Home » PPE » Taking Of Concussion History Important Part of Preparticipation Exam

From the Fourth International Concussion Consensus Statement

Taking Of Concussion History Important Part of Preparticipation Exam

Questions about concussion symptoms and length of recovery, not just perceived number of past concussions recommended

Concussion experts agree (1,2,3) that the taking of a detailed concussion history as part of a student-athlete's preparticipation physical evaluation is valuable for three reasons:

  1. The taking of such a history may identify athletes who, because of their previous concussion history, are at higher risk of suffering another concussion and should carefully consider with their family retirement from further participation in contact or collision sports; Head filled with post it notes with question marks
  2. The taking of such a history provides the healthcare provider an opportunity to educate the athlete (and his or her family) about the significance of concussive injury in terms of its possible effects on their long-term cognitive and emotional health; and
  3. In the event the taking of the history discloses that the athlete's dangerous style of play (using football/lacrosse/hockey helmet as a weapon in tackling or body checking, for example) may have been a contributing factor in a previous concussion, it provides the healthcare provider a chance to consider modifying playing style or behavior to reduce the risk of further injury.

Questions to ask 

According to the most recent international consensus of concussion experts (1), a structured concussion history should include the following:
  • specific questions about previous symptoms of concussion and length of recovery, not just the perceived number of concussions. This is because many athletes will not recognize all of the concussions they may have suffered in the past because they may think that a concussion requires a loss of consciousness (as MomsTEAM found out during the filming of its high school football concussion documentary, The Smartest Team);
  • questions about all previous head, face or cervical spine injuries, because coexistent concussive injuries may have been missed unless specifically assessed at the time of such injuries;
  • questions pertaining to disproportionate impact versus symptom severity which may alert the clinician to a progressively increasing vulnerability to injury, which is not only an important "modifying factor" in concussion management but in considering possible retirement from contact or collision sports; and
  • questions about the protective equipment, if any, being worn at the time of such injury (which may raise concerns about so-called "risk compensation," which is where the use of protective equipment - say, for example, a football helmet - results in behavioral change, such as the adoption of more dangerous playing technique, e.g. leading with the helmet in tackling, running back lowering his head when about to be tackled). 
It is especially important for younger athletes (ages 5 to 12) that the questions be age-appropriate and that questions also be directed to their parents as well as suggested in the Child SCAT3 (2).

1. McCrory P, et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Br J Sports Med 2013;47:250-258

2. Harmon K, et al. American Medical Society for Sports Medicine position statement: concussion in sport. Br J Sports Med 2013;47:15-26.

3. Giza C, Kutcher J, Ashwal S, et. al. Summary of evidence-based guideline update: Evaluation and management of concussion in sports: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology 2013 (published online ahead of print March 18, 2013): DOI:10.1212/WNL.ob013e31828d57dd (accessed March 23, 2013)

4. Child SCAT3, Br J Sports Med 2013;47:263

Posted April 12, 2013; revised May 27, 2013; updated May 25, 2015