Sports concussion: A return-to-play guide

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Applied Evidence

Sports concussion: A return-to-play guide

J Fam Pract. 2012 June;61(6):323-328

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References

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Anticipate complications
Most patients with concussions who are managed appropriately do well. However, complications can occur. The most serious complication is second impact syndrome, which usually occurs when concussion is unrecognized or not well managed. While not well understood, this condition is thought to result from a sudden increase in intracranial pressure after a second head injury in an athlete already suffering from concussion symptoms. The injury typically results in serious long-term neurologic deficits, or even fatality.²⁹ Second impact syndrome has been documented as occurring in the same game after an initial injury, as well as in subsequent games.²⁹

A more common, but less serious, complication is postconcussion syndrome.³⁰ This is an ill-defined condition in which the patient suffers from concussive symptoms for an extended period of time, generally for more than 3 months.³⁰ As with acute concussion, the constellation of symptoms ranges from headache to cognitive impairment. In cases of postconcussion syndrome, it is appropriate to consult with neuropsychologists, psychiatrists, or neurologists for assistance with symptoms and associated mood disorders. Similar to acute concussion management, it is generally recommended that athletes not be cleared to resume play while struggling with the symptoms of postconcussion syndrome.³⁰

There have also been recent reports of late-life sequelae in those who have sustained multiple concussions. Depression and dementia have been suggested in surveys of retired NFL players.^31,32 There have also been studies both suggesting¹⁴ and questioning^33,34 whether multiple concussions result in long-term cognitive deficits. While the evidence available at this time is not firm, there seems to be an increasing belief that multiple concussions can affect long-term cognitive abilities. For these reasons, use caution in making return-to-play decisions for patients with multiple concussions or concussions with long-lasting symptoms.

CORRESPONDENCE Aaron M. Lear, MD, 224 West Exchange Street, Suite 440, Akron, OH 44302; aaron.lear@akrongeneral.org