Review Question - QID 211194

This athlete sustained a concussion. Appropriate side-line management includes asking the athlete to recall 5 or 10 words from a set list. Reciting of this list of words should be done in an immediate and delayed recall fashion. This is one part of the Sport Concussion Assessment Tool, 5th Edition (SCAT5).

Concussions represent a traumatic injury to the brain. These can be mild or moderate injuries and in some cases severe. Concussions can be associated with other head injuries or neck injuries, which also need to be ruled out. Appropriate initial side-line management includes immediate removal from play without return to play that day, appropriate history and physical examination, and evaluation with a neurocognitive test.

One of the most common tests is the Sport Concussion Assessment Tool, 5th edition (SCAT5). This on-field and side-line assessment tool looks at many aspects. Initial assessment involves looking for red flags, general observation of the athlete, Maddocks Questions, Glasgow Coma Scale, and Cervical Spine Assessment. After verifying that the athlete is stable and does not require immediate cervical spine stabilization or emergent transfer to a hospital, the assessment continues with athlete's history and current symptoms. Additional testing includes orientation questions, testing immediate memory with 5 or 10 word recall, testing concentration using digit series repeated backwards, reciting the months in reverse order, a neurological screen, balance testing using single, double or tandem stance, and finally delayed recall of either the 5 or 10 word list. The current SCAT 5 for athletes 5-12 years old and athletes 12 years or older.

Cahill et al. reviewed the initial side-line management, clinical management, and long-term care associated with concussions in athletes. They conclude appropriate side-line management include immediate removal of play, evaluation of the airway, breathing and circulation, excluding neck injuries, symptom identification and monitoring, and use of a neurocognitive side-line test (i.e. SCAT5, King-Devick test or others). Appropriate return to play criteria involves a step-wise progression over a week.

Durand et al. discuss the importance of identifying severe head injuries such as Epidural and Subdural hematomas. The importance of identifying concussions and appropriate removal from play and return to play criteria to avoid second impact syndrome. Additionally, they discuss appropriate on-field management such as proper head and neck control in football players with concerns for cervical spine injuries. They also discuss appropriate return to play criteria based on the Cantu system.

Incorrect Answers:
1. An athlete should never return to play on the same day of a concussion
3. Athletes should never return to play the same day they sustained a concussion even if they are able to complete sport-specific activities that day symptom-free. The standard progression of return to play lasts at least one week.
4. Concentration is not assessed by counting forward by 5s. Rather it is assessed by either reciting the months in reverse order or asking the athlete to recite a series of digits in backwards order
5. Balance is not assessed with hopping as this would cause additional trauma. Rather balance is assessed via single, double and tandem stance positions.