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Return to play after concussion differs for each athlete

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BOSTON — There is no rigid return-to-play protocol for every concussion, and no athlete responds the same way to a concussion, according to data presented here.

In most cases, the severity of a concussion cannot be determined directly after the injury and most often only becomes clear over time, Mark R. Proctor, MD, said at the Congress of Neurological Surgeons Annual Meeting.

Although 80% to 90% of concussions resolve themselves in 3 days to 7 days, about 10% of concussions have prolonged symptoms, according to Proctor.

Determining a neurological baseline in athletes prior to the beginning of a season using the Sport Concussion Assessment Tool, third edition (SCAT3) is one of the most effective ways to clear a concussed athlete for return to play, he said.

“No athlete should ever go back the same day, or if they still remain symptomatic. The clinical judgments remain crucial, but really now over the past 5 [years] to 10 years, we are starting to see some science to back this up,” Proctor said. “We are starting to see that concussions have different trajectories, and the management can be much more individualized.”

Proctor recommended the sports concussion graded-exertion protocol as a useful tool for determining whether an athlete is ready for return to play. The protocol consists of six steps, including rest, light aerobic exercise and sport-specific training. If an athlete passes the six steps without exhibiting any concussion symptoms, he or she can be cleared. However, if the athlete does exhibit symptoms, then he or she must start step one over again, he said.

With no setbacks, athletes can typically clear the protocol after 1 week. If they fail it multiple times, additional neurological tests should be performed, and the athlete should be evaluated by a concussion specialist, according to Proctor. — by Robert Linnehan

Reference:

Proctor MR. Hot Topics I: The management of concussion in children and young adults. Return to play criteria. Presented at: Congress of Neurological Surgeons Annual Meeting; Oct. 18-22, 2014; Boston.

Disclosure: Proctor has no relevant financial disclosures.