How to reduce severity of sport-related concussion and improve return-to-play decisions


Recommendations Offered During Wednesday, June 16, Press Conference at Baltimore Convention Center BALTIMORE (June 16, 2004) – Due to recurrent concussions that several high-profile athletes have sustained, awareness about the serious matter of sport-related concussion has dramatically increased. In recent years, new scientific research and clinical-based literature in this area have provided the athletic training and medical professions with a wealth of updated information to improve the immediate and long-term health of athletes with concussions. To provide clinicians with recommendations based on these latest studies, the National Athletic Trainers’ Association (NATA), a not-for-profit organization representing and supporting 30,000 members of the athletic training profession, issued an advance release of its position statement on sport-related concussion this morning at a press conference held at the Baltimore Convention Center. The position statement – one of the first of its kind given by a health care organization on the management of concussions – was the centerpiece of NATA’s Media Day, held during the second day of the organization’s 55th Annual Meeting. Lead author Kevin M. Guskiewicz, PhD, ATC, and Robert C. Cantu, MD, a member of the writing group for the position statement, presented highlights from the report, which will be published in its entirety in The Journal of Athletic Training in September 2004. Ozzie Newsome, general manager and executive vice president of the Baltimore Ravens, who is very familiar with the disorienting effects of sport-related concussion in professional football, introduced Guskiewicz and Cantu at the press conference. Also speaking at the event was Harry Carson, the former New York Giants linebacker, who has suffered from post-concussion syndrome following several concussions sustained during his 13-year NFL career. The position statement is the result of 20 months of research, interpretation and writing, conducted by a prominent team of experts that included Guskiewicz, Cantu and six other health care professionals representing the fields of athletic training, sports medicine, neurology, neuropsychology and general medicine. “This statement should provide valuable information for certified athletic trainers (ATCs), physicians, and other medical professionals caring for athletes at the youth, high school, collegiate, and elite levels, as well as educating parents and coaches,” says Guskiewicz, a certified athletic trainer, who is a professor, and director of the Sports Medicine Research Laboratory in the department of Exercise and Sport Science at the University of North Carolina at Chapel Hill. “The focus on most of the current research is to help eliminate the guesswork involved with treating athletes with concussion.” The position statement, according to Guskiewicz, will hopefully teach clinicians how to implement an effective concussion management plan. “Bridging the gap between research and clinical practice,” says Cantu, “is the key to reducing the incidence and severity of sport-related concussion and improving return-to-play decisions.” Cantu is chief of Neurosurgery Service and director of Sports Medicine at Emerson Hospital in Concord, Mass.; adjunct professor, Exercise and Sport Science, at the University of North Carolina, Chapel Hill; and co-director, Neurologic Sports Injury Center, at Brigham and Women’s Hospital in Boston. Guskiewicz and Cantu presented a summary of their findings, which were organized into six sections: “Defining and Recognizing the Concussion;” “Evaluating and Making the Return-to-Play Decision;” “Concussion Assessment Tools;” “When to Refer to a Physician;” “When to Disqualify;” “Special Considerations for Young Athletes;” “Home Care;” and “Equipment Issues.” Among their key recommendations:

  • If an athlete shows concussion-like signs and reports symptoms after a contact to the head, the athlete has, at the very least, sustained a mild concussion and should be treated for a concussion. The writing team discourages the use of the term “ding” to describe even the mildest form of concussion.
  • In addition to a thorough clinical evaluation, formal cognitive and postural-stability testing is recommended to assist in objectively determining injury severity and readiness to return to play (RTP). The writing team strongly recommends that high schools, colleges and professional teams institute a testing program that incorporates baseline testing of athletes.
  • Once symptom-free, the athlete should be reassessed to establish that cognition and postural stability have returned to normal for that player.
  • An athlete with a concussion should be referred to a physician on the day of injury if he or she lost consciousness or experienced amnesia lasting longer than 15 minutes.
  • A team approach should be used in making RTP decisions after concussion. This approach should involve input from the ATC, physician, athlete, and any referral sources.
  • Athletes who are symptomatic at rest and after exertion for at least 20 minutes should be disqualified from returning to participation on the day of the injury.
  • Athletes who experience loss of consciousness or amnesia should be disqualified from participating on the day of the injury.
  • Because damage to the maturing brain of a young athlete can be catastrophic, younger athletes (under age 18) should be managed more conservatively, using stricter RTP guidelines than those used to manage concussion in the more mature athlete.
  • Any athlete with a concussion should be instructed to rest, but complete bed rest is not recommended.
  • Because of an increased risk for future concussions, as well as for slowed recovery, athletes with a history of three concussions should be advised that terminating participation in contact sports may be in their best interest.

About the NATA: Certified athletic trainers (ATCs) are unique health care providers who specialize in the prevention, assessment, treatment and rehabilitation of injuries and illnesses that occur to athletes and the physically active. The National Athletic Trainers' Association represents and supports 30,000 members of the athletic training profession through education and research. NATA, 2952 Stemmons Freeway, Ste. 200, Dallas, TX 75247, 214.637.6282; 214.637.2206 (fax).

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