Journal of Athletic Training2014;49(2):245–265 doi: 10.4085/1062-6050-49.1.07 by the National Athletic Trainers’ Association, Inc www.natajournals.org position statementNational Athletic Trainers’ Association Position Statement: Management of Sport Concussion St even P. Brogli o, PhD, ATC*; Robert C. Cantu, MD†; Gerard A. Gioia, PhD‡; Kevin M. Guskiewicz, PhD, ATC, FNATA, FACSM§; Jeffrey Kutcher, MD*; Michael Palm, MBA, ATC||; Tamara C. Valovich McLeod, PhD, ATC, FNATA¶ *Universi ty of Michigan, Ann Arbor; †Depa rtment of Sur gery, Emerson Hospital, Concord, MA; ‡Division of Pediatric Neuropsychology, Children’s National Medical Center, Washington, DC; §Department of Exercise and Sport Science, University of North Caro lina, Chapel Hill; ||Ath letico Physic al Thera py, Oak Brook, IL; ¶Athletic Training Program, A.T. Still University, Mesa, AZ Objective:To provid e athletic train ers, physi cian s, and other health care professionals with best-practice guidelines forthe management of sport-related concussions. Background:An estimate d 3.8 milli on concu ssions occ ureach year in the United States as a result of sport and physical activi ty. Athletic trainers are commonly the fir st medical providers available onsite to identify and evaluate these injuries. Recommendations:The re commend ations fo r concu ssion management pr ovi ded here are based on the most current research and divided into sections on education and prevention, documentation and legal aspects, evaluation and return to play, and other considerations. Key Words:mild traumatic brain i njuries, pe diatric con cus- sions, education, assessment, evaluation, documentation D espite a significant increase in research dedicatedto identifying and managing sport-related concus- sion, it remains one of the most complex injuries sports medicine professionals face. Concussions occur from forces applied directly or indirectly to the skull that result in the rapid acceleration and deceleration of the brain. The sudden change in cer ebr al velocity eli cits neu ronal shear ing, which prod uces changes in ioni c balan ce 1 andmetabolism. 2 When acc omp ani ed by cli nic al sig ns andsympto ms, cha nges at the cel lul ar lev el are commonly referred to as mild traumatic brain injury , or concussion. Concussions occur in males and females of all ages and in all sports, but are most common in contact and collision activities. Data collected from emergency department visits show a 62% increase (153375 to 248 41 8) in no nf at al traumatic brain injuries between 2001 and 2009, 3 with as man y as 3.8 mil lio n rep ort ed and unr epo rte d spo rt- andrecrea tion -relat ed conc ussio ns occu rring each year in the United States. 4 As licensed medical professionals, athletic trainers (ATs) rec eive compre hensive did act ic and cli nic al traini ng in concussio n man ageme nt. The y are typ ically the firs t providers to identify and evaluate injured persons and are integ ral in the posti njur y mana gemen t and return -to-p lay (RTP ) decis ion-makin g proc ess. With out excep tion, ATs sho uld be pre sent at all org ani zed spo rti ng eve nts at all levels of play and should work closely with a physician ordes ign ate who has spe cifi c traini ng and exp erience in concussi on management to develop and impl ement a concussion -mana geme nt plan based on the recommenda- tions outlined here. An update to the initial 2004 National Athletic Trainers’ Ass oci ati on posit ion statement on the man ageme nt of sport-related concussion, 5 this document contains recom- mendation s on concussio n management for practicing ATs based on the most recent scientific evidence. A review ofthe literature supporting these recommendations has also bee n incl uded. The document cove rs the topi cs ofEducation and Prevention,’’ ‘‘Documentation and Legal Aspects, ’ Evaluation and RTP, andOther Consider- ations. Journal of Athletic Training 245
