Hit on the head? Hit the bench!-- New concussion guidelines urge caution for athletes, coaches, doctors

September 26, 1999

Ann Arbor, Mich.-- Athletes who take a serious blow to the head on the field, court or ice should see a doctor immediately and leave the game for the day if they lose consciousness or have persistent or delayed symptoms, according to new concussion guidelines based on the latest scientific research and endorsed by six major medical organizations.

If their symptoms last more than 15 minutes, the guidelines say, athletes need to be monitored for up to a week and return to competition gradually based on tolerance of increasing physical demands. If their symptoms worsen, they should head straight for the emergency room.

The new recommendations give doctors and coaches a cautious, science-based consensus standard for dealing with one of the most common sports injuries. They are published in the current issue of the American Journal of Sports Medicine by a team led by Edward Wojtys, M.D., professor of surgery in the University of Michigan Health System.

"Just because an athlete says he or she 'feels fine' doesn't mean he or she should get right back in the game. Concussion has already cut short too many professional athletic careers, and left too many amateurs with lasting problems," says Wojtys, an orthopaedic surgeon and associate team physician for the U-M Athletics Department. "As we discover more about brain function, science and sport must come together to protect athletes using the most current information."

The guidelines endorse the use of neuropsychological testing on the sidelines as part of the physical exam. They stress that a full examination by a physician usually can best judge the effects of concussion.

Above all, the authors state, only more research will answer questions about how quickly and how well the brain can recover from concussion, and how best to evaluate and treat injured athletes. From junior high and high school squads to college and professional teams, they recommend large-scale studies of brain injuries, standardization of post-concussion tests and a database to follow the progress of every athlete who sustains a concussion.

The guidelines were formulated after a 1997 conference that brought together representatives of prominent medical societies whose members treat athletes, and major national professional and collegiate sports leagues.

They are endorsed by the American Academy of Orthopaedic Surgeons, the American Academy of Pediatrics, the American Orthopaedic Society for Sports Medicine, the American Osteopathic Academy of Sports Medicine, the National Academy of Neuropsychology and the International Neuropsychological Society. The guidelines are a consensus statement, but they do not necessarily represent the views of all the conference participants.

Experts define concussion as an alteration of cerebral function. Common symptoms include headache, dizziness, nausea, brief loss of consciousness, vertigo, light-headedness, ringing in the ears, difficulty concentrating, amnesia, vomiting and balance problems.

"The signs can be subtle, and can clear up quickly or last hours or days," says Wojtys. "But even after symptoms are gone, neurological research has shown that lasting 'bruises' on brain tissue may still be present. Rest, sleep, protection from additional impact and abstinence from alcohol can allow the brain to heal."

Meanwhile, symptoms that are delayed, more severe or worsen over time can signal serious problems, including blood clots in the brain. With the advent of sophisticated medical imaging, the diagnosis of such problems is made easier - but only if the person is adequately examined.

More than 300,000 American athletes sustain concussions or other mild to moderate brain injuries each year, according to the Centers for Disease Control, but a 1991 survey found that a third did not see a doctor. Most sports-related concussions occur in people ages 15 to 24.

No reliable statistics exist for the number of concussion victims who had a second brain injury soon after their first concussion, but research strongly suggests that such repeated blows to the brain are likely to cause lasting damage. The CDC estimates that there are 500 deaths from sports-related traumatic brain injuries each year, though it is not an official classification for cause of death.
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University of Michigan Health System

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