Concussions in Athletes
Head Injuries in Contact Sports Should be Managed Conservatively
Feb 17, 2008
What is a Concussion?
A concussion is a head injury that results in disruption in normal mental function. The loss of function usually resolves in less than 24 hours, but other symptoms may linger. Persistent concussion symptoms include:
- Loss of Coordination
- Lightheadedness
- Fatigue
- Depression or anxiety
- Headache
- Dizziness
- Nausea or vomiting
- Slurred speech
- Loss of balance
Mechanism of Injury.
In most concussions, the patient either suffers a direct blow to the head, or is subjected to rapid acceleration or deceleration force. This causes a sudden shift of the brain inside the skull which, in turn, disrupts normal metabolic activity in an unknown number of neurons (brain cells). The loss of function results in concussion symptoms. Usually, there are no visible or structural changes of the brain seen on Neuroimaging such as CT scans or MRI scans of the brain. In rare cases, a small blood clot may be present.
How are Concussions Classified?
Concussions are classified by severity and duration of symptoms. Injuries are classified as Grade 1, Grade 2 or Grade 3, using the following criteria:
- Grade 1 - Patient experiences mild confusion, and remains conscious. Symptoms resolve in less than 15 minutes.
- Grade 2 - Patient experiences mild confusion, which may last beyond 15 minutes, as well as some degree of amnesia (short term memory loss). As in a grade 1 injury, the victim remains conscious.
- Grade 3 - Patient loses consciousness. When he/she regains consciousness, the patient experiences grade 2 type symptoms.
How are Concussions in Athletes Managed?
The athlete suffering from head trauma should be evaluated immediately by available medical personnel on the sideline. The evaluation should include an attempt to accurately grade the injury.
Loss of Consciousness - If the injured player loses consciousness for any length of time after the injury, the concussion is classified grade 3, and the player should be taken to the local hospital Emergency Department for detailed evaluation and observation. The player should be held out of competition for at least one month, and may resume participation if he/she has been free of symptoms for at least one week (after the initial month). A second grade 3 injury requires one month of mandatory rest. The athlete may return to action if he/she has been symptom free for one additional month. If a third grade three injury occurs, the player’s season should be terminated, and he/she should be encouraged to give up the sport.
No loss of Consciousness - If the player does not lose consciousness, a brief neurological exam is conducted to confirm that the player has, in fact, suffered a concussion. Once a concussion is diagnosed, the player should be monitored on the sidelines for signs of worsening or improvement of symptoms. If symptoms resolve within 15 minutes, and there is no history of previous concussion for the player, he/she can return to play, although this is recommendation is controversial. Most current concussion managment recommendations are more conservative – the player should be removed from the game, and be fully evaluated by a physician as soon as possible. The player can return to action after he/she has been asymptomatic for at least one week. If the player has had previous concussions, he/she should be held out of competition for at least one symptom-free month.
