National Athletic Trainers’ Association Position Statement: Management of Sport Concussion
To provide athletic trainers, physicians, and other health care professionals with best-practice guidelines for the management of sport-related concussions.
An estimated 3.8 million concussions occur each year in the United States as a result of sport and physical activity. Athletic trainers are commonly the first medical providers available onsite to identify and evaluate these injuries.
The recommendations for concussion management provided here are based on the most current research and divided into sections on education and prevention, documentation and legal aspects, evaluation and return to play, and other considerations.
- Define a concussion as a “trauma-induced alteration in mental status that may or may not involve loss of consciousness.”
- ATs need to educate administrators, parents, coaches, athletes on concussions including limitations of protective equipment
- Include modifying RTP factors, athlete’s understanding of injury, contact with team physician, evaluation, management, RTP of concussion
- High Risk Athletes should be baseline tested
- Ideally re-baseline all athletes; adolescent athletes and those with history of recent concussions should be baselined as priority
- Any athlete suspected of a concussion needs to be removed from participation immediately
- SAC test should be used in conjunction with a motor-control evaluation and symptom assessment to support the physical and neurologic clinical evaluation.
- Once a concussion has been diagnosed daily exams are needed to monitor recovery
- No “day of” return to play for concussed athletes; all concussed athletes must be cleared by a physician before returning to play
- Physical exertion may begin after all tests have returned to baseline levels and the athlete is no longer symptomatic
- We no longer grade concussion severity
- ATs should enforce the standard use of certified helmets
- Children and young adolescents have a longer recovery time than adults
- Be sure to use age appropriate testing
- Have a “return to learn” plan
- All concussed athletes should be sent home with instructions. A copy should be kept and filed in their medical file
- All medications should be avoided with the exception of Acetaminophen
- Instruct concussed athlete to not use illicit drugs or alcohol
- During the acute stage of a concussion rest is important, including cognitive rest
- After multiple concussions the RTP should be modified to be more conservative
- AT should be aware of Second Impact Syndrome and long term effects of concussions