A guideline for managing concussion treatment
There is a level of risk for injury in every sport, but contact sports, of course, have a much higher potential for risk. Head injuries can be among the most severe, and repeated incidents can be cumulative and sometimes result in delayed impairments. Historically, the severity of concussions and traumatic brain injuries has been assessed using imprecise terminology: mild, moderate, and severe. These terms are nearly impossible to quantify.
In 1998, a tri-level grading scale for sports-induced concussions was developed. The goal was to set guidelines for managing athlete concussions, preventing catastrophic consequences, and avoiding cumulative brain injuries. It’s not unusual during competition for athletes or coaches to lose their objectivity and feel pressured about returning an injured athlete to play under possibly unsafe conditions.
Below is a summary of the graded system and recommendations for treatment of concussed athletes:
- Grade 1: Confusion but no loss of consciousness with symptoms resolved in less than 15 minutes. Remove athlete from play for immediate examination. Examinations for abnormalities or post-concussion symptoms should continue at 5-minute intervals. Athlete may return to play if all abnormalities clear within 15 minutes. If a second Grade 1 concussion is suffered in the same competition, athlete should be removed from play. Athlete can be cleared for return to play when clear of all symptoms while at rest and during exercise for one week.
- Grade 2: Confusion and remains conscious, but the signs and symptoms last longer than 15 minutes. Remove the athlete from play for the remainder of the competition and examine on site. Athlete should be frequently re-examined the next day for symptoms. Return to play should only be permitted upon clearance by a physician following a full neurological exam. Athletes suffering a second Grade 2 concussion during the same season should not compete until clear of all symptoms at rest and during exertion for at least two weeks.
- Grade 3: Loss of consciousness, regardless of duration. Transport athlete to an emergency room by ambulance for a thorough evaluation. Athletes suffering a loss of consciousness for a few seconds with a Grade 3 concussion should kept from play until clear of all symptoms while at rest and during exertion for at least one week. Athletes who lose consciousness for minutes should only return to play when clear of all symptoms both at rest and during exertion for at least two weeks. Athletes suffering a second Grade 3 concussion during the same season should only return to play after being clear of all symptoms for a minimum of one full month.
Paramedics and other emergency professionals, athletic trainers and coaches can use this scale to assess head injuries on site and offer a pre-diagnosis to medical professionals treating the injured athlete.
- Nausea and/or vomiting
- Blurred vision
- Sensitivity to light/noise
- Problems with balance
- Lack of energy
- Sleeping more or less than usual
- Difficulty falling asleep
- Easily upset or angry
- Nervous or anxious
- Not thinking clearly or inability to concentrate
- Feeling slowed down
- Inability to remember new information