Concussion in Sports and Recreation

James P. Kelly

doi:10.1055/s-2000-9835

Seminars in Neurology, Table of Contents

Semin Neurol 2000; 20(2): 165-172
DOI: 10.1055/s-2000-9835

Concussion in Sports and Recreation

James P. Kelly

Department of Neurology, Chicago Neurological Institute, Chicago, Illinois

Abstract

ABSTRACT

More than 800 sports-related concussions occur in the United States each day, sometimes involving high-profile athletes whose injuries reach public awareness through sports broadcasts and news media. Although nonphysicians are often present and relied upon for the detection of concussion in the sports setting, the proper diagnosis and management of this neurological problem require a physician's thoughtful attention to the athlete's signs and symptoms. This article offers a diagnostic protocol and treatment recommendations as well as a useful grading scale and management strategy for return to competition.

KEYWORD

Brain concussion - sports injury - traumatic brain injury - sports concussion guidelines

Full Text

References

REFERENCES

1 Centers for Disease Control. Sports-related recurrent brain injuries-United States. (MMWR 1997;46:224-227). JAMA . 1997; 277 1190-1191
2 Kelly J P, Rosenberg J H. The diagnosis and management of concussion in sports. Neurology . 1997; 48 575-579
3 Fisher C M. Concussion amnesia. Neurology . 1966; 16 826-830
4 Powell J W, Barber-Foss K D. Traumatic brain injury in high school athletes. JAMA . 1999; 282 958-963
5 Farber M. The worst case. Sports Illustrated . 1994; 81(25) 38-46
6 Gerberich S G, Priest J D, Boen J R, Straub C P, Maxwell R E. Concussion incidences and severity in secondary school varsity football players. Am J Public Health . 1983; 73 1370-1375
7 Zemper E. Analysis of cerebral concussion frequency with the most commonly used models of football helmets. J Athletic Train . 1994; 29(1) 44-50
8 Kelly J P. Traumatic brain injury and concussion in sports. JAMA . 1999; 282 989-991
9 Kelly J P. Preface. J Head Trauma Rehabil . 1998; 13(2) v-vi
10 Saunders R L, Harbaugh R E. The second impact in catastrophic contact-sports head trauma. JAMA . 1984; 252 538-539
11 Kelly J P, Nichols J S, Filley C M, Lillehei K O, Rubinstein D, Kleinschmidt-DeMasters B K. Concussion in sports: guidelines for the prevention of catastrophic outcome. JAMA . 1991; 266 2867-2869
12 Gronwall D, Wrightson P. Cumulative effect of concussion. Lancet . 1975; 2 995-997
13 Ommaya A K, Gennarelli T A. Cerebral concussion and traumatic unconsciousness. Correlation of experimental and clinical observations on blunt head injuries. Brain . 1974; 97 633-654
14 Povlishock J T, Lontos H A. Continuing axonal and vascular change following experimental brain trauma. J Cent Nerv Syst Trauma . 1985; 2 285-298
15 Hovda D A, Le H M, Lifshitz J. Long-term changes in metabolic rates for glucose following mild, moderate and severe concussive head injuries in rats. Soc Neurosci . 1994; 20 85
16 Jordan B D, Relkin N R, Ravdin L D. Apolipoprotein E4 associated with chronic traumatic brain injury in boxing. JAMA . 1997; 278 136-140
17 Jordan B D, Zimmerman R D. Computed tomography and magnetic resonance imaging comparisons in boxers. JAMA . 1990; 263 1670-1674
18 Plum F, Posner J B. The Diagnosis of Stupor and Coma. 3rd ed. Philadelphia: FA Davis Co 1986: 349
19 Report of the Mild Traumatic Brain Injury Committee of the Head Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine. Definition of mild traumatic brain injury. J Head Trauma Rehabil . 1993; 8 86-87
20 Cooper P R, ed.. Head Injury. Baltimore: Williams & Wilkins; 1993
21 Stone J L, ed.. Head Injury and Its Complications. Costa Mesa: PMA Publishing Corp; 1993
22 Narayan R K, Wilberger Jr E J, Povlishock J T, eds.. Neurotrauma. New York: McGraw-Hill; 1996
23 Torg J S, Shephard R J, eds.. Current Therapy in Sports Medicine. 3rd ed. Philadelphia: Mosby; 1995
24 Hugenholtz H, Richard M T. Return to athletic competition following concussion. Can Med Assoc J . 1982; 127 827-829
25 Cantu R C. Guidelines for return to contact sports after a cerebral concussion. Physician Sports Med . 1986; 14 75-83
26 Nelson W E, Jane J A, Gieck J H. Minor head injury in sport: a new system of classification and management. Physician Sports Med . 1984; 12 103-107
27 Wilberger J E, Maroon J C. Head injuries in athletes. Clin Sports Med . 1989; 8 1-9
28 Kelly J P, Rosenberg J H. American Academy of Neurology Report of Quality Standards Subcommittee. Practice Parameter: the management of concussion in sports (summary statement). Neurology . 1997; 48 581-585
29 McCrea M, Kelly J P, Randolph C. Standardized assessment of concussion (SAC): onsite mental status evaluation of the athlete. J Head Trauma Rehabil . 1998; 13 27-35
30 Levin H S, Amparo E G, Eisenberg H M. Magnetic resonance imaging and computerized tomography in relation to the neurobehavioral sequelae of mild and moderate head injuries. J Neurosurg . 1987; 66 707-713
31 Lovell M R, Collins M W. Neuropsychological assessment of the college football player. J Head Trauma Rehabil . 1998; 13 9-26
32 Bleiberg J, Halpern E L, Reeves D, Daniel J C. Future directions for the neuropsychological assessment of sports concussion. J Head Trauma Rehabil . 1998; 13 36-44
33 Lovell M R, Iverson G L, Collins M W, McKeag D, Maroon J C. Does loss of consciousness predict neuropsychological decrements after concussion?. Clin J Sport Med . 1999; 9 193-198
34 Wojtys E M, Hovda D, Landry G. Concussion in sports. Am J Sports Med . 1999; 27 676-687
35 Bailes J E, Lovell M R, Maroon J C, eds.. Sports-Related Concussion. St. Louis: Quality Medical Publishing, Inc; 1999