Neurologists offer guidelines on diagnosing sports concussions

Updated recommendations on evaluating and managing sports-related concussions were released by the American Academy of Neurology (AAN) last week.

The guideline authors reviewed the literature from 1955 to 2012 to update a 1997 AAN practice parameter and assess risk factors, diagnostic tools, interventions and risk for complications related to concussions. The evidence-based guideline update was published online by Neurology on March 18.

According to the guidelines, the Post-Concussion Symptom Scale and Graded Symptom Checklist are likely to accurately identify sports-related concussions and may be administered by trained personnel, nurses or physicians. The Standardized Assessment of Concussion is also likely to identify concussions in early stages postinjury. Neuropsychological testing could, as well, but requires a neuropsychologist for accurate interpretation. The Balance Error Scoring System identifies concussions with low to moderate diagnostic accuracy, the guidelines said.

CT imaging should not be used to diagnose sports-related concussions but may be used to rule out more serious traumatic brain injury in athletes who have loss of consciousness, post-traumatic amnesia, persistently altered mental status, focal neurological deficits, evidence of skull fracture or signs of clinical deterioration.

Patients who have been diagnosed with a concussion are more likely to suffer postconcussion impairments if they have ongoing clinical symptoms, concussion history or a younger age (high school age or younger concussion patients should be managed more conservatively than older athletes, the guidelines noted). Athletes should be prohibited from returning to play or practice until a licensed health care professional has judged that the concussion has resolved and the athlete is asymptomatic off medication.

Data are insufficient to show that any intervention enhances recovery or diminishes long-term sequelae postconcussion, although, based on research in mild traumatic brain injury, clinicians might provide cognitive restructuring (brief psychological counseling that consists of education, reassurance and reattribution of symptoms) to shorten the duration of subjective symptoms and diminish the risk for chronic postconcussion syndrome, the guidelines said.

An accompanying editorial noted that neurologists have become much more closely involved in maintaining the health and safety of professional athletes in recent years and will play an essential part in responses to the public health problem of sports-related concussions.