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Concussion Protocol


Concussion Baseline Testing

A baseline test is a pre-season computerized exam overseen by a trained healthcare professional. Baseline tests are administered before the start of a sports season. It assesses an athlete’s brain function and the presence of any concussion symptoms. “Only a trained health care professional with experience in concussion management should interpret the results of a baseline exam. When possible, ideally a neuropsychologist should interpret the computerized or paper-pencil neuropsychological test components of a baseline exam.”

Expert opinion on baseline testing has shifted in the last few years. The 5th consensus statement on Concussion in Sport states that “Baseline testing may be useful, but is not necessary for interpreting post-injury scores. If used, clinicians must strive to replicate baseline testing conditions.” Parachute Canada, a reputable organization dedicated to injury prevention, says that “Baseline testing is not required for post-injury care of youth athletes with suspected or diagnosed concussion and mandatory testing is not recommended." Hence, current evidence suggests that concussion baseline testing is not useful for amateur and youth sports.

If an athlete has sustained a concussion, how likely are they to have another one?

The Cleveland Clinic states that “once you’ve had a concussion, you are three to five times more likely to have another concussion. The highest risk is for those who return to competition before their symptoms have completely gone away. No one should return to active play if they are still having symptoms from a concussion.”

Concussion Protocol

The concussion protocol described below is adapted from the Concussion Awareness Training Tool (CATT).

  1. Remove the athlete from play. Following a potential concussion-causing event, the individual should be immediately removed from activity and assessed for a medical emergency. When in Doubt, Sit Them Out!

  2. If any of the following Red Flags are present, seek immediate emergency medical care:

    1. ​Neck pain or tenderness

    2. Double vision

    3. Weakness or tingling/burning in arms or legs

    4. Severe or increasing headache

    5. Seizure or convulsion

    6. Loss of consciousness

    7. Deteriorating conscious state

    8. Vomiting

    9. Increasingly restless, agitated, or combative)

  3. Inform the athlete’s parents or caretakers about the possible concussion. Make sure they know that the athlete should be seen by a health care professional experienced in evaluating for concussion.

  4. Keep the athlete out of play the day of the injury and until a healthcare professional, experienced in evaluating for concussion, says the athlete is symptom-free and it’s OK to return to play. ​Do not try to judge the severity of the injury yourself.

Ultimately, there is no way to know for certain whether a particular event will lead to a concussion—a relatively minor impact may result in a concussion while a higher-magnitude impact may not. It is important to note that if there is a history of concussions, even a minor impact or forceful motion can cause a concussion.

Second Impact Syndrome

Second impact syndrome “describes a condition in which an individual experiences a second head injury before complete recovery from an initial head injury. It is thought that athletes who sustain a concussion and return to their sport early are at particularly high risk.”

When an individual sustains a second concussion before the brain has recovered from the initial concussion, catastrophic neurological injury may occur.

Partly because of second impact syndrome, concussion protocols have been established in youth sports organizations to prohibit concussed athletes from returning to a game prematurely and without medical clearance.

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