Diagnosis and management of concussion in sports

Any sport has an inherent risk of injury. A balance must be reached between maintaining a competitive edge in a sport and ensuring participant safety. Frequently the loss of objectivity on the part of the athlete, coaches, sports media, and spectators is an unfortunate and potentially harmful bias. In that setting, the health professional's role is to provide objective assessment of the injured athlete and guidance about the advisability of safe return to competition. There are three main issues that should be addressed by any guideline for the management of concussion. The health outcomes that need to be addressed at the time of the injury and during the follow-up period include (1) the appropriate management of the injured athlete at the time of injury to identify potential neurosurgical emergencies (epidural, subdural, and intracerebral hemorrhages); (2) the prevention of catastrophic outcome related to acute brain swelling; and (3) the avoidance of cumulative brain injury related to repeated concussions. Mild traumatic brain injury typically does not require neurosurgical intervention, and the treatment of postconcussion symptoms often falls to the neurologist. 1 Questions addressed during neurologic or neurosurgical consultation for sports-related concussion call for advice to the patient that is guided by neuroscience and the consensus of experts, rather than local lore and individual opinion. Most importantly, consultation regarding the prevention of catastrophic outcome and cumulative neurobehavioral deficits from repeated concussions can best be provided by the well-informed physician. This report, based on a project already completed by the Colorado Medical Society, 2 was written to provide background information for a practice parameter of the American Academy of Neurology (AAN). 3 Disagreement about the terminology of mild traumatic brain injury and concerns about the proper management of sports-related concussion led to the development of this document. Several articles and textbook chapters have appeared …