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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

The following chart compares how soon an athlete may return to play under the Cantu, Colorado, and AAN Guidelines (remember, though, that, because the grade of concussion assigned a particular set of symptoms varies under the three guidelines, direct comparison is difficult).

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Concussion Grade	Number of Concussion Suffered	Cantu Guidelines (Revised)1	Colorado Medical Society Guidelines2	American Academy of Neurology (AAN) Guidelines3
Grade 1 (mild)	First	Return to play after 1 symptom-free week End season if CT or MRI abnormal	Remove from contest May return to same contest or practice if symptom free for at least 20 minutes	Remove from contest May return to play if symptom free within 15 minutes
Grade 1 (mild)	Second	Return to play in 2 weeks after 1 symptom free week	May not return to contest or practice May return after 1 symptom-free week	May not return to contest or practice May return to play after 1 symptom-free week
Grade 1 (mild)	Third	End season May return to play next season if no symptoms	End season May return to play in 3 months if without symptoms
Grade 2 (moderate)	First	Return to play after 1 symptom-free week	May not return to contest or practice May return to play after 1 symptom-free week	May not return to contest or practice May return to play after 1 full symptom-free week CT or MRI recommended if symptoms or signs persist
Grade 2 (moderate)	Second	May not return for minimum of 1 month May return to play then if symptom-free for 1 week Consider ending season	Consider ending season May return in 1 month if symptom-free	May not return to contest or practice May return to play after at least 2 symptom-free weeks End season if any CT or MRI abnormality
Grade 2 (moderate)	Third	End season May return to play next season if without symptoms	End season May return to play next season if without symptoms
Grade 3 (severe)	First	May not return to play for minimum of 1 month May then return to play then after 1 symptom-free week	May not return to contest or practice Transport to hospital for evaluation May return to play in 1 month, after 2 symptom-free weeks	May not return to contest or practice Transport to hospital if unconscious or neurological abnormality CT or MRI recommended if post-traumatic symptoms or signs persist If LOC brief (seconds) may return to play in 1 week if no symptoms or signs If LOC is prolonged (minutes), return after 2 symptom-free weeks
Grade 3 (severe)	Second	End season May return to play next season if no symptoms	End season May return to play next season if no symptoms	May not return to contest or practice May return to play after minimum of 1 symptom-free month End season if any CT or MRI abnormality
Grade 3 (severe)	Third		End season Strongly discourage any return to contact or collision sports

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Author: Lindsay Barton
Date created: January 22, 2008
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Article Updated August 27, 2007

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Related Articles

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 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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