November 17th 2003
Clinicians need to put heads together on sports concussions
It's repeated on gridirons across the country every fall: A football player smashes into an opponent, the whistle blows and the athlete shakily walks off the field and is immediately examined by the medical staff.
Sports-related concussions, often referred to by clinicians as mild traumatic brain injury (TBI), occur thousands of times each year on athletic fields and courts. While many such injuries are dealt with correctly and rapidly, sports medicine clinicians and researchers need greater collaboration to more effectively evaluate and treat such injuries, says Douglas B. McKeag, M.D., M.S., chair of the Department of Family Medicine at the Indiana University School of Medicine, in an editorial appearing in the Nov. 19 issue of the Journal of the American Medical Association.
"First, any athlete with a concussion must be removed from competition," says Dr. McKeag, who directs the IU Center for Sports Medicine, adding more recommendations:
No athlete should return to play or practice until he or she is completely asymptomatic at rest and with exertion.
Any athlete with prolonged loss of consciousness or evidence of amnesia should not return to play that day.
Careful and repeated assessments by individuals with training and experience in evaluating concussive injuries should be the rule.
Any patient with a concussion whose symptoms evolve downward requires immediate neurologic evaluation and possible hospital admission."
Dr. McKeag's editorial was a commentary to articles in the same issue reporting on studies conducted on collegiate athletes and data from the National Collegiate Athletic Association's Injury Surveillance System. One article evaluated the effects of concussion and the time to recovery following injury among collegiate football players. The other article examined the association between history of previous concussions and the likelihood of experiencing recurrent concussions.
"Concussion management has been a particularly vexing issue, dominated more by opinion than by evidence," Dr. McKeag notes, adding, "While these two studies might not surprise sports clinicians because the results are generally consistent with current experience in concussion management, these reports add to the understanding of the natural history of TBI. In an evidence-based environment, this is an extremely important initial step."
Collegiate football players may need up to seven days to recover from a concussion, including full recovery of cognitive function and balance, one of the articles reported.
"Now is the time to consider sports-induced mild TBI differently," Dr. McKeag says.
Contact: Joe Stuteville
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