Concussion experts agree that the taking of a detailed concussion history is important in the post-concussion treatment of an athlete and in identifying athletes during a pre-participation physical evaluation1 at high-risk of further concussion.
Questions to ask
Because many athletes will not recognize all the concussions they have suffered in the past, the taking a concussion history should include questions about:
- previous symptoms of a concussion, not just the perceived number of past concussions (note: relying on the recall of concussions by teammates or coaches has also been shown to be unreliable);
- all previous head, face or cervical spine injuries;
- concussions where the severity of symptoms seemed disproportionate to the force of the blow or impact that caused it (listed by the 3rd Concussion Consensus Statement1 as a "modifying factor" in concussion treatment which may alert the doctor to a progressively increasing vulnerability to injury); and
- the protective equipment (e.g. helmet) worn at the time of the most recent injury and injuries more remote in time.
Value of concussion history during PPE
The taking of a detailed concussion history during a pre-participation physical evaluation or examination (PPE) is helpful, concussion experts say, because it:
- May identify at-risk athletes: the history may pre-identify athletes who are at greater risk of further concussions which can have long-term health consequences, including cognitive, emotional, physical, and behavioral problems;
- Provides a teachable moment: bringing up the subject of concussion provides the healthcare provider an opportunity to educate the athlete to the significance of his concussion history; and
- Offers an opportunity for behavior modification: it may allow the examiner a chance to suggest that the athlete modify his behavior (i.e. avoiding a dangerous style of play; employing safe tackling techniques).
1. 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.
Added June 28, 2009; revised March 2, 2011