The vast differences between individual athletes makes identifying and evaluating sports-related concussion one of the most complex and perplexing injuries faced by medical personnel.
Evidence Acquisition:
This review summarizes the existing literature supporting the use of a multifaceted approach to concussion evaluation on the sideline of the athletic field. Information was drawn from a PubMed search (MEDLINE) for the terms sport concussion for the most recent and relevant literature.
Conclusions:
By using a standardized clinical examination that is supported by objective measures of concussion-related symptoms, mental status, and postural control, the medical professional becomes well equipped to make an informed diagnosis.
AgelJDickRNelsonBMarshallSW. Descriptive epidemiology of collegiate women’s ice hockey injuries: National Collegiate Athletic Association Injury Surveillance System, 2000–2001 through 2003–2004. J Athl Train. 2007;42(2):249–254.
2.
AubryMCantuRDvorakJSummary and agreement statement of the first International Conference on Concussion in Sport, Vienna 2001. Br J Sports Med. 2002;36(1):6–7.
3.
BarrWBMcCreaM. Sensitivity and specificity of standardized neurocognitive testing immediately following sports concussion. J Int Neuropsychol Soc. 2001;7(6):693–702.
4.
BroglioSPMonkASopiarzKCooperER. The influence of ankle support on postural control. J Sci Med Sport. 2009;12(3):388–392.
5.
CantuRC. Athletic concussion: current understanding as of 2007. Neurosurgery. 2007;60(6):963–964.
6.
Center for Disease Control. Sports-related recurrent brain injuries: United States. MMRW. 1997;46(10):224–227.
7.
CollinsMWGrindelSHLovellMRRelationship between concussion and neuropsychological performance in college football players. JAMA. 1999;282(10):964–970.
8.
DartAMKingwellBA. Pulse pressure: a review of mechanisms and clinical relevance. J Am Coll Cardiol. 2001;37(4):975–984.
9.
DelaneyJSLacroixVJLeclercSJohnstonKM. Concussions among university football and soccer players. Clin J Sport Med. 2002;12(6):331–338.
10.
DickRAgelJMarshallSW. National Collegiate Athletic Association Injury Surveillance System commentaries: introduction and methods. J Athl Train. 2007;42(2):173–182.
11.
FieldMCollinsMWLovellMRMaroonJC. Does age play a role in recovery from sports-related concussion? A comparison of high school and collegiate athletes. J Pediatr. 2003;142(5):546–553.
12.
FoxZGMihalikJPBlackburnJTBattagliniCLGuskiewiczKM. Return of postural control to baseline after anaerobic and aerobic exercise protocols. J Athl Train. 2008;43(5):456–463.
13.
GizaCCHovdaDA. The neurometabolic cascade of concussion. J Athl Train. 2001;36(3):228–235.
14.
GrindelSHLovellMRCollinsMW. The assessment of sport-related concussion: the evidence behind neuropsychological testing and management. Clin J Sport Med. 2001;11(3):134–143.
15.
GuskiewiczKMBruceSLCantuRCNational Athletic Trainers’ Association position statement: management of sport-related concussion. J Athl Train. 2004;29(3):280–297.
16.
GuskiewiczKMMcCreaMMarshallSWCumulative effects associated with recurrent concussion in collegiate football players: the NCAA concussion study. JAMA. 2003;290(19):2549–2555.
17.
GuskiewiczKMMihalikJPShankarVMeasurement of head impacts in collegiate football players: relationship between head impact biomechanics and acute clinical outcome after concussion. Neurosurgery. 2007;61(6):1244–1252.
18.
GuskiewiczKMRossSEMarshallSW. Postural stability and neuropsychological deficits after concussion in collegiate athletes. J Athl Train. 2001;36(3):263–273.
19.
GuskiewiczKMWeaverNLPaduaDAGarrettWE. Epidemiology of concussion in collegiate and high school football players. Am J Sports Med. 2000;28(5):643–650.
20.
LangloisJARutland-BrownWWaldMM. The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil. 2006;21(5):375–378.
21.
LovellMRCollinsMW. Neuropsychological assessment of the college football player. J Head Trauma Rehabil. 1998;13(2):9–26.
22.
LovellMRCollinsMWIversonGLJohnstonKBradleyJP. Grade 1 or “ding” concussions in high school athletes. Am J Sports Med. 2004;32(1):47–54.
23.
LovellMRIversonGLCollinsMWMcKeagDBMaroonJC. Does loss of consciousness predict neuropsychological decrements after concussion?Clin J Sport Med. 1999;9(4):193–198.
24.
MaddocksDLDickerGDSalingMM. The assessment of orientation following concussion in athletes. Clin J Sport Med. 1995;5(1):32–35.
25.
McCreaM. Standardized mental status assessment of sports concussion. Clin J Sport Med. 2001;11(3):176–181.
26.
McCreaMBarrWBGuskiewiczKMStandard regression-based methods for measuring recovery after sport-related concussion. J Int Neuropsychol Soc. 2005;11:58–69.
27.
McCreaMHammekeTOlsenGLeoPGuskiewiczK. Unreported concussion in high school football players: implications for prevention. Clin J Sport Med. 2004;14(1):13–17.
28.
McCreaMKellyJPKlugeJAckleyBRandolphC. Standardized assessment of concussion in football players. Neurology. 1997;48(3): 586–588.
29.
McCroryPRAriensMBerkovicSF. The nature and duration of acute concussive symptoms in Australian football. Clin J Sport Med. 2000;10: 235–238.
30.
McCroryPJohnstonKMeeuwisseWSummary and agreement statement of the second International Conference on Concussion in Sport, Prague 2004. Br J Sports Med. 2005;39(4):196–204.
31.
McCroryPMeeuwisseWJohnstonKConsensus statement on concussion in sport: the 3rd International Conference on Concussion in Sport held in Zurich, November 2008. Clin J Sport Med. 2009;19: 185–200.
32.
MooreKLDalleyAF. eds. Summary of cranial nerves. In: Clinically Oriented Anatomy. 4th ed. Philidelphia, PA: Lippincott Williams & Wilkins; 1999:1082–1111.
33.
PatelAVMihalikJPNotebaertAJGuskiewiczKMPrenticeWE. Neuropsychological performance, postural stability, and symptoms after dehydration. J Athl Train. 2007;42(1):66–75.
34.
PilandSGMotlRWFerraraMSPetersonCL. Evidence for the factorial and construct validity of a self-report concussion symptoms scale. J Athl Train. 2003;38(2):104–112.
35.
PotterSLeighEWadeDFlemingerS. The Rivermead Post Concussion Symptoms Questionnaire: a confirmatory factor analysis. J Neurol. 2006;253(12):1603–1614.
36.
RiemannBLGuskiewiczKMShieldsEW. Relationship between clinical and forceplate measures of postural stability. J Sport Rehabil. 1999;8(2):71–82.
37.
RopperAHGorsonKC. Clinical practice: concussion. N Engl J Med. 2007;356(2):166–172.
38.
SandersMJMcKennaK. Head and facial trauma. In: Mosby’s Paramedic Textbook. 2nd ed. St Louis, MO: Mosby; 2001:624–651.
39.
SuscoTMValovich McLeodTCGansnederBMShultzSJ. Balance recovers within 20 minutes after exertion as measured by the Balance Error Scoring System. J Athl Train. 2004;39(3): 241–246.
40.
Valovich McLeodTCBarrWBMcCreaMGuskiewiczKM. Psychometric and measurement properties of concussion assessment tools in youth sports. J Athl Train. 2006;41(4):399–408.
41.
WilkinsJCValovichTCPerrinDHGansnederBM. Performance on the Balance Error Scoring System decreases after fatigue. J Athl Train. 2004;39(2):156–161.
