Concussions in young athletes: Don't rush to get back in the game

This past week I had half a dozen calls from parents and coaches requesting that I see high school and college athletes with concussions. They all wanted the same thing: urgent medical clearance to play. Their goal was to get the players back in the field or on the court right away. It seems that all the recent media attention has helped to raise awareness about long-term consequences of head trauma, but we still have a long way to go.

While schools are appearing to tighten up their policies about getting doctors involved, I'm not sure the message about the potential seriousness of sports-related injuries has gotten through. Indeed, earlier this week, a school nurse told me that she has been seeing more "doctor shopping" by parents. In one recent case, both a pediatrician and neurologist advised against a student's return to play, so the parents went to a 24-hour urgent care clinic hoping that the doctor there would give them a different answer. 

Sports are now second only to motor-vehicle accidents as the leading cause of traumatic brain injury in people ages 15 to 24. While the majority of concussions are self-limited injuries, there is increasing concern about the effects of multiple head injuries (including chronic traumatic encephalopathy, a dementia that can develop) and sequential concussions (such as life-threatening second-impact syndrome). In order to guide clinicians, the American Academy of Neurology has just released a new position statement that includes the recommendation that any athlete who is suspected to have suffered a concussion should be removed from participation until he or she is evaluated by a physician with training in the management of sports concussions.

1. No athlete should be allowed to participate in sports if he or she is still experiencing symptoms from a concussion.
2. Following a concussion, a neurologist or physician with proper training should be consulted prior to clearing the athlete for return to participation.
3. A certified athletic trainer should be present at all sporting events, including practices, where athletes are at risk for concussion.
4. Education efforts should be maximized to improve the understanding about the seriousness of concussions by all athletes, parents, and coaches.

 —Orly Avitzur, M.D., Consumer Reports medical adviser 

 For more information on sports and concussion, see:

When it comes to head injuries, football still has a long way to go

Sports and head injuries--When is it serious?

Sports-related concussions: Don't be a head case