Concussion (Mild Traumatic Brain Injury) and the Team Physician: A Consensus Statement*

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DEFINITIONConcussion or mild traumatic brain injury (MTBI) is a pathophysiological process affecting the brain induced by direct or indirect biomechanical forces.Common features include:Rapid onset of usually short-lived neurological impairment, which typically resolves spontaneously.Acute clinical symptoms that usually reflect a functional disturbance rather than structural injury.A range of clinical symptoms that may or may not involve loss of consciousness (LOC).Neuroimaging studies that are typically normal.GOALThe goal is to assist the team physician in providing optimal medical care for the athlete with concussion.To accomplish this goal, the team physician should have knowledge of and be involved with:EpidemiologyPathophysiologyGame-day evaluation and treatmentPost–game-day evaluation and treatmentDiagnostic imagingManagement principlesReturn-to-playComplications of concussionPreventionSUMMARYThis document provides an overview of select medical issues that are important to team physicians who are responsible for athletes with concussion. It is not intended as a standard of care, and should not be interpreted as such. This document is only a guide, and as such, is of a general nature, consistent with the reasonable, objective practice of the healthcare professional. Individual treatment will turn on the specific facts and circumstances presented to the physician. Adequate insurance should be in place to help protect the physician, the athlete, and the sponsoring organization.This statement was developed by a collaboration of six major professional associations concerned about clinical sports medicine issues; they have committed to forming an ongoing project-based alliance to bring together sports medicine organizations to best serve active people and athletes. The organizations are: American Academy of Family Physicians, American Academy of Orthopaedic Surgeons, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and the American Osteopathic Academy of Sports Medicine.EXPERT PANELStanley A. Herring, M.D., Chair, Seattle, WashingtonJohn A. Bergfeld, M.D., Cleveland, OhioArthur Boland, M.D., Boston, MassachusettsLori A. Boyajian-O’Neill, D.O., Kansas City, MissouriRobert C. Cantu, M.D., Concord, MassachusettsElliott Hershman, M.D., New York, New YorkPeter Indelicato, M.D., Gainesville, FloridaRebecca Jaffe, M.D., Wilmington, DelawareW. Ben Kibler, M.D., Lexington, KentuckyDouglas B. McKeag, M.D., Indianapolis, IndianaRobert Pallay, M.D., Hillsborough, New JerseyMargot Putukian, M.D., Princeton, New JerseyINTRODUCTIONIt is essential the team physician understand:The recognition and evaluation of the athlete with concussion.Management and treatment of the athlete with concussion be individualized.The factors involved in making return-to-play (RTP) decisions after injury should be based on clinical judgment.A game-day medical plan specific to concussion injuries be developed.The need for documentation.There is a paucity of well-designed studies of concussion and its natural history.It is desirable the team physician:Coordinate a systematic approach for the treatment of the athlete with concussion.Identify risk factors and implement appropriate treatment.Understand the potential sequelae of concussive injuries.Understand prevention strategies.EPIDEMIOLOGYConcussions occur commonly in helmeted and nonhelmeted sports, and account for a significant number of time loss injuries.Published reports indicate concussion injuries occur at a rate of:0.14–3.66 injuries per 100 player seasons at the high school level, accounting for 3–5% of injuries in all sports0.5–3.0 injuries per 1,000 athlete exposures at the collegiate level.Self-report data suggests significantly higher incidence of concussion.Because of under recognition and/or under reporting, the incidence of concussion and its sequelae is unknown.

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