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Applying Concussion Guidelines in Real World: Return to Play Advice Will Vary

Some Guidelines Allow Earlier Return Than Others

The question of when it is safe for your child to return to the playing field after suffering a concussion is one that continues to vex team doctors, athletic trainers, and other sports medicine practitioners.

Consider the following scenarios:

Scenario 1: Your football-playing son tells you he blacked out briefly during a game after making a hard tackle. He sits out practice for the next couple of days during which he has headaches and can't remember what happened either before the game or after. Is it okay for him to play in the next game?

Scenario 2: Your son has his "bell rung" but doesn't lose consciousness and yet an hour after the game is still somewhat disoriented, but has no symptoms for a full week before the next game. Is it safe for him to play?

Scenario 3: Your son takes a blow to the head in the last minute of the first half of a football game and is woozy as he comes off the field but symptom-free within 15 minutes. He is allowed to return to the field in the second half and is hit in the head a second time. He blacks out and doesn't regain consciousness for two minutes.  He sits out the remainder of the game, but on the drive home is still disoriented, is mildly dizzy, has ringing in his ears, and can't remember what happened.  He is appears fine the next day. The biggest game of the season is the following week. His coach wants him to play. Should you let him?

Return-to-play: different results

The return-to-play (RTP) decision will vary.

Scenario 1:

  • No return to play in the next game under the Zurich consensus statement1because while the athlete's symptoms eventually cleared, he has not completed the step-wise return to play protocol, which ordinarily takes about a week to complete.

Scenario 2:

Scenario 3:

  • Return to play in next game unlikely. The athlete should not have been allowed to return to play in the same game after suffering concussion symptoms.  That he appears to have suffered two concussions in rapid successsion, the second resulting in a prolonged loss of consciousness (both of which are considered so-called "modifying factors" in the management of his concussion) suggests that he should be held out for more than a week, more conservative management and additional testing.