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Three Different Approaches
Comparison of Concussion Grading Scales
Comparison Of Concussion Return-To-Play Guidelines
Prague return-to-play guidelines: A new approach
Similarities And Differences
Which guidelines to follow?
Just Guidelines

There are currently three approaches to determining the severity of sports-related concussions.

1. Grading the concussion at the time of injury. This is the approach taken by the 1991 Colorado Medical Society and 1997 American Academy of Neurologists (AAN) concussion grading scales. Both emphasize loss of consciousness (LOC) and post-traumatic amnesia (PTA) over other post-concussion symptoms.

2. Grade the concussion based on the presence and duration of symptoms. This is the approach taken by MomsTeam expert, Robert C. Cantu, M.D., in his revised (2001) Cantu Evidence-Based Grading Scale. The Cantu concussion grading scale and guidelines place less weight on LOC as a potential predictor of subsequent impairment and additional weight on the overall persistence of post-concussion symptoms and grade the injury only after the athlete is symptom-free.

3. Eliminate grading to focus on whether the athlete is symptomatic or symptom free. The 2nd International Conference on Concussion in Sport held in Prague in 2004 (Prague consensus statement) introduced a third approach to the grading scale dilemma by simply eliminating the use of a grading scale. Like Dr. Cantu's revised guidelines, the Prague consensus statement focuses on whether the athlete is symptomatic or symptom free and determines severity retrospectively, after all post-concussion signs and symptoms have cleared, the neurological exam is normal, and cognitive function has returned to pre-injury level (e.g. baseline). It classifies concussions as either simple or complex depending on how long it takes for all concussion signs to clear.

The chart below compares the Cantu, Colorado and AAN concussion grading scales (because the Prague consensus statement does not classify concussions by grade, it is not included):

Concussion Grade	Cantu Grading System (2001 Revision)	1991 Colorado Medical Society Guidelines	1997 American Academy of Neurology (AAN) Guidelines
Grade 1 (mild)	No (LOC) Either PTA or post-concussion signs and symptoms that clear in less than 30 minutes	Transient mental confusion No PTA No LOC	No LOC Transient confusion Post-concussion symptoms clear in less than 15 minutes
Grade 2 (moderate)	LOC lasting less than 1 minute and PTA or LPost-concussion symptoms lasting longer than 30 minutes but less than 24 hours	No LOC Confusion with PTA	No LOC Post-concussion symptoms last more than 15 minutes
Grade 3 (severe)	LOC lasting more than 1 minute or PTA lasting longer than 24 hours or Post-concussion signs or symptoms lasting longer than 7 days	Any LOC, however brief	Any LOC, either brief (seconds) or prolonged (minutes)

Author: Lindsay Barton
Date created: January 22, 2008
© MomsTeam.com, Inc.

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Related Articles

 Retrograde and Post-Traumatic Amnesia: What Are They?
 Signs & Symptoms of Acute Concussion And Graded Symptom Checklist
 Updating Traumatic Brain Injury Guidelines
 Concussion Severity & Return to Play: Prague Consensus Statement

For more on this topic

 What are Concussions?
 Concussion Recovery: the Parent's Role

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