Updated Expert Guidelines on Risks for and Management of Sports Concussion

How to manage 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 to update the 1997 clinical practice guideline. The full guideline and supplementary materials are available online.

The following highlights of the update will be helpful to primary care clinicians who care for athletes with concussions on the field or in the office setting:

• Concussion risk is higher for female athletes than for male athletes participating in the same sport (e.g., soccer, basketball).

• Concussion risk is higher in American football and Australian rugby than in other sports.

• Head protection probably lowers 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 are 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 required unless evidence exists for more severe trauma, clinical deterioration, loss of consciousness, posttraumatic amnesia, or focal neurological deficits.

The critical objective in caring for athletes with concussions is to monitor each athlete to complete resolution of symptoms before allowing them to return to play or practice. High school and younger athletes might require more conservative care and longer time to return to play. Prior grading systems have not proven to be useful; individual monitoring to full recovery (off all medication), with graded physical activity to full participation, is the most important clinical objective. No known treatment speeds recovery or prevents long-term impairment. Prior concussion predicts future concussions and that, plus prolonged recovery, might predict long-term sequelae.