Concussion Discussion

Pediatrics for Parents, Jan, 2001

One of the toughest decisions for an athlete with a concussion is when it's safe to return to playing sports. One reason it's a difficult decision is that there are few objective signs or symptoms that accurately reflect the degree of brain injury after the immediate post-injury period.

A concussion is a bruised brain. It occurs when there is a sudden acceleration of the head followed by a sudden deceleration. The brain hits the interior of the skull and becomes bruised.

The signs and symptoms that occur immediately after the injury -- change in level of consciousness, vision problems, balance difficulties, headache, confusion or amnesia -- often resolve even when the injury to the head may still be life threatening.

A survey was completed by 242 high school and college certified athletic trainers representing 17,549 football players. In this group there were 888 (5.1%) players who sustained at least one concussion. One hundred thirty-one (14.7%) of the 888 players sustained a second concussion during the same season. The greatest incidence of concussions was found at the high school (5.6%) and collegiate III (5.5%) levels.

Nine percent of the players with a concussion had a loss of consciousness and 86% had a headache. Slightly over 30% of the players who sustained a concussion returned to play the same day. Playing on artificial turf was associated with more concussions than playing on grass.

The decision about when it's safe for a player who has sustained a concussion to return to participation is a difficult one. Evaluating current symptoms and complaints are insufficient. One major issue is if the coach alone should make the decision or if additional input is needed from properly trained and neutral medical personnel.

American Journal of Sports Medicine, 10/00, pp. 643-50.