Concussion Protocols

More on Concussions

SIGNIFICANCE

The initial recognition and management of concussions are particularly important in high school athletes in preventing two potential complications associated with concussions in this age group: post-concussion syndrome and second-impact syndrome. Younger athletes may be at increased risk of cerebral swelling after a mild head injury with greater vulnerability for postconcussion symptoms for a longer period of time. Proper management should minimize the risk for these catastrophic results.

 

RECOGNITION OF CONCUSSIONS

Severity
The severity or seriousness of a concussion is primarily based on how long the symptoms last. The number and severity of symptoms may have some correlation but no specific symptoms are more likely to help determine severity. Restricting mental and physical activity immediately after the concussion seems to correlate with a quicker return to play. Signs and Symptoms of Concussions
Coaches, administrators, officials (See Table 10 below) parents and athletes need to be aware of the observable signs and reported symptoms of a concussion.
Table 10. Signs and Symptoms of Concussions
Signs observed by medical staff Symptoms reported by athlete
Player appears dazed
Player has vacant facial expression
Confusion about assignment
Athlete forgets plays
Disorientation to game, score, opposing
team
Inappropriate emotional reaction
(laughing, crying)
Player displays incoordination or
clumsiness
Player is slow to answer questions
Loss of consciousness
Repeating the same questions or comments
over and over again
Headache
Nausea
Balance problems or dizziness
Double or fuzzy vision
Sensitivity to light or noise
Feeling slowed down
Feeling "foggy" or "not sharp"
Change in sleep pattern
Concentration or memory problems
Irritability
Sadness
Feeling more emotional
Concussions
National Federation of State High School Associations

• Even though most concussions are mild, all concussions are potentially serious and may result in complications that range from prolonged brain damage to death if not managed properly.
• An athlete who has a head injury should not return to play without evaluation by medical personnel.
• Do not allow any athlete to return to participation if he/she has any symptoms.
• If an apparent head injury occurs, even if uncertainty exists about the severity of the injury and whether a true concussion< occurred, that athlete should not return to action until medical clearance is obtained.
• Even a seemingly minor head injury, often referred to as "a ding" or "bell ringer," is now considered a true concussion and must be managed as such to avoid potential long-term consequences.
• Neither loss of consciousness, vomiting or amnesia is necessary for a head injury to be considered a concussion.

RECOGNITION

A concussion, by definition, means "to shake violently." A blow to the head that causes the brain to shake inside the skull and result in EVEN A BRIEF AND MILD alteration in brain function is considered a concussion. Although no obvious signs or symptoms may show up immediately, listed below are some of the symptoms that may suggest a concussion has occurred. Any of these

• Headache
• Dazed and vacant expression ("foggy")
• Confusion
• Difficulty with balance and coordination skills
• Difficulty with concentration, memory and
  organizational skills
• Nausea and/or vomiting
• Amnesia
• Slurred and/or inappropriate speech
• Repeating the same questions or comments
• Apparent loss of consciousness
• Moves slowly and/or clumsily
• Unsure of game, score or opponent
• Forgets play responsibilities
• Double vision or blurred vision
• Increased sensitivity to light or noise
• Sleep difficulties
• Increased irritability
• Hypersensitivity to light and noise
• Abnormal vision, hearing, smell and/or taste
• Excessive fatigue
• Abnormal sleep patterns
• Ringing in the ears
• Numbness and tingling
• Emotional problems, especially sadness and depression

National Federation of State High School Associations
Sports Medicine Handbook-Third Edition
Complications Associated with Concussions

POST-CONCUSSION SYNDROME

Following a concussion, athletes may suffer a number of lingering symptoms for varying lengths of time. Below are listed some of the more common symptoms that may last for weeks or months. Again, no athlete with any symptom related to head injury should even begin the return-to-play protocol.
*Often high school athletes may return to sport prematurely because the headache can mistakenly be seen as a common ailment. However, recent research has shown that athletes with residual headaches even a week post concussion do poorly on specialized tests such as reaction time and memory (Collins et al, 2003). It is imperative that even a seemingly nonsignificant headache not be dismissed as a common ailment prior to returning to sports.

SECOND-IMPACT SYNDROME

Second-impact syndrome is a rare event, which poses a significant concern for athletes who return too soon after suffering a previous concussion. Second-impact syndrome occurs when a second concussion occurs before a previous concussion has completely healed even if both of the injuries were very mild. Second-impact syndrome is characterized by an autoregulatory dysfunction that causes rapid and fatal brain swelling, and can result in death in as little as two to five minutes (McCrory, 1998). It is particularly important to note that virtually all of the second-impact syndrome cases that have been reported have occurred in adolescent athletes. The signs of second-impact syndrome are as follows

• Impaired attention
• Concentration and memory deficits
• Dizziness
• Tinnitus (ringing in the ears)
• Prolonged or recurring headaches (especially with exertion)*
• Fatigue
• Irritability
• Visual problems
• Neurasthenia, weakness or numbness
• Previous history of concussion
• Visual, motor or sensory changes
• Difficulty with memory and/or thought process
• Collapse into coma
• Neurological abnormalities in strength, range of motion or sensory feelings.