"I Didn't Get Knocked Out, So I Must Be OK!"
Concussion means the "immediate but also temporary change in mental status after a head injury".
In the general public though, it may have several different definitions. Some think a concussion occurs only
after loss of consciousness such as a "knock out punch". Others believe it is a concussion only if the athlete
has severe symptoms such as vomiting, visual changes, or loss of memory.
The truth is, concussion has 3 grades and a variety of symptoms- all are important for the parent and coach
to understand for return to sport criteria, necessity for further work-up and overall understanding of athlete
safety.
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The reason that it is important to label the severity of a concussion is medical researchers
believe it is safe for some athletes to return to sport the next day, while others MUST be
disqualified for their safety (even if it is the state tournament!)
| Symtoms of a Concussion: Any (but not all at once are necessary) to be a hint of concussion Headache Nausea Vision Change Vomiting Speech Slurring Dizziness Memory Loss Loss of Consciousness Coordination problems Queasiness or "funny feeling" |
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The more times an athlete has a concussion- even Grade I concussions, the more long
term damage can be done, look at Mohammed Ali for instance...
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The scariest possibility is the controversial "Second Impact Syndrome" which is catastrophic, and not well understood
phenomenon where a young athlete has a second concussion before completely resolving a first one. The second
concussion may be far less severe than the first. The consequences can be immediate, not-treatable, and devastating. So
unlike many things in medicine that have varying approaches depending on the comfort level of the medical person treating
the patient- (such as how to treat and ankle sprain)- multiple head injuries have more strict rules and should be followed-
even in the pros!!
The more times an athlete has a concussion- even Grade I concussions, the more long
term damage can be done, look at Mohammed Ali for instance...
--------------------------------------------------------------------------------------------------------------------------------------------------
The scariest possibility is the controversial "Second Impact Syndrome" which is catastrophic, and not well understood
phenomenon where a young athlete has a second concussion before completely resolving a first one. The second
concussion may be far less severe than the first. The consequences can be immediate, not-treatable, and devastating. So
unlike many things in medicine that have varying approaches depending on the comfort level of the medical person treating
the patient- (such as how to treat and ankle sprain)- multiple head injuries have more strict rules and should be followed-
even in the pros!!
| Return to Play Guidelines depending on Grade and Number of Concussions in the Season *This is a guideline for information only and not to be used as absolute criteria by coaches, officials, or parents. MEDICAL EVALUATION IS ALWAYS NECESSARY!! Grade Ist injury 2nd injury 3rd injury 1 May return the next Return in 1 week following Terminate season day if no symptoms the first day the athlete has no 20-60 min. after injury symptoms New guidelines suggest children and adolescents CAN NOT return the same day from any severity of concussion, regardless of their level (recreational to Elite.)* 2 Return after no Return after no symptoms Terminate season symptoms in 1 week after 4 weeks 3 Return in 4 weeks Terminate Season and at least 2 weeks following the first day the athlete has no symptoms Guidelines differ depending on Standard, These are based off of Colorado Concussion Guidelines ** A certified Athletic Trainer or other qualified medical personnel should evaluate before return to sport after any grade of concussion. |
Realize that return to play is ANY practice or competition where an athlete could have a second
head injury. And time off BEGINS when symptoms are gone- not necessarily the same time as the
incident occured!
Example- A football player is knocked out on the 20 yard line, his first grade 3 concussion. He is removed from play but
continues to have nausea and headache for three days. On the fourth day he feels "normal". When can he return to
play?
Answer: one month and FOUR DAYS after the incident.
head injury. And time off BEGINS when symptoms are gone- not necessarily the same time as the
incident occured!
Example- A football player is knocked out on the 20 yard line, his first grade 3 concussion. He is removed from play but
continues to have nausea and headache for three days. On the fourth day he feels "normal". When can he return to
play?
Answer: one month and FOUR DAYS after the incident.
| The workup: Often a good history and physical exam by a medical professional is all that is needed for grading of the head injury and decisions on when it is safe for return to play. Sometimes more testing is required such as a CT scan or MRI- this is not necessary in every head injury. The American Academy of Pediatrics suggests a medical evaluation for EVERY concussion but no absolute rules on when CT or MRI is required. A CT is to be considered for every Grade 3 consussion though, depending on the case. Treatment: Normally, after a history and physical by a medical professional- dependable parental observation, pain medication such as acetominophen or ibuprofen , and close follow up is all that is necessary. |
| Bottom Line: 1. An athlete does not have to be knocked out to have a REAL CONCUSSION. 2. Multiple head injuries are dangerous. 3. Following guidelines are important to protect the athlete from future injuries and medical problems. 4. More rare head injuries such as subdural and epidural hematomas can be life threatening- and often have change of consciousness (not necessarily loss of consciousness) Always ask a medical professional when making decisions on concussion, head injury, and neck injury. |
| The Most Likely Sports for Head Injury In High School Males Females _____________________________________________________ Football Cheerleading Baseball Gymnastics National Center for Catastrophic Sports Injury Research ranks these youth sports as the highest risk for head and spine injury per 100,000 participants, Clinics in Sports Med Cantu and Proctor, 2000 1. Auto Racing 2. Boxing 3. Cycling 4. Diving 5. Equestrian 6. Football 7. Gymnastics The most likely NON-SPORT reason for head injury in Adolescents: Automobile Accidents wellbody |
| Grade 1 (mild) 2 3 Loss of Consciousness NO NO YES OR Amnesia/OtherSymptoms <20 min 1-24 hours >24 hours |
| wellbody at Blue Valley Pediatrics recommends Children's Mercy Hospital or KU Medical Center for after hours care if our clinic is unavailable. A telephone call to our after hours line: 913-469-4178 while taking your child is requested to assist you in the process. |
| Notice that looking in the eyes (the size of the pupils) is not a great indicator- unless medically trained- the size of the pupils may only confuse the examiner rather than answer whether the child has had a concussion. Kids with seemingly large pupils may be normal and those with normal pupils may have just gotten "knocked out". |
