INDIANAPOLIS - Team physicians who assess and treat athletes suspected of concussion have new marching orders from the American College of Sports Medicine (ACSM), according to a team physician consensus statement released today. Under no circumstances should an athlete suspected of, or diagnosed with, a concussion return to play the day of their injury.
"There is to be no same-day return-to-play after a concussion, even if the athlete's initial symptoms resolve as the athletic event or practice progresses," said Stanley A. Herring, M.D., FACSM, chair of the writing group and one of the team physicians for the Seattle Seahawks and Seattle Mariners. "Also, the subsequent decision to return an athlete to play should be individualized, not based on a rigid timeline or solely on the demands of a particular sport."
The team physician consensus statement, titled "Concussion (Mild Traumatic Brain Injury) and the Team Physician: A Consensus Statement - 2011 Update," updates recommendations made in 2006. While advising against same-day return-to-play is the biggest change from the 2006 statement, there are other changes team physicians should note.
- Physicians should use standardized concussion assessment tools, such as the NFL Baseline and Sideline Tools, for pre-season and post-injury evaluation. Neurological assessments should emphasize cognitive function, cranial nerve and balance testing.
- Physicians should use the preseason to develop an emergency medical action plan, including a specific plan for concussion management, and they should also assemble a concussion management team.
- Neuropsychological (NP) testing is one component of the evaluation process, and it should not be used as a stand-alone tool to diagnose, manage or make return-to-play decisions in concussion.
- Tests using event-related and evoke-related potentials, as well as tests using biomarkers, have been inconclusive in identifying individuals with concussions; however, they may one day be applicable.
- Physicians should understand their states' laws regarding concussion as well as the rules and regulations from their sports' governing bodies.
"There are more than 3.8 million concussions suffered in sports and recreational activities each year," said Herring. "Proper management by team physicians is crucial because it can mitigate potentially life-threatening complications."
Before returning to play, an
athlete should have no symptoms (at rest or with cognitive effort),
should not be taking any medications to mask concussion symptoms and
should be back at baseline with their neurological examinations and NP
testing if available. The process may take days, weeks or months, and
the recurrence of symptoms should warrant additional rest and
monitoring.
"Concussion
(Mild Traumatic Brain Injury) and the Team Physician: A Consensus
Statement - 2011 Update" was a collaboration among ACSM, the American
Academy of Family Physicians, the American Academy of Orthopaedic
Surgeons, the American Medical Society for Sports Medicine, the American
Orthopaedic Society for Sports Medicine and the American Osteopathic
Academy of Sports Medicine.
The team physician consensus statement is published in the December 2011 issue of Medicine & Science in Sports & Exercise®.
[Editor's Note: An article containing a complete review and analysis
of the new consensus statement will be posted on MomsTeam, but this
press release is posted now as a service to our users].
Source: American College of Sports Medicine
Posted November 17, 2011
