New Concussion Procedures

By Jon Heck, MS, ATC
Coordinator of Athletic Training
7/98

In March I sent you an update on brain injuries and concussions.  At that time, I informed you if we change any of our guidelines when we review them I would forward that information to you.  Two important changes have occurred that will be in effect for the 1998-99 seasons. 

New Guidelines 
We have adopted new guidelines for grading concussions and determining return-to-play after a concussion.  We are now using the new guidelines established by the American Academy of Neurology.  These guidelines are more in line with the current research and allow more latitude in establishing return- to- play times after the more serious grade 2 and grade 3 concussions.  I have enclosed a copy of the new Management of Concussion in Sports guidelines.  

Standardized Assessment of Concussions (SAC) 
We will also begin using the SAC to help determine return- to- play immediately after a possible concussion and to monitor progress in the days after a concussion has occurred.  The SAC is an assessment tool that numerically measures an athletes orientation, concentration, and memory.  A copy of the SAC is enclosed.  It will be part of our evaluation for a concussion and can be administered in a few minutes. 

The SAC is very objective, either the athlete knows the answer or not.  Responses can not be faked and symptoms can not be hidden.  Age, education, and intelligence do not effect the outcome of the test.  Equally important, on the field research has shown there is no difference in scores when tested at practice compared to games.  So fatigue, emotions, stress and other "game day" variables have no impact on the results. 

We will be using the SAC for two main purposes.  All athletes with a history of concussion will be pre-tested before their season begins.  These results will then be used as "normal" for these athletes and compared to the results when tested after a new concussion has occurred.  They will have to score as well to be considered to return to play that day.  If their score is lower than the pre-season score they will automatically be removed from participation, at least for that day. 

All other athletes will only be given the SAC after a possible concussion has occurred.  The research has shown what the minimal normal score is for orientation, concentration, and memory based on a large sample of athletes in game and practice situations.  These athletes will have to score at or above this cut-off number to be considered to return to play that day.  If their score is lower than the cut-off they will automatically be removed from participation, at least for that day. 

Any athlete who is held out of practice by a student athletic trainer will have to see me the next day.  I will then re-assess this athlete and decide on their participation status.  Any athlete who fails to show for follow-up, will not be permitted to particpate. 

AAN Concussion Guidelines (abbreviated)

Grades of Concussio

Grade 1 1)No loss of consciousness. 2)Concussion symptoms or mental status abnormalities on examination resolve in less than 15 minutes.

Grade 2 1)No loss of consciousness. 2)Concussion symptoms or mental status abnormalities on examination last more than 15 minutes.

Grade 3 1)Any loss of consciousness.

Return to Play

Grade of Concussion	Return to play only after being asymptomatic with normal neurologic assessment at rest and with exercise.
Grade 1	15 minutes or less
Grade 2	1 week
Grade 3-- Brief loss of consciousness (seconds)	1 week
Grade 3-- Prolonged loss of concscousness (minutes)	2 weeks