New Concussion Guidelines for Athletes: When In Doubt, Sit It Out
In new guidelines for dealing with concussions, the American Academy of Neurology recommends that any athlete who may have a concussion be immediately removed from play and not returned without thorough medical evaluation.
By Amir Khan
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MONDAY, March 18, 2013 —“When in doubt, sit it out.”
That’s the essence of new American Academy of Neurology concussion guidelines for coaches, parents and players, published in the journal Neurology. The best course of action whenever a concussion is suspected is take the player out of the game, get prompt medical attention, and keep him or her out of play until they are fully cleared by a doctor.
"Being seen by a trained professional is extremely important after a concussion,” Jeffrey S. Kutcher, MD, AAN member and sports neurologist at the University of Michigan, said in a statement. “If headaches or other symptoms return with the start of exercise, stop the activity and consult a doctor.”
Concussions can occur after hard hits to the head, according to the AAN, and they cause a variety of symptoms, including headache; sensitivity to light and sound; changes in reaction time, balance and memory; and, in some cases, loss of consciousness. Repeated concussions have been linked to memory loss and depression, according to Boston Children’s Hospital.
The new guidelines replace the previous concussion advice published in 1997. The biggest change is the elimination of the timetable for return to play, according to the statement. Now, instead of establishing a set period of time before athletes return to action based on the severity of the injury, AAN urges doctors and coaches to assess each individual on a case-by-case basis.
"We've moved away from the concussion grading systems we first established in 1997 and are now recommending concussion and return to play be assessed in each athlete individually," Christopher C. Giza, MD, co-author of the guidelines and neurologist at UCLA, said in a statement.
Endorsements of the New Guidelines From Sports Groups
Jim Thornton, president of the National Athletic Trainers Association, said removing players from the game if a concussion is suspected is "absolutely the right move."
"If they are exhibiting concussion symptoms, they should be removed and evaluated to make sure they are not in danger," he said. "The long-term effects of concussions make it necessary. Every instance needs to be taken seriously."
Shital N. Parikh, MD, an associate professor of orthopedic surgery at the University of Cincinnati School of Medicine, who recently published a study on the rising rate of childhood concussions, said the guidelines should help curb the increase.
“I totally think that the statement was necessary,” Dr. Parikh said. “These guidelines are meant to prevent and diagnose concussions, which have more than doubled in the last 10 years in kids between the ages of 5 and 14.”
Parikh also emphasized that the guidelines will help athletes avoid long-lasting damage by making sure they are fully healed from a first injury before heading back onto the field.
“Players often return before the first injury is healed, and that puts them at a higher risk to get injured again,” he said. “The second injury is often more severe than the first.”
Christopher Radford, associate director of public and media relations for the National Collegiate Athletic Association (NCAA), said the organization is in favor of any guidelines that will help keep players safe.
"The NCAA is actively collaborating with member institutions and research facilities to study concussions in sport and encourages organizations such as the AAN to publish and promote consensus statements on concussion," he said in an emailed statement. "We applaud any research that helps us all understand this phenomenon better."
New Understanding of Concussion Symptoms and Effects
In an editorial accompanying the study, Anthony G. Alessi, MD, a private-practice neurologist from Connecticut, wrote that the concussion guidelines were long-overdue for an update.
“Guidelines for the diagnosis and treatment of concussion were last published 15 years ago,” he wrote in the editorial. “Over the course of those years, much has changed, not only in our knowledge of this clinical syndrome, but also in the neurologist’s role in the field of sports.”
Parikh agreed, saying that as we learn more about the effects of concussions and preventative measures, coaches, parents and doctors need to be educated to ensure that athletes are not seriously harmed.
“Education is a vital part,” said Parikh. “Once you know what to look out for, you can educate the family, the coaches and trainers to look out for these injures and try to prevent them.”
However, Alessi wrote, while guidelines are important, players themselves need to be aware of the dangers of concussions and be proactive in alerting their coaches if they are experiencing any concussion-like symptoms, adding that "like any public health problem, the most important element in future endeavors regarding concussion in sports will be educating athletes.”
While the guidelines are a positive for the player, Thornton said, not everyone will see it that way.
"Unfortunately, if you ask some coaches, it may affect them negatively because the star quarterback may have a concussion and not be able to play," he said. "Some of them may be upset, but we have to be concerned and pay attention to proviiding a safe environment for athletes to play. Up until these guidelines, we haven’t done a very good job at that."
In the statement on the new guidelines, Dr. Kutcher offered one piece of advice to athletes. “You only get one brain,” he said.
Video: Is Your “Minor Concussion” Really Minor?
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