New Concussion Guidelines: If In Doubt, Sit it Out

"If In Doubt, Sit it Out" was the slogan of an NFL concussion training video a couple of years ago, required viewing for NFL players in view of highly publicized cases of depression and encephalopathy in older American football players. Now, the American Academy of Neurology has endorsed more conservative and stringent handling of concussion at the high school level as well, where there is some evidence players may be even more vulnerable to sequelae of TBI.

The new guidelines are available here.

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A Handout For Sports Personnel:  See also HERE.
 Use this guide to help you evaluate if someone may have a concussion and needs to see a licensed health care provider.*
EVALUATE
Know these signs and symptoms of concussion. Every athlete is unique and may experience different combinations of reactions.
Common Signs of Concussion— Things You Can Observe
Behavior or personality changes
Blank stare, dazed look
Changes to balance, coordination, or reaction time
Delayed or slowed spoken or physical responses
Disorientation (confused about time, date, location, game)
Loss of consciousness (blackout) (occurs in less than 10 percent of people with concussion)
Memory loss of event before, during, or after injury occurred
Slurred/unclear speech
Trouble controlling emotions
Vomiting
Symptoms of Concussion— Things the Athlete Tells You
Blurry vision/double vision
Confusion
Dizziness
Feeling hazy, foggy, or groggy
Feeling very drowsy, having sleep problems
Headache
Inability to focus, concentrate
Nausea (stomach upset)
Not feeling right
Sensitivity to light or sound
TAKE ACTION

What should I do if an athlete has a head injury during a game?
Immediately address safety concerns. If the person is unconscious (knocked out), check his or her Airway, Breathing, and Circulation (ABCs).
Airway: Check that the mouth and throat are not blocked
Breathing: Be sure the person is breathing normally
Circulation: Check that the person’s heart is beating regularly
If you suspect the person may have a neck injury or if the person is unconscious:
Do not move the head, neck, or spine. This could worsen any spinal injury to the neck
Contact emergency medical services with any concern about breathing, circulation, or spinal injury
Do not let the athlete return to play until examined and cleared by a licensed health care provider trained in diagnosing and managing concussion
SEEK CARE
What should I do if it appears the athlete has a concussion?
If a concussion is suspected, remove the athlete from play. If a concussion is diagnosed, the athlete should not return to play for the rest of the day.
Monitor the athlete for the next three to four hours. You may need to monitor for a longer time
Notify a licensed health care provider trained in diagnosing and managing concussion
Do not let the athlete return to play until evaluated and cleared by a licensed health care provider trained in diagnosing and managing concussion
When is it okay for the athlete to return to the game?
Clearance from a licensed health care provider trained in diagnosing and managing concussion is needed before allowing the athlete to return to play. The health care provider may:
Advise the athlete to return to physical activity slowly
Explain the process for this clearly
Tell the athlete to increase activity levels carefully, step by step
Remember, if the person has any concussion symptoms, he or she should not advance to the next activity level. Before full return to play, the final activity level should imitate game conditions as much as possible.

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