Pioneering sport concussion expert, Dr. Robert Cantu [1], has issued revised return to play guidelines which focus on loss of consciousness, post-traumatic amnesia, concussion number, and time concussion signs and symptoms take to clear at rest and with progressive exertion as major factors driving the return to play decision.
First Concussion | Second Concussion | Third Concussion |
|
OR signs or symptoms [3] clear in 30 minutes |
May return to play after 1 week IF asymptomatic* at rest and during progressive exertion period [4]. | May return to play in 2 weeks IF asymptomatic* for 1 week at rest and during progressive exertion protocol [4] |
Terminate season;
May return to play next season IF asymptomatic* at rest and during progressive exertion protocol [4] |
[2]
Loss of consciousness for less than one minute [2] [2] [2][2]more than 30 minutes post-traumatic amnesia [5] [2]signs or symptoms [3] last less than 1 week [2] [2] [2] |
May return to play IF asymptomatic* for 1 week and during progressive exertion period [4] |
Out for a minimum of 1 month;
May return to play IF asymptomatic* for one week at rest and during progressive exertion protocol [4]; Consider terminating season |
Terminate season
May return to play next season IF asymptomatic* at rest and during progressive exertion protocol [4] |
Loss of consciousness for one minute or longer [2] OR more than 24 hours of post-traumatic amnesia [5] OR signs or symptoms [3]last more than 7 days |
Out for a minimum of 1 month
May return to play AFTER 4 weeks IF asymptomatic* for 1 week at rest and during progressive exertion period [4] |
Terminate season;
May return to play next season IF asymptomatic* at rest and during p [4]rogressive exertion protocol
|
*No headache, dizziness, or impaired orientation, concentration, or memory during rest or exertion
Dr. Cantu notes that a number of "modifying" factors [6]"1may influence concussion management considerations beyond simple return to play advice. Some of these include number of, duration, and severity of symptoms, multiple concussion history [7], and history of migraines or depression.
Dr. Cantu's guidelines may be especially useful for primary care physicians who, according to a 2011 study [8],2 see 60% of concussed athletes at the high school level* and make half of the return to play decisions, even though the same study noted that many report lacking adequate resources or understanding of current concussion management practices.
* At high schools with at least one athletic trainer on staff
For the most comprehensive and up-to-date concussion information for sports parents and coaches on the Internet, visit MomsTeam's pioneering concussion center [9].
Posted October 9, 2011
1. Consensus Statement on Concussion in Sport: the 3rd InternationalConference on Concussion in Sport held in Zurich, November 2008. Br.J. Sports Med. 2009;43:i76-i84 (Table 2) [10].
2. Meehan WP, d'Hemecourt P, Collins C, Comstock RD, Assessment and Management of Sport-Related Concussions in United States High Schools. Am. J. Sports Med. 2011;20(10)(published online on October 3, 2011 ahead of print) as dol:10.1177/0363546511423503 (accessed October 3, 2011).
Links:
[1] https://mail.momsteam.com/node/93
[2] https://mail.momsteam.com/node/150
[3] https://mail.momsteam.com/node/149
[4] https://mail.momsteam.com/node/128
[5] https://mail.momsteam.com/node/203
[6] https://mail.momsteam.com/note/2695
[7] https://mail.momsteam.com/node/156
[8] https://mail.momsteam.com/node/3935
[9] https://mail.momsteam.com/node/305
[10] http://bjsm.bmj.com/content/43/Suppl_1/i76/T2.expansion.html
[11] https://mail.momsteam.com/health and safety/loss-of-consciousness-not-required-for-concussion-finding
[12] https://mail.momsteam.com/health-safety/return-to-play/concussion-return-to-play-step-by-step-approach-recommended
[13] https://mail.momsteam.com/health-safety/post-traumatic-amnesia-retrograde-anterograde-factor-concussion-recovery-severity
[14] https://mail.momsteam.com/health-safety/concussion-evaluation-management-return-to-play-decision-involves-many-factors
[15] https://mail.momsteam.com/health-safety/retiring-from-sports-after-concussion-no-magic-number
[16] https://mail.momsteam.com/health-safety/concussion-safety/multiple-concussion-history-important-factor-in-concussion-management
[17] https://mail.momsteam.com/pcss/teens-with-multiple-concussion-history-much-more-likely-report-continuing-symptoms
[18] https://mail.momsteam.com/health-safety/persistent-effects-concussion
[19] https://mail.momsteam.com/health-safety/effects-concussion-suble-yet-prolonged-those-with-multiple-concussion-history