Current Recommendations for the Diagnosis and Treatment of Concussion in Sport: A Comparison of Three New Guidelines

Abstract

Currently, there is considerable debate within the sports medicine community about the role of concussion and the risk of chronic neurological sequelae. This concern has led to significant confusion among primary care providers and athletic trainers about how to best identify those athletes at risk and how to treat those with concussion. During the first quarter of 2013, several new or updated clinical practice guidelines and position statements were published on the diagnosis, treatment, and management of mild traumatic brain injury/concussion in sports. Three of these guidelines were produced by the American Medical Society for Sports Medicine, The American Academy of Neurology, and the Zurich Consensus working group. The goal of each group was to clearly define current best practices for the definition, diagnosis, and acute and post-acute management of sports-related concussion, including specific recommendations for return to play. In this article, we compare the recommendations of each of the three groups, and highlight those topics for which there is consensus regarding the definition of concussion, diagnosis, and acute care of athletes suspected of having a concussion, as well as return-to-play recommendations.

Risk of suicide after a concussion

“…95 Long-term predictions and generalizability are also problematic because of the network of intervening factors and shifting definitions of concussion. 47,96,97 Some patients with concussion receive care that may mitigate the risk of suicide, such as antidepressant medication; 98,99 however, our study lacked data on such care, which remains a topic for future research.…”

Return to play management after concussion in football: recommendations for team physicians

“…During the past 20 years different organizations and research groups have developed guidelines and positional statements for the management of concussion in football and other sports (Aubry et al, 2002;Cantu et al, 2006;Casson, Pellman, & Viano, 2009a;Doolan, Day, Maerlender, Goforth, & Gunnar Brolinson, Field, Collins, Lovell, & Maroon, 2003;Giza et al, 2013;Guskiewicz et al, 2004;Harmon et al, 2013;Kirkwood, Yeates, & Wilson, 2006;Lovell & Fazio, 2008;McCrory et al, 2009;McCrory, Meeuwisse, Aubry et al, 2013). West & Marion (2014) have recently compared the current guidelines from the American Medical Society for Sports Medicine (Harmon et al, 2013), the American Academy of Neurology (Giza et al, 2013) .…”

Emergency Neurological Life Support: Traumatic Brain Injury

“…The SAC is a brief assessment of four cognitive domains including orientation, immediate memory, concentration, and delayed recall. When administered by qualified individuals, it possesses a high sensitivity (80-94 %) and specificity (76-91 %) for concussion [41]. While most concussive symptoms are transient and selflimited, a history of concussion, ongoing symptoms, amnesia, and a younger patient age should raise concern for prolonged recovery [41].…”

“…When administered by qualified individuals, it possesses a high sensitivity (80-94 %) and specificity (76-91 %) for concussion [41]. While most concussive symptoms are transient and selflimited, a history of concussion, ongoing symptoms, amnesia, and a younger patient age should raise concern for prolonged recovery [41]. Multiple guidelines exist for evaluation and management of individuals with suspected sports-related concussion [42][43][44].…”