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.