show normal results for that player.

4. Referral to a Doctor

• On the day of injury, an athlete with a concussion should be referred to a doctor if he or she lost consciousness or experienced amnesia lasting longer than 15 minutes.
• A team approach should be used in making return-to-play decisions after concussion. This approach should involve input from the athletic trainer, physician, athlete, and others involved.

5. Disqualifying Athletes

• Athletes who have symptoms of injury -- both at rest and after exertion for at least 20 minutes -- should be disqualified from returning to participate in a sport on the day of the injury.
• Athletes who lose consciousness or have amnesia should be disqualified from playing on the day of injury.
• Athletes with a history of three or more concussions and experiencing slowed recovery, temporary or permanent disqualification from contact sports may be indicted.