JAMA PATIENT PAGE | Neurology A concussion is a type of traumatic brain injury. Concussion is caused by a strong impact to the head that leads to problems with thinking or other neurological symptoms. Concus- When a sport-related concussion sions can occur in any sport when there is a blow to the head, neck, is suspected, the athlete should immediately be removed from or body that sends a strong force to the head. The symptoms of con- play and assessed by a physician or other licensed health cussion include headache, cognitive problems such as mental fog- care professional. giness or changes in memory, problems with balance and coordi- nation, behavioral changes such as irritability, and slowed reaction time. Although most concussions are not associated with loss of con- sciousness, temporary loss of consciousness can occur. Evaluation Incasesofsuspectedsport-relatedconcussion,athletesshouldimme- diately be removed from play and assessed by a physician or other licensed health care professional. Assessment begins with evaluation for serious signs of injury such as severe headache, neck pain, double vision,weaknessortinglinginthearmsorlegs,vomiting,seizure,orde- creased level of consciousness. If any of these “red flags” are present, emergency transportation to a medical facility may be needed. shouldbeslowlyreintroducedforshortperiods(ie,5-15minutes)and If no “red flags” are present, then a more detailed evaluation for thenincreasedaslongasconcussionsymptomsdonotworsen.Men- concussion may be performed on the sidelines or in the locker room. talactivitiesandschoolworkshouldbegraduallyresumedastolerated. There is no single test that can definitively diagnose concussion, and Once the athlete is able to complete usual daily activities without various tools are available to aid in diagnosis. One instrument that is concussion-relatedsymptoms,lightaerobicactivity(suchasbriskwalk- commonly used by health care professionals is the Sport Concussion ing)canberesumed.Ifthisiswelltolerated,runningorothernoncon- AssessmentTool—5thEdition(SCAT5).TheSCAT5involvesquestions tacttrainingexercisescanbeadded,followedlaterbylightresistance aboutsymptoms;brieftestingofcognitivefunctionssuchasmemory exercises.Thedecisiontoultimatelyreturntoplayshouldbeindividu- and concentration; and a screening neurological examination that in- alized,andathletesshouldbeclearedbyahealthcareprofessionalbe- cludes evaluation of eye movements, balance, and coordination. fore returning to full contact practice or regular play. Head imaging is not needed to diagnose concussion but may be In most cases, concussion-related symptoms usually resolve by usedtoruleoutothercausesofbraininjury.Neuropsychologicaltesting 10 to 14 days after the concussion. If symptoms persist for longer, maybeconductedformoredetailedassessmentofmentalprocesses additional evaluation and treatment may be needed. Treatment for such as memory, reaction time, and cognitive processing speed. prolonged symptoms may include symptom-limited aerobic exer- cise, physical therapy, balance training, and psychological interven- Management and Return to Play tions such as cognitive behavioral therapy. Newproblemscanariseduringthefirst24to48hoursafteraconcus- sion,sotheathleteshouldnotbeleftaloneduringthistimeandmedi- calcareshouldbeurgentlysoughtifsymptomsworsen.Repeatconcus- FOR MORE INFORMATION sionsaremostlikelytooccurinthefirstseveraldaysafteraconcussion • Centers for Disease Control and Prevention andcancauseseriousinjury,soathletesshouldnotrushtoreturntoplay. www.cdc.gov/headsup/index.html Thegeneralapproachtorecoveryfromconcussioninvolvesboth • Mayo Clinic physicalandmentalrestforthefirstfewdaysaftertheinjury,followed www.mayoclinic.org/diseases-conditions/concussion/symptoms -causes/syc-20355594 by gradual increases in activity over time (graduated return to activity). If concussion-related symptoms worsen at any point as ac- To find this and other JAMA Patient Pages, go to the For Patients tivitylevelisbeingincreased,thentheathleteshouldreturntotheprior collection at jamanetworkpatientpages.com. level of activity. Typically, after 24 to 48 hours of rest, daily activities Author: Christopher C. Muth, MD The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they Published Online: February 1, 2018. doi:10.1001/jama.2018.0436 are not a substitute for medical diagnosis. For specific information concerning your Sources: American Academy of Neurology personal medical condition, JAMA suggests that you consult your physician. This page McCrory P, Meeuwisse W, Dvořák J, et al. Consensus statement on concussion in may be photocopied noncommercially by physicians and other health care sport—the 5th International Conference on Concussion in Sport held in Berlin, professionals to share with patients. To purchase bulk reprints, call 312/464-0776. October 2016. Br J Sports Med. 2017;51:838-847. Sport Concussion Assessment Tool—5th Edition. Br J Sports Med. 2017;51:851-858. 840 JAMA February 27, 2018 Volume 319, Number 8 (Reprinted) jama.com © 2018 American Medical Association. All rights reserved.
JAMA – American Medical Association
Published: Feb 27, 2018
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