Concussion Recognition & Evaluation

The SCAT3 is a standardized method of evaluating injured athletes for concussion ages 13 years and older. Although designed for use by medical and health professionals, it includes advice for athletes and parents about signs to watch for in the first 24 to 48 hours after suspected concussion and a list of other important points, including the need for rest and avoiding strenuous activity, and not training or playing sport until medically cleared.

Baseline and post-concussion neuropsychological (NP) testing is now recommended for all athletes in sports with a high risk of concussion (e.g. football, lacrosse, hockey, soccer, basketball), regardless of age or level of performance, but the timing and type of testing may need to be adjusted for children and adolescents.

One of the signs of concussion is poor balance. An athlete's balance and equilibrium can be tested through use of the Balance Error Scoring System (BESS).

The emerging model of sport concussion assessment now involves the use of brief screening tools to evaluate post-concussion signs and symptoms on the sideline immediately after a concussion and neuropsychological testing to track recovery further out from the time of injury. One of the tools of value for sideline evaluation is called the Standardized Assessment of Concussion.

An athlete can experience two types of amnesia after a concussion: anterograde (reduced ability to form new memories) and/or retrograde (partial or total loss of the ability to recall events before injury). Whether anterograde amnesia is an indicator of more serious injury and slower recovery remains unclear.

Game officials are often in the best position to detect the subtle signs of concussions in athletes during a game but are not often given the power to order a sideline evaluation and assessment of concussion and few have received concussion education.

Less than half of U.S. high schools have an athletic trainer on staff.  Given their key role in assessing sports concussions and return to play decisions, every school should have one.

Because one of the keys to keeping athletes safe when it comes to concussion is education, a concussion education and safety meeting should be held for parents and athletes should be held before every season. Ideally, the meeting should include presentations by medical doctors, former athletes, and parents of concussed current or former athletes.

Study shows LOC of greater than one minute duration may be associated with delayed return to play.  As a result, prolonged LOC is considered a factor that may influence management of such concussions.

Until 2004, the three most commonly used concussion grading systems were the Cantu, Colorado Medical Society (CMS), and American Academy of Neurology (AAN) guidelines. They have since been abandoned in favor of a symptom-based approach to individually guide management and return to play decisions.