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Concussion Expert Revises Return To Play Guidelines

Pioneering sport concussion expert, Dr. Robert Cantu, has issued revised return to play guidelines which focus on loss of consciousness, post-traumatic amnesia, concussion number, and time concussion signs and symptoms take to clear at rest and with progressive exertion as major factors driving the return to play decision.

  First Concussion Second Concussion Third Concussion

No loss of consciousness

OR

signs or symptoms clear in 30 minutes

May return to play after 1 week IF asymptomatic* at rest and during progressive exertion period. May return to play in 2 weeks IF asymptomatic* for 1 week at rest and during progressive exertion protocol

Terminate season;

May return to play next season IF asymptomatic* at rest and during progressive exertion protocol

Loss of consciousness for less than one minute

OR

more than 30 minutes post-traumatic amnesia

OR

signs or symptoms last less than 1 week


 

 

May return to play IF asymptomatic* for 1 week and during progressive exertion period

Out for a minimum of 1 month;

 

May return to play IF asymptomatic* for one week at rest and during progressive exertion protocol;

Consider terminating season

Terminate season

 

May return to play next season IF asymptomatic* at rest and during progressive exertion protocol

 

Loss of consciousness for one minute or longer

OR

more than 24 hours of post-traumatic amnesia

OR

signs or symptoms last more than 7 days

Out for a minimum of 1 month

 

 

May return to play AFTER 4 weeks IF asymptomatic* for 1 week at rest and during progressive exertion period

Terminate season;

 

 

May return to play next season IF asymptomatic* at rest and during progressive exertion protocol

 

 

*No headache, dizziness, or impaired orientation, concentration, or memory during rest or exertion

Dr. Cantu notes that a number of "modifying" factors"1may influence concussion management considerations beyond simple return to play advice. Some of these include number of, duration, and severity of symptoms, multiple concussion history, and history of migraines or depression.

Useful for primary care physicians

Dr. Cantu's guidelines may be especially useful for primary care physicians who, according to a 2011 study,2 see 60% of concussed athletes at the high school level* and make half of the return to play decisions, even though the same study noted that many report lacking adequate resources or understanding of current concussion management practices.

* At high schools with at least one athletic trainer on staff

For the most comprehensive and up-to-date concussion information for sports parents and coaches on the Internet, visit MomsTeam's pioneering concussion center.


Posted October 9, 2011

1. Consensus Statement on Concussion in Sport: the 3rd InternationalConference on Concussion in Sport held in Zurich, November 2008.  Br.J. Sports Med. 2009;43:i76-i84 (Table 2).

2. Meehan WP, d'Hemecourt P, Collins C, Comstock RD, Assessment and Management of Sport-Related Concussions in United States High Schools. Am. J. Sports Med. 2011;20(10)(published online on October 3, 2011 ahead of print) as dol:10.1177/0363546511423503 (accessed October 3, 2011).

 

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