Advertisement

Immediate “On-the-Field” Assessment of Concussion

  • Susannah M. Briskin
  • Amanda K. Weiss Kelly
Chapter

Abstract

Immediate evaluation of the injured athlete begins with a primary survey to assess airway, breathing, circulation, and determination of consciousness. Evaluation of the conscious athlete for concussion necessitates ruling out a cervical spine injury. The conscious athlete with no associated cervical spine injury should undergo a comprehensive sideline evaluation for concussion using Sport Concussion Assessment Tool 2 to document findings. A concussion sign and symptom severity scale should be performed. The physical exam should include a complete head and neck exam and neurological exam. On-the-field cognitive testing is performed with Standardized Assessment of Concussion (SAC) questions to assess orientation, immediate memory, concentration, and recall. Sideline assessment of postural stability can be performed with Balance-Error Scoring System (BESS) testing. Determining if an athlete has suffered a concussion necessitates analyzing the information obtained from symptom scales, SAC questions, and BESS performance. Use of baseline data is particularly helpful for interpretation if available. Grading of concussion is no longer performed. If an athlete is determined to have suffered a concussion, he/she should be restricted from returning to sports the same day. Transportation to the ER should occur if any signs or symptoms concerning for an intracranial bleed are present. Appropriate guidelines for care of the concussed athlete and appropriate medical follow-up should be arranged.

Keywords

Cervical Spine Force Plate Cervical Spine Injury Injured Athlete Tandem Stance 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. Alla, S., Sullivan, S. J., Hale, L., et al. (2009). Self-report scales/checklists for the measurement of concussion symptoms: a systematic review. British Journal of Sports Medicine, 43(Suppl. 1), i3–i12.PubMedCrossRefGoogle Scholar
  2. Aubry, M., Cantu, R., Dvorak, J., et al. (2002). Summary and agreement statement of the 1st International Symposium on Concussion in Sport: Vienna 2001. Clinical Journal of Sport Medicine, 12, 6–11.PubMedCrossRefGoogle Scholar
  3. Blinman, T. A., Houseknecht, E., Snyder, C., et al. (2009). Postconcussive symptoms in hospitalized pediatric patients after mild traumatic brain injury. Journal of Pediatric Surgery, 44, 1223–1228.PubMedCrossRefGoogle Scholar
  4. Broglio, S. P., & Guskiewicz, K. M. (2009). Concussion in sports: the sideline assessment. Sports Health, 1, 361–369.Google Scholar
  5. Broglio, S., & Puetz, T. (2008). The effect of sports concussion on neurocognitive function, self-report symptoms and postural control: a meta-analysis. Sports Medicine, 38, 53–67.PubMedCrossRefGoogle Scholar
  6. Cantu, R. C. (1986). Guidelines for return to contact sports after cerebral concussion. The Physician and Sportsmedicine, 14, 75–83.Google Scholar
  7. Cantu, R. C. (2001). Posttraumatic retrograde and anterograde amnesia: pathophysiology and implications in grading and safe return to play. Journal of Athletic Training, 36, 249–252.Google Scholar
  8. Collins, M. W., Iverson, G., et al. (2003). On-field predictors of neuropsychological and symptom deficit following sports-related concussion. Clin J Sports Med, 13(4), 222–229.CrossRefGoogle Scholar
  9. Crowell, D. H., Guskeiwicz, K. M., Prentice, W. E., & Onate, J. A. (2001). The effect of fatigue on postural stability and neuropsycholoical function (abstrct). Journal of Athletic Training, 36, S33.Google Scholar
  10. Delaney, J. S., Lacroix, V. J., Leclerc, S., & Johnson, K. M. (2002). Concussions among university football and soccer players. Clinical Journal of Sport Medicine, 12(6), 331–338.PubMedCrossRefGoogle Scholar
  11. Echemendia, R. L., Putukian, M., Mackin, R. S., et al. (2001). Neuropsychological test performance prior to and following sports-related mild traumatic brain injury. Clinical Journal of Sport Medicine, 11, 23–31.PubMedCrossRefGoogle Scholar
  12. Gastel, J. A., Palumbo, M. A., Hulstyn, M. J., et al. (1998). Emergency removal of football equipment: a cadaveric cervical spine injury model. Annals of Emergency Medicine, 32, 411–417.PubMedCrossRefGoogle Scholar
  13. Gioia, G. A., Schneider, J. C., Vaughan, C. G., et al. (2009). Which symptom assessments and approaches are uniquely appropriate for paediatric concussion? British Journal of Sports Medicine, 43, i13–i22.PubMedCrossRefGoogle Scholar
  14. Guskiewicz, K. M., McCrea, M., Marshall, S. W., et al. (2003). Cumulative effects associated with recurrent concussion in collegiate football players: the NCAA concussion study. Journal of American Medical Association, 290(19), 2549–2555.CrossRefGoogle Scholar
  15. Guskiewicz, K. M., Perrin, D. H., & Gansneder, B. M. (2000a). Effects of mild head injury on postural stability in athletes. Journal of Athletic Training, 35, 19–25.PubMedGoogle Scholar
  16. Guskiewicz, K. M., Riemann, B. L., Perrin, D. H., & Nasher, L. M. (1997). Alternative approaches to the assessment of mild head injury in athletes. Medicine and Science in Sports and Exercise, 29, S213–S221.PubMedGoogle Scholar
  17. Guskiewicz, K. M., Ross, S. E., & Marshall, S. W. (2001). Postural stability and neuropsychological deficits after cuncussion in collegiate athletes. Journal of Athletic Training, 36, 263–273.PubMedGoogle Scholar
  18. Guskiewicz, K. M., Weaver, N. L., Padua, D. A., & Garrett, W. E. (2000b). Epidemiology of concussion in collegiate and high school football players. The American Journal of Sports Medicine, 28, 643–650.PubMedGoogle Scholar
  19. Hecht, S., Puffer, J., Clinton, C., Aish, B., Cohen, P., Concoff, A., et al. (2004). Concussion assessment in football and soccer players. Clinical Journal of Sport Medicine, 14, 310.CrossRefGoogle Scholar
  20. Hunt, T., Ferrara, M. S., Bornstein, R. A., & Baumgartner, T. A. (2009). The reliability of the modified balance error scoring system. Clinical Journal of Sport Medicine, 19, 471–475.PubMedCrossRefGoogle Scholar
  21. Johnston, K. M., McCrory, P., Mohtadi, N., & Meeuwisse, W. (2001). Evidence-based review of sport-related concussion: clinical science. Clinical Journal of Sport Medicine, 11, 150–159.PubMedCrossRefGoogle Scholar
  22. Kelly, J. (2001). Loss of consciousness: pathophysiology and implications in grading and safe return to play. Journal of Athletic Training, 36, 249–252.PubMedGoogle Scholar
  23. LaPrade, R. F., Schnetzler, K., Boxterman, R. J., et al. (2000). Cervical spine aligment in the immobilized ice hockey player: a computed tomographic analysis of the effects of helmet removal. The American Journal of Sports Medicine, 28, 800–803.Google Scholar
  24. Lovell, M. (2009). The management of sports-related concussion: current status and future trends. Clinics in Sports Medicine, 28, 95–111.PubMedCrossRefGoogle Scholar
  25. Lovell, M. R., Collins, M. W., Iverson, G. L., Johnston, K. M., & Bradley, J. P. (2004). Grade 1 or “Ding” concussions in high school athletes. American Journal of Sports Medicine, 32, 47–54.PubMedCrossRefGoogle Scholar
  26. Lovell, M. R., Iverson, G. L., Collins, M. W., McKeag, D. B., & Maroon, J. C. (1999). Does loss of consciousness predict neuropsychological decrements after concussion? Clinical Journal of Sport Medicine, 9(4), 193–198.PubMedCrossRefGoogle Scholar
  27. Maddocks, D. L., Dicker, G. D., & Saling, M. M. (1995). The assessment of orientation following concussion in athletes. Clinical Journal of Sport Medicine, 5, 32–35.PubMedCrossRefGoogle Scholar
  28. Maroon, J., Lovell, M., Norwig, J., et al. (2000). Cerebral concussion in athletes: evaluation and neuropsychological testing. Neurosurgery, 47, 659–669. discussion 669–672.PubMedGoogle Scholar
  29. McCrea, M. (2001a). Standardized mental status testing on the sideline after sport-related concussion. Journal of Athletic Training, 36, 274–279.PubMedGoogle Scholar
  30. McCrea, M. (2001b). Standardized mental status assessment of concussion. Clinical Journal of Sport Medicine, 11, 176–181.PubMedCrossRefGoogle Scholar
  31. McCrea, M., Burr, W. B., & Guskiewicz, K. (2005). Standard regression-based methods for measuring recovery after sport-related concussion. Journal of International Neuropsychology Society, 11, 58–69.Google Scholar
  32. McCrea, M., Guskiewicz, K. M., Marshall, S. W., Barr, W., Randolph, C., Cantu, R., et al. (2003). Acute effects and recovery time following concussion in collegiate football players. The NCAA concussion study. Journal of American Medical Association, 290, 2556–2563.CrossRefGoogle Scholar
  33. McCrea, M., Hammeke, T., Olsen, G., Leo, P., & Guskiewicz, K. (2004). Unreported concussion in high school football players: implications for prevention. Clinical Journal of Sport Medicine, 14(1), 13–17.PubMedCrossRefGoogle Scholar
  34. McCrea, M., Kelly, J. P., Kluge, J., Ackley, B. A., & Randolph, C. (1997). Standardized assessment of concussion in football players. Neurology, 48, 586–588.PubMedGoogle Scholar
  35. McCrea, M., Kelly, J. P., Randolph, C., Kluge, J., Bartolic, E., Finn, G., et al. (1998). Standardized assessment of concussion (SAC): on-site mental status evaluation of the athlete. The Journal of Head Trauma Rehabilitation, 13(2), 27–35.PubMedCrossRefGoogle Scholar
  36. McCrory, P., Johnston, K., Meeuwisse, W., et al. (2005). Summary and agreement statement of the 2nd International Symposium on Concussion in Sport 2004, Prague. British Journal of Sports Medicine, 39, 196–204.PubMedGoogle Scholar
  37. McCrory, P., Meeuwisse, W., Johnston, K., et al. (2009). Concensus statement on Concussion in Sport 3rd International Symposium on Concussion in Sport held in Zurich, November 2008. Clinical Journal of Sports Medicine, 19(3), 185–200.CrossRefGoogle Scholar
  38. Metz, C. M., Kuhn, J. E., & Greenfield, M. L. (1998). Cervical spine alignment in immobilized hockey players: radiographic analysis with and without helmets and shoulder pads. Clinical Journal of Sport Medicine, 8, 92–95.PubMedCrossRefGoogle Scholar
  39. Nardone, A., Tarantola, J., Galante, M., & Schieppati, M. (1998). Time course of stabilometric changes after a strenuous treadmill exercise. Archives of Physical Medicine and Rehabilitation, 79, 920–924.PubMedCrossRefGoogle Scholar
  40. Osmond, M. H., Klasen, T. P., Wells, G. A., Correll, R., Jarvis, A., Joubert, G., et al. (2010). CATCH: a clinical decision rule for the use of computed tomography in children with minor head injury. Canadian Medical Association Journal. doi: 10.1503/cmaj.091421.
  41. Palumbo, M. A., Hulstyn, M. J., Fadale, P. D., et al. (1996). The effect of protective football equipment on alignment of the injured cervical spine: radiographic analysis in a cadaveric model. The American Journal of Sports Medicine, 24, 446–453.PubMedCrossRefGoogle Scholar
  42. Piland, S., Motl, R., Ferrara, M., et al. (2003). Evidence for the factorial and construct validity of a self-report concussion symptoms scale. Journal of Athletic Training, 38, 104–112.PubMedGoogle Scholar
  43. Practice Parameter: the management of concussion in sports (summary statement). (1997). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 48, 581–585.Google Scholar
  44. Prinsen, R. K. E., Syrotuik, D. G., & Reid, D. C. (1995). Position of the cervical vertebrae during helmet removal and cervical collar application in football and hockey. Clinical Journal of Sport Medicine, 5, 155–161.PubMedCrossRefGoogle Scholar
  45. Rehberg, R. S. (1999). Facemask removal tools come in all shapes, styles. NATA News, 8, 8–9.Google Scholar
  46. Riemann, B. L., & Guskiewicz, K. M. (2000). Effects of mild head injury on postural stability as measured through clinical balance testing. Journal of Athletic Training, 35, 19–25.PubMedGoogle Scholar
  47. Riemann, B. L., Guskiewicz, K. M., & Shields, E. W. (1999). Relationship between clinical and forecplate measures of postural stability. Journal of Sport Rehabilitation, 8, 71–82.Google Scholar
  48. Segan, R. D., Cassidy, C., & Bentkowski, J. (1993). A discussion of the issue of football helmet removal in suspected cervical spine injuries. Journal of Athletic Training, 28, 294–305.PubMedGoogle Scholar
  49. Shehata, N., Wiley, J. P., Richea, S., et al. (2009). Sport concussion assessment tool: baseline values for varsity collision sport athletes. British Journal of Sports Medicine, 43, 730–734.PubMedCrossRefGoogle Scholar
  50. Society, C. M. (1991). Report of the Sports Medicine Committee: Guidelines for the Management of Concussions in Sport (Revised). Denver: Colorado Medical society.Google Scholar
  51. Stephensen, A., Horodyski, M. B., Meister, K., et al. (1999). Cervical spine alignment in the immobilized ice hockey player: radiographic analysis before and after helmet removal [abstract]. Journal of Athletic Training, 34, S27.Google Scholar
  52. Susco, T. M., Valovich, T. C., Gansneder, B. M., & Shultz, S. J. (2004). Balance recovers within 20 minutes after exertion as measured by the balance error scoring system. Journal of Athletic Training, 39, 241–246.PubMedGoogle Scholar
  53. Swenson, T. M., Lauerman, W. C., Donaldson, W. F., et al. (1997). Cervical spine alignment in the immobilized football player: radiographic analysis before and after helmet removal. The American Journal of Sports Medicine, 25, 226–230.PubMedCrossRefGoogle Scholar
  54. US Department of Health and Human Services, Center for Disease Control and Prevention. Heads up: facts for physicians about mild traumatic brain injury (MTBI) (2010) http://www.cdc.gov/concussion/headsup/pdf/Facts_for_Physicians_booklet_a.pdf. Accessed September 23, 2011.
  55. Van Kampen, D., Lovell, M., Pardini, J., et al. (2006). The “value added” of neurocognitive testing after sports-related concussion. American Journal of Sports Medicine, 34, 1630–1635.PubMedCrossRefGoogle Scholar
  56. Waninger, K. N. (1998). On-field management of potential cervical spine injury in helmeted football players: leave the helmet on! Clinical Journal of Sports Medicine, 8, 124–129.CrossRefGoogle Scholar
  57. Waninger, K. N. (2004). Management of the helmeted athlete with suspected cervical spine injury. The American Journal of Sports Medicine, 32, 1331–1350.PubMedCrossRefGoogle Scholar
  58. Wilkins, J. C., Valovich McLeod, T. C., Perrin, D. H., & Gansneder, B. M. (2004). Performance on the balance error scoring system decreases after fatigue. Journal of Athletic Training, 39, 156–161.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Rainbow Babies and Children’s HospitalUniversity Hospitals Case Medical CenterClevelandUSA

Personalised recommendations