UMEM Educational Pearls

Title: Concussions (Pediatric Sports Medicine)

Keywords: Concussion, Second Impact Syndrome, Sports Medicine (PubMed Search)

Posted: 10/5/2007 by Sean Fox, MD (Updated: 11/22/2024)
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Concussions

Symptoms
- HA, Dizziness, Confusion, Tinnitus, Nausea, Vomiting, Vision changes
3 grades of Concussions
- Grade 1 = transient concussion symptoms. No amnesia. No LOC.
- Grade 2 = transient concussion symptoms with amnesia. No LOC.
- Grade 3 = + LOC of any durations
Return to Play Guidelines
- (there is no consensus statement. What follows is based on the most conservative approach)
- Grade 1: Remove from game, Examine q 5 min.
  Return to game when asymptomatic for 20 minutes.
- Grade 2: Remove from game until asymptomatic for 1 week.
- Grade 3: ED evaluation. No contact sports for 1 month once asymptomatic for 2 weeks.
  - These apply to first concussions. Increase concern with 2nd concussion.
Second-Impact Syndrome
- Occurs when a player returns to contact sport before symptoms of 1 concussion have fully resolved.
- Even a minor blow to the head can result in loss of brain’s autoregulation of blood flow.
  - Leads to vascular engorgement and subsequent herniation.

Colorado Medical Society School and Sports Medicine Committee. Guidelines for the management of concussion in sports. Colo Med 1990;87:4.