Abstract
Objective: To update the 1997 American Academy of Neurology (AAN) practice parameter regarding sports concussion, focusing on 4 questions: 1) What factors increase/decrease concussion risk? 2) What diagnostic tools identify those with concussion and those at increased risk for severe/prolonged early impairments, neurologic catastrophe, or chronic neurobehavioral impairment? 3) What clinical factors identify those at increased risk for severe/prolonged early postconcussion impairments, neurologic catastrophe, recurrent concussions, or chronic neurobehavioral impairment? 4) What interventions enhance recovery, reduce recurrent concussion risk, or diminish long-term sequelae? The complete guideline on which this summary is based is available as an online data supplement to this article.
Methods: We systematically reviewed the literature from 1955 to June 2012 for pertinent evidence. We assessed evidence for quality and synthesized into conclusions using a modified Grading of Recommendations Assessment, Development and Evaluation process. We used a modified Delphi process to develop recommendations.
Results: Specific risk factors can increase or decrease concussion risk. Diagnostic tools to help identify individuals with concussion include graded symptom checklists, the Standardized Assessment of Concussion, neuropsychological assessments, and the Balance Error Scoring System. Ongoing clinical symptoms, concussion history, and younger age identify those at risk for postconcussion impairments. Risk factors for recurrent concussion include history of multiple concussions, particularly within 10 days after initial concussion. Risk factors for chronic neurobehavioral impairment include concussion exposure and APOE ε4 genotype. Data are insufficient to show that any intervention enhances recovery or diminishes long-term sequelae postconcussion. Practice recommendations are presented for preparticipation counseling, management of suspected concussion, and management of diagnosed concussion.
GLOSSARY
- AAN=
- American Academy of Neurology;
- BESS=
- Balance Error Scoring System;
- CR=
- concussion rate;
- GSC=
- Graded Symptom Checklist;
- LHCP=
- licensed health care provider;
- LOC=
- loss of consciousness;
- mTBI=
- mild traumatic brain injury;
- PCSS=
- Post-Concussion Symptom Scale;
- RTP=
- return to play;
- SAC=
- Standardized Assessment of Concussion;
- SRC=
- sport-related concussion;
- SOT=
- Sensory Organization Test;
- TBI=
- traumatic brain injury
Footnotes
Approved by the Guideline Development Subcommittee on July 14, 2012; by the Practice Committee on August 3, 2012; and by the AAN Board of Directors on February 8, 2013.
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Editorial, page 2178
Supplemental data at www.neurology.org
- Received August 6, 2012.
- Accepted in final form February 12, 2013.
- © 2013 American Academy of Neurology
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