Immediate “On-the-Field” Assessment of Concussion
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.
KeywordsCervical Spine Force Plate Cervical Spine Injury Injured Athlete Tandem Stance
- Broglio, S. P., & Guskiewicz, K. M. (2009). Concussion in sports: the sideline assessment. Sports Health, 1, 361–369.Google Scholar
- Cantu, R. C. (1986). Guidelines for return to contact sports after cerebral concussion. The Physician and Sportsmedicine, 14, 75–83.Google Scholar
- 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
- 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
- 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
- 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
- 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.
- 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
- Rehberg, R. S. (1999). Facemask removal tools come in all shapes, styles. NATA News, 8, 8–9.Google Scholar
- 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
- 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
- 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
- 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.