Concussion Classification: Historical Perspectives and Current Trends
There is still enormous controversy both in the literature and in clinical practice as to how to classify concussed individuals. There is still NO universally accepted concussion grading system. The overall problem with concussion classification is that with the exception of an unconscious athlete (which is a relatively rare case in athletics) or someone who is severely dazed, it is often very difficult to identify who has sustained a concussion and who has not (Cantu, 2006). Despite some advances in clinical practice and research, NO consensus has been reached on how to classify concussion cases nor on proposed universal criteria for a return to sport participation. That said, there are currently three more or less conventionally accepted grading systems which serve to classify concussion based on four criteria: presence/absence of loss of consciousness (LOC), presence/absence and length of injury-related memory problems (amnesia), presence/absence of disorientation/confusion at the time of injury, and the duration of postconcussive symptoms.
A consensus committee of experts released a report in 2002 which recommended that grading systems and their corresponding return to play (RTP) guidelines be abandoned largely because there did not seem to be widespread compliance with RTP due to its conservative nature. Moreover, there still little empirical support for any of the existing return to play criteria. A more recently convened consensus committee that assembled in Prague to revise the recommendations from the 2002 report concluded that a two-grade classification should be used to assist in the management of concussion.
KeywordsGrade System Sport Participation Retrograde Amnesia Post Concussion Symptom Cerebral Concussion
Unable to display preview. Download preview PDF.
- Cantu, R.C. (2002). Neurologic Athletic Head and Spine Injuries. Philadelphia, W.B. Saunders Company.Google Scholar
- Entire July 2001 issue Clinical Journal of Sports Medicine, 11(3), 131-209.Google Scholar
- Entire October 2001 issue Journal Athletic Training, 36(3), 213-348.Google Scholar
- National Athletic Trainers Association Position Statement: Sport-Related Concussion. (2004). Journal of Athletic Training, 39, 280-295.Google Scholar
- Summary and Agreement Statement of the 1st International Conference on Concussion in Sport. Vienna - November 2-3, 2001. (2002). Published simultaneously in British Journal of Sports Medicine, and Physician and Sports Medicine.Google Scholar
- Summary and Agreement Statement of the 2nd International Conference on Concussion in Sport. Prague 2004. (2005). British Journal of Sports Medicine, 39(4), 196-205, Clinical Journal of Sport Medicine, (2005), 15(2), 48-56, Physician and Sports Medicine, (2005) 33 (4), 29-44.Google Scholar
- Nelson, W.E., Jane, J.A., Gieck, J.H. (1984). Minor head injury in sports: a new system of classification and management. Physician Sportsmedicine, 12(3), 103-10.Google Scholar
- Ommaya, A.K. Biomechanics of Head Injury: Experimental Aspects. In Nahum AM, Melvin J (eds), Biomedics of Trauma. Appleton & Lange, pp 245-269. 1985.Google Scholar
- Cantu, R.C. (1986). Guidelines for return to contact sports after a cerebral concussion. Physician Sportsmedicine, 14, 76-79.Google Scholar
- From Report of the Sports Medicine Committee. (1990). Guidelines for management of concussion in sports. Colorado Medical Society, (revised May 1991). Class III. Jordan, B.J., Tsairis, P.T., Warren, R.F. (eds), Head Injury in Sports: Sports Neurology. Aspen Publications, p 227. 1989.Google Scholar
- Torg, J.S. Athletic Injuries to the Head, Neck, and Face. St. Louis, MO:Mosby-Year, 1991.Google Scholar
- Roberts, W.O. (1992). Who plays? Who sits? Managing concussion on the sidelines. Physician Sportsmedicine, 20, 66-76.Google Scholar
- Kelly JP, Nicholas JS, Filley CM, et al. Concussion in sports: Guidelines for the prevention of catastrophic outcomes. JAMA 1991; 266-2867; Report of the Sports Medicine Committee for the management of concussion in sports. Colorado Medical Society, 1990 (revised May 1991). Class IIIGoogle Scholar