1

During a soccer game, a 12-year-old girl collides (head to head) with the opponent while jumping for the ball. After the incident, she complains to the athletic trainer of a headache, nausea, and some dizziness. She is evaluated by the trainer, who decides to sit her out of the game on suspicion of a concussion. Her mother asks, “What is a concussion?”

Concussion is a disruption to the normal function of the brain secondary to a force such as a blow or punch to the head, which may be manifested by neurologic or cognitive symptoms.

2

The patient’s mother indicates she has seen several players collide with each other who were not diagnosed with concussion, and therefore she wants to know how common concussions are

There are approximately 300,000 sports-related concussions and as many as 3.8 million sports and recreation–related concussions seen annually.

3

What are some of the risk factors for a concussion?

Athletes playing in high-risk sports such as American football are at greater risk, but athletes in any sport can and do get concussions. A major determinant of sustaining a sports-related concussion is a prior history of a concussion. For comparable sports females have more concussions than males. Females tend to have more symptoms and require more time to recover. Attention-deficit disorder, psychiatric disorders, or a history of headaches/migraines can impact concussion recovery time (lengthen).

4

What sports or activities have high concussion rates?

Concussion can occur in almost any type of sport but more commonly contact sports. Heading a soccer ball incorrectly, a hit to the head with a ball/puck, and player-to-player contact are the most common mechanisms of sustaining a concussion. Sports such as wrestling, ice and field hockey, lacrosse, football, rugby, soccer, basketball, baseball, and softball are examples of sports with high concussion rates.

5

What are the symptoms and signs of a concussion?

The symptoms and signs of a concussion are divided into physical, cognitive, emotional, and sleep.

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  Physical manifestations of concussion include nausea, dizziness, imbalance, visual problems, and sensitivity to light and sound.

  
  
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  Cognitive impairments include mental fogginess, memory difficulties, difficulty with concentration, and confusion about recent events.

  
  
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  Emotional symptoms of concussion include sadness, irritability, personality changes, depression, and nervousness.

  
  
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  Sleep disturbances include difficulty initiating sleep, decreased sleep, and increased drowsiness.

6

What red flag symptoms suggest a more severe injury in concussion?

Prolonged loss of consciousness (LOC) and amnesia may indicate severe brain injury.

Recognized red flag signs are the athlete complains of neck pain, deteriorating conscious state, increasing confusion or irritability, severe or increasing headache, repeated vomiting, unusual behavior change, seizure or convulsion, double vision, and weakness or tingling/burning in arms or legs.

7

What do you do with a patient who is suspected of having severe injury or persistent red flag symptoms?

Athletes with longer than brief LOC or persistent red flag symptoms should be transferred to the emergency department.

8

How quickly do concussion symptoms appear?

The symptoms of concussion are generally apparent after an injury but can be delayed often 5 to 10 minutes; presentations up to 24 hours after impact have been reported.

9

You are at a college football game, and a receiver is hit while running with the ball. After the play, he reports feeling “slow” and has difficulty remembering the events leading up to the hit and after the impact. What are three basic steps you should do to evaluate the injury?

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  Remove the athlete from the game or practice to a quiet location.

  
  
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  Take away a piece of essential equipment (i.e., helmet).

  
  
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  Ask questions about symptoms and perform a full cognitive and neurologic examination.

10

What should be included in the sideline neurologic exam?

Assess for amnesia and check for cranial nerves, peripheral sensation, extremity strength, and coordination.

11

What are some of the cognitive tools available for evaluation of concussion on the sideline?

Some of the cognitive assessment tools available include:

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  Balance Error Scoring System (BESS): Consists of three tests lasting 20 seconds each, performed on a firm surface, with the eyes closed, and scored based on the number of errors across trials.

  
  
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  Sport Assessment Concussion Tool 3 (SCAT3): Combines three tests, the Standard Assessment of Concussion (SAC), Maddock’s questions, and the BESS. The SAC and Maddock’s questions focus on orientation, immediate memory, concentration, and delay recall.

  
  
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  King-Devick (KD) test: Measures how fast an athlete can read aloud single-digit numbers from three test cards. Captures attention, language, and eye movement impairments.