By Dev K. Mishra, M.D., President, Sideline Sports Doc
At the recent annual meeting of the American Orthopaedic Society For Sports Medicine, a paper was presented titled “Sideline Management of Concussions in Adolescent Athletes: Can the Sport Concussion Assessment Tool 2 (SCAT2) be accurately used to determine Return to Play status?” The SCAT2 is a tool that was developed by a group of international experts at the 3rdInternational Consensus meeting on Concussion in Sport held in Zurich,Switzerland in November 2008. The aim of the tool is to give professionals skilled in the evaluation and management of sports-related concussion a tool that can be given to the athlete prior to the start of the season, and then used after a suspected concussion to help determine an athlete’s readiness for return to play. The SCAT2 combines many elements such as the athlete’s complaints, the physical examination, balance testing, and memory testing. The study examined 872 males and 262 females, about 15 years old. Some of the key findings showed that the athlete should have a baseline pre-season score to compare later on, and that athletes with a prior history of at least one concussion scored significantly lower compared to their peers without a concussion history. Also, females scored significantly higher on the SCAT2 total score compared to males. There are other concussion assessment tools in use in the United States too, with similar recommendations: the tools are useful in determining return to play only when compared to an accurate pre-concussion baseline, and when they are interpreted by a physician skilled in concussion management.
It means you should leave all return to play decisions to a physician. What I would strongly recommend is that all youth sports coaches take a zero-tolerance approach to suspected concussions: if you think an athlete had a concussion, remove him or her from play immediately, and have the athlete evaluated by a physician who has the responsibility for determining safe return to play. The typical concussion may take 5-7 days before the athlete can safely return to play through a gradual increase in exercise only after they are completely symptom-free. Note that the recommendation I’m giving above is very broad, and may result in more athletes being held out of play than the coach may be used to. There will be situations where the coach is challenged to try and keep the player on the field or court (such as championship games, “star” player, etc.) but we have increasing evidence that early concussion care gives the player the best chance of normal brain function for life.
- Suspect a concussion if there has been contact (head-to-player, ball-to-head, or head-to-ground) and the athlete appears confused, dazed, or just not at usual behavior
- All athletes with a suspected concussion should be removed from play and should not be allowed to return to play until evaluated and cleared by a physician
A concussion properly managed from the start should allow a young athlete to return to play in a reasonably short number of days, but a mis-managed concussion can lead to a lifetime of problems.