Diagnosis and Management of Sports-related Concussions
I read a very interesting article by Russ Zafonte, D.O., in the July 6, 2011 issue of the Journal of the American Medical Association (JAMA 2011; 306(1); 79-86). The articles was based on a conference which took place at the Grand Medical Grounds at Children’s Hospital, Boston, Massachusetts. Dr. Zafonte is the Earle P. and Ida Charlton Professor and Chair, Department of Physical Medicine and Rehabilitation, Harvard Medical School.
There, Dr. Zafonte discusses the diagnosis and management of sports-related concussion of a 15-year-old athlete who had sustained a concussion. From a neuro-attorney’s point of view what was most noteworthy, was that Dr. Zafonte’s definition and pathophysiology of concussion. Dr. Zafonte wrote:
Concussion is a complex pathophysiologic process induced by external traumatic forces and capable of long-term functional disturbance. The term concussion describes the mild end of the traumatic brain injury continuum. Typically, concussion results in rapid-onset neurophysiologic and neurologic dysfunction that resolves in a spontaneous manner over a relatively short period. Sports-related concussion is generally due to functionally or metabolic rather than structural dysfunction and standard neuroimaging results usually appear normal. Concussion can be graded by clinical manifestations and does not require LOC. Symptoms of concussion may include headaches, fatigue, mood swings, neck pain, nausea and vomiting, dizziness, blurred vision, balance difficulty, photosensitivity, phonosensitivity, cloudiness, difficulty concentrating, memory problems, slowed reaction times, cognitive impairment, confusion, drowsiness, insomnia, emotional lability, irritability, anxiety or nervousness, sadness or depression and amnesia. Although most patients with concussion improve rapidly, a small percentage (approximately 10%-20%) of those with sports-related concussion may remain symptomatic, particularly children and adolescents.
From a public policy standpoint, a player who shows any features of a concussion should be evaluated by a healthcare professional on-site using a concussive injury tool such as SCAT 2. If no healthcare professional is available, the player should be removed from practice or play and an urgent follow-up with a healthcare professional arranged.
The article also discusses the CDC dictate that coaches should not evaluate players for concussions; the coach’s role is to remove the athlete from play, insure that the athlete is evaluated by a healthcare professional, inform the athlete’s parents or guardians about possible concussion and keep the athlete out of play on the day injury and until a healthcare professional states that the player is symptom free and may return to play.
This article is an important read for all athletes and their parents, as well as for neuro-attorneys.