19 Mar 2013
The American Academy of Neurology has released its guideline for evaluating and managing athletes with concussion. The AAN says that over one million sportsmen and sportswomen in the USA experience a concussion annually. This is the first concussion update in 15 years.
According to the AAN (American Academy of Neurology), which published the new guideline in Neurology (March 18th, 2013 issue), Americans now have an objective, evidence-based review of the literature by a committee of experts from various fields.
The Academy added that its guideline has been endorsed by a wide range of sports, medical and patient groups, including: The National Association of Emergency Medical Service Physicians, the Neurocritical Care Society, the American Football Coaches Association, the National Football League Players Association, the Child Neurology Society, the National Academy of Neuropsychology, the National Association of School Psychologists, and the National Athletic Trainers Association.
Co-lead guideline author, Christopher C. Giza, MD, with the David Geffen School of Medicine and Mattel Children’s Hospital at UCLA, explained that it is imperative that any athlete who is suspected of experiencing concussion be removed from play straight away.
Dr. Giza said:
“We’ve moved away from the concussion grading systems we first established in 1997 and are now recommending concussion and return to play be assessed in each athlete individually. There is no set timeline for safe return to play.”
The updated guideline recommends:
The authors of the guideline gathered and examined all available evidence that was published in academic journals up to the end of June 2012.
The author panel included a broad range of expertise, the AAN informed. They spent “thousands of work hours” locating and examining scientific studies. They excluded studies that did not provide compelling evidence to make recommendations, such as expert opinions or anecdotal accounts. Each study was independently analyzed and graded by two or more authors.
The guideline says that:
The AAN emphasized that “Concussion is a clinical diagnosis. Symptom checklists, the Standardized Assessment of Concussion (SAC), neuropsychological testing (paper-and-pencil and computerized) and the Balance Error Scoring System may be helpful tools in diagnosing and managing concussions but should not be used alone for making a diagnosis.”
Jeffrey S. Kutcher, MD, with the University of Michigan Medical School in Ann Arbor and a member of the AAN, said:
“If in doubt, sit it out. Being seen by a trained professional is extremely important after a concussion. If headaches or other symptoms return with the start of exercise, stop the activity and consult a doctor. You only get one brain; treat it well.”
Should there be absolute rest after a concussion? – the guideline states that there is insufficient compelling evidence to support absolute rest after concussion, but the athlete should be immediately removed from play.
Part of concussion management may include activities known not to worsen symptoms and which are not linked to a risk of repeat concussion.
The AAN has also launched an app called (opens in a new tab) which is available for iPad, Android, IOS (Apple) and some other mobile devices. It is aimed at helping coaches, trainers, parents and other athletes rapidly decide whether somebody is experiencing concussion and needs to see a doctor.