Pioneering sport concussion expert, Dr. Robert Cantu, 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 clear in 30 minutes |
May return to play after 1 week IF asymptomatic* at rest and during progressive exertion period. | May return to play in 2 weeks IF asymptomatic* for 1 week at rest and during progressive exertion protocol |
Terminate season;
May return to play next season IF asymptomatic* at rest and during progressive exertion protocol |
|
Loss of consciousness for less than one minute more than 30 minutes post-traumatic amnesia signs or symptoms last less than 1 week |
May return to play IF asymptomatic* for 1 week and during progressive exertion period |
Out for a minimum of 1 month;
May return to play IF asymptomatic* for one week at rest and during progressive exertion protocol; Consider terminating season |
Terminate season
May return to play next season IF asymptomatic* at rest and during progressive exertion protocol |
|
Loss of consciousness for one minute or longer OR more than 24 hours of post-traumatic amnesia OR signs or symptoms 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 |
Terminate season;
May return to play next season IF asymptomatic* at rest and during progressive exertion protocol
|
*No headache, dizziness, or impaired orientation, concentration, or memory during rest or exertion
Dr. Cantu notes that a number of "modifying" factors"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, and history of migraines or depression.
Useful for primary care physicians
Dr. Cantu's guidelines may be especially useful for primary care physicians who, according to a 2011 study,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.
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).
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).
