Review Question - QID 4420

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Concussions (Mild Traumatic Brain Injury) Treatment Nonoperative QID: 4420 (OBQ12.60)

QID 4420 (Type "4420" in App Search)

In which of the following situations is it appropriate to allow the athlete to return to play on the same day?

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15-year-old American Football player develops a headache with no further symptoms after being tackled to the ground and parents sign a waiver giving permission for him to play

14%

1081/7616

21-year-old baseball player collides with another player while sliding head-first into second base and has five minutes of right upper extremity pain, paresthesias, and deltoid weakness

82%

6277/7616

23-year-old college soccer player sustains a hit to the head from a long kick with 15 seconds loss of consciousness

82/7616

16-year-old American Football player who strikes a player head-first can't remember the last play he was injured on but parents agree to sign consent for him to play

71/7616

18-year-old African American baseball player is hit in the head with a 95 mph fastball with immediate nausea and diplopia, but normal neuropsychologic testing

62/7616

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Only in answer 2, where there is no evidence of concussive symptoms, should the athlete be allowed to return to play on the same day. The patient has evidence of a "stinger" which resolves quickly and shouldn't inhibit his further play

This question tests knowledge of concussive symptoms and return to play criteria. If a player has symptoms (i.e. diplopia, tinnitus, amnesia, loss of consciousness, nausea, and/or headache) of a concussion, even with negative advanced imaging or neurologic testing, that player should not be allowed to play for at least that same day.

Meehan et al. noted that headache is the most common symptom of a concussion, and that a concussion may present with only a headache and no other neurologic symptoms.

McCrory et al., in the 3rd Consensus Statement on Concussion in Sport, noted his conclusion on concussion management was that all athletes less than 18 years of age and all non-elite athletes, as well as “elite” athletes greater than 18 years of age who do not have team personnel with experience in concussion management and sufficient resources (neuropsychologists, neuroimaging) should return to play using a graduated return to play protocol. This graduated return to play protocol is found in the” Consensus Statement” and consists of six stages. The athlete should spend at least 24 hours in each stage, meaning that the earliest return to play in most instances should be one week after concussion, even if symptoms resolve relatively quickly.

Illustration A shows a table listing the different rehabilitation stages for return to play from the McCrory article.

Incorrect Answers:
Answer 1: Athletes <18 years of age with symptoms of a concussion (i.e. headache) should be gradually returned to play over a one week period despite parent waiver
Answer 3: An amateur athlete with loss of consciousness after a head injury should be presumed to have experienced a concussion and should return with a gradual return to play protocol.
Answer 4: A player should not return to play the same day after experiencing concussive symptoms, even if parents sign an injury waiver.
Answer 5: Neuropsychological testing is useful for concussion evaluation, but does not have a defined role in return to play criteria.

ILLUSTRATIONS: