Management of Sports-Related Concussions: Staying Ahead of the Game, 2nd Edition: Summary 21
Challenges in Management Managing sports-related concussions is challenging due to several factors: • Inconsistent definitions across different organizations and time periods • Subjective nature of many symptoms, relying on athlete self-reporting • Team culture that may discourage symptom reporting • Wide age range of affected individuals, from youth to professional athletes • Evolving management techniques and guidelines RISK REDUCTION AND PREVENTION Equipment Recommendations The role of equipment in concussion prevention has evolved over time. While helmets are primarily designed to prevent skull fractures and facial injuries, recent research has shown some promise in concussion reduction: • Mouthguards have shown reduced concussion rates in ice hockey, contrary to earlier beliefs • Helmet sensors are being developed to monitor impacts and potentially provide data for concussion risk assessment It is important to note that while equipment can help, it does not completely eliminate the risk of concussions. Rule Changes and Policy Modifications Several rule changes have been implemented to reduce concussion risk: • Elimination of body checking in youth ice hockey has shown a reduction in concussion incidence • Changes to practice policies have led to a reduction in practice-related concussions • Professional and college football rule changes are expected to trickle down to high school and youth levels Education and Awareness Educating coaches, parents, and athletes about concussion signs, symptoms, and the importance of reporting is crucial. All 50 states now have youth concussion laws, emphasizing the need for proper management and return-to-play protocols. SIDELINE EVALUATION The sideline evaluation is critical for identifying potential concussions and making immediate decisions about an athlete's ability to continue play. A brief concussion evaluation tool should be used in conjunction with a motor-control evaluation.
Standardized Assessment Tools The Sport Concussion Assessment Tool (SCAT) is widely used for sideline evaluation. Clinical utility decreases 3-5 days post injury and should not be performed in less than 10 minutes. The latest version, SCAT6, added the following components: • A longer word list for immediate and delayed memory • Added digits to a string of numbers for concentration section • Added time component to months backwards section • Added timed dual gait task (subtract by 7) • Added more robust observable signs LEARNING TIP!
The SCAT should inform clinical decision- making but should not be used as the sole basis for diagnosis or return-to-play decisions.
Step 0: Red Flags • Neck pain, seizures, convulsions, double vision, loss of consciousness, weakness/tingling/burning more than one extremity, deteriorating conscious state, vomiting, severe headache, agitation or combative behavior, GCS <15, deformity of the skill Step 1: Observable Signs of Head Trauma Coaches and medical professionals should be aware of observable signs such as: • Lying motionless on the playing surface • Falling without protective action • Motor coordination/balance problems/ataxia • Disorientation/confusion/altered mental status • Blank or vacant look • Facial injury after head trauma • Seizure • High-risk mechanism of injury • Loss of consciousness • Tonic posturing • Slow to get up following a hit to the head • Clutching the head after contact • Behavior changes Step 2: Glascow Coma Scale: out of 15 • Best eye response (4) • Best verbal response (5) • Best motor response (6) Step 3: Cervical Spine Assessment • Pain, tenderness, ROM, extremity strength and sensation
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