UMEM Educational Pearls

Category: Pediatrics

Title: Concussions (Pediatric Sports Medicine)

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

Posted: 10/5/2007 by Sean Fox, MD (Updated: 10/14/2019)
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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.