Applying Concussion Guidelines in Real World: Return to Play Advice Will Vary

The question of when it is safe for your child to return to the playing field after suffering a concussion is one that continues to vex team doctors, athletic trainers, and other sports medicine practitioners.

Consider the following scenarios:

Scenario 1: Your football-playing son tells you he blacked out briefly during a game after making a hard tackle. He sits out practice for the next couple of days during which he has headaches and can't remember what happened either before the game or after. Is it okay for him to play in the next game?

Scenario 2: Your son has his "bell rung" but doesn't lose consciousness and yet an hour after the game is still somewhat disoriented, but has no symptoms for a full week before the next game. Is it safe for him to play?

Scenario 3: Your son takes a blow to the head in the last minute of the first half of a football game and is woozy as he comes off the field but symptom-free within 15 minutes. He is allowed to return to the field in the second half and is hit in the head a second time. He sits out the remainder of the game, but on the drive home is still disoriented, is mildly dizzy, and has ringing in his ears. He is appears fine the next day. The biggest game of the season is the following week. His coach wants him to play. Should you let him?

Grading/Classification

Scenario 1

Using the three approaches to determining concussion severity, the player in Scenario 1 would be viewed as having suffered a:

• Grade 3 (severe) concussion under the 1991 Colorado Medical Society (Colorado) and 1996 American Academy of Neurology (AAN) guidelines, which measure concussion severity at the time of injury and emphasize loss of conciousnes (LOC) as a determining factor in assigning a concussion a grade. The concussion would be Grade 3 because any LOC, however, brief, is Grade 3 under the Colorado and AAN guidelines.
• Grade 3 (severe) concussion under Dr. Cantu's 2001 Revised Guidelines, which measure concussions severity after the symptoms have cleared, because post-traumatic amnesia (both anterograde and retrograde) persisted as a symptom for more than 24 hours.
• Concussion of unknown classification under the 2004 Prague consensus guidelines, which jettisons grading scales and instead classifies concussion based on how long it takes for all post-concussion signs and symptoms to clear, the neurological exam is normal, and cognitive function has returned to pre-injury level (e.g. baseline), as well as other factors (concussion history, whether the loss of consciousness has been prolonged), Because we don't know in Scenario 1 whether the athlete's amnesis has cleared, until it has, his concussion can't be classified as "simple" (a concussion that progressively resolves without compplication over a 7 to 10 day period) or "complex: (symptoms persisting beyond 7 to 10 days).
  123next ›last »