Concussion Signs and Symptoms

The diagnosis of acute concussion usually involves the assessment of a range of factors, including symptoms (reported by the athlete), physical signs and behavior (observed by trainers, coaches, other athletes and parents), balance, sleep and cognition (orientation to time and place, concentration and immediate memory).

A detailed concussion history is also an important part of the evaluation, both in the injured athlete and when taking a pre-participation physical examination (PPE).

A concussion should be suspected when an athlete receives a direct or indirect blow to the head which causes him to experience physical signs such as loss of consciousness (LOC)and post-traumatic amnesia or symptoms - somatic (e.g. headache), cognitive (e.g. feeling like in a fog ) and/or emotional (inappropriate emotions, such as uncontrollable laughter) .

If any of the following signs or problems¹ is present, a head injury should be suspected and appropriate management, including monitoring for deterioration begun:

This checklist should be used not only for the initial evaluation but for each subsequent follow-up assessment until all signs and symptoms have cleared both at rest and with physical exertion. In lieu of simply checking each symptom that is present, the athlete can be asked to grade or score the severity of the symptom on a scale of 0 to 6, with 0=not present 1 and 2 =mild, 3 and 4 = moderate, and 5 and 6 = severe (This is the approach used for self-assessment by the athlete on the Sport Concussion Assessment Tool 2 (SCAT2).

No same day return to play

The 3rd International Consensus Statement on Concussion in Sport (May 2009)² "strongly endorsed the view that children should not be returned to practice or play until clinically completely symptom-free, which may require a longer time frame than for adults."

In addition, the Consensus Statement said it was "not appropriate for a child or adolescent athlete with concussion to [return to play] on the same day as the injury regardless of the level of athletic performance." Studies show that college and high school athletes allowed to return to play on the same day may demonstrate neuropsychological deficits that may not be evident during an initial sideline evaluation and are more likely than adult athletes to have delayed onset of symptoms. As a result, the Consensus Statement emphasizes the importance of treating athletes under 18-years-old more conservatively (such as by extending the amount of time of asymptomatic rest and/or the length of the graded exertion program), even if the resources (e.g. the presence of team physicians experienced in concussion management, access to neuropsychologists, consultants, neuroimaging etc.) may be the same as for an older, professional athlete.

1. Sport Concussion Assessment Tool 2 (SCAT2), Br. J. Sports Med. 2009; 43; i85-i88; Guskiewicz, KM, Bruce SL, Cantu RC et al. National Athletic Trainers' Association position statement: management of sport-related concussion.  J. Athl. Train. 2004; 29(3): 280-287.

2. Concussion Statement on Concussion in Sport: the 3rd International Conference on Concussion in Sport held in Zurich, November 2008, P. McCrory et. al, Br. J. Sports Med. 2009; 43; i76-i84.

Revised and updated: August 27, 2009