New Guidelines Raise Safety Bar on Concussions

If head trauma is suspected, health care professional should determine it is safe to return to play, recommendations say

By Alan Mozes

HealthDay Reporter

MONDAY, March 18 (HealthDay News) -- Any athlete who suffers a suspected concussion should be withdrawn from play and stay on the sidelines until a qualified health care professional determines that all symptoms have subsided and it is safe to return to the field, new guidelines state.

Issued by the American Academy of Neurology, the latest recommendations aim to keep young athletes as safe as possible.

"With the older guidelines, we were trying to rate concussions at the time of the injury and predict recovery times, but now we know, 'When in doubt, sit 'em out,'" said guideline co-author Dr. Christopher Giza, an associate professor of pediatric neurology and neurosurgery with the David Geffen School of Medicine at the University of California, Los Angeles, and Mattel Children's Hospital.

"The point is that no single quick test is really a litmus test for a concussion," he said. "We know now that we need to make sure a player has had a thorough and proper evaluation, involving a symptoms checklist, a standardized assessment and balance and cognitive testing, before being returned to play. This evaluation has to be done on a case-by-case basis, so each person goes through an individualized recovery process."

Giza and his colleagues reported the new guidelines in the March 18 online issue of the journal Neurology.

According to the academy, upwards of 1 million professional and amateur U.S. athletes suffer a concussion every year.

The new guidelines were issued following a thorough look at all the available concussion research through June 2012.

Among the conclusions: experiencing a concussion raises the risk for experiencing a second, and perhaps more debilitating, one. That risk was found to be highest in the 10 days following the initial injury.

One expert said the new guidelines are needed.

"One of the big problems is that we have a culture within many sports that still encourages young people to play through the pain, including head pain," said Dr. Gail Rosseau, a clinical assistant professor in the department of neurosurgery at the Northshore University Health System in Chicago.

"But one of the most important things we now know is that until those who have had one concussion are fully recovered they are more likely to have a second concussion," Rosseau said. "The stories we hear that are horrific to every parent and every coach is the child who gets a concussion and goes back to play too soon, and gets a second one with devastating consequences."

Just how devastating it can be was outlined earlier this year in the Journal of Neurosurgery: Pediatrics, which detailed the harrowing double-concussion experience of Indiana high school student Cody Lehe. Resuming football too soon after an initial concussion, Lehe suffered a second concussion. Severe brain injury ensued, leaving Lehe mentally impaired and largely wheelchair-bound.

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