Peter T. Hurley, M.D.Hickory Orthopaedic Center

Evaluation on the Field

Rule Out Neck InjuryNeurologic deficits?

Signs & Symptoms of ConcussionsMost common symptoms

Confusion and amnesia

Others…

Headache, dizziness, ringing in ears, nausea or vomiting, slurred speech, fatigue, light intolerance, inappropriate affect, irritability, balance problems, blurry vision, double vision.

Sidelines EvaluationAmnesia Retrograde, antegrade Affect, Appropriate?Eyes pupil evaluation and light toleranceBalanceMotor strength

Grading Systems

41+ systems with little agreement

American Academy of Neurology Grade I – Confusion, symptoms less

than 15 minutes, NO loss of consciousness

Grade II – Symptoms greater than 15 minutes, NO loss of consciousness

Grade III – Loss of consciousness

Recommends NO return to play or practice on the day of concussion, grading not needed.

North Carolina High School Association

What does the coach want to know?

If L.O.C.-(loss of consciousness) Athlete is out.

No L.O.C., mild symptoms, symptoms resolve in less than 15 minutes player might resume play. Reevaluate, do symptoms return with exertion?

No L.O.C., greater than 15 minutes of symptoms athlete is done for the night.

No L.O.C., symptoms greater than 15 minutes Controversy exists for when to return to play.

Symptoms of concussions can persist for days – weeks – months

Objective Evaluation would be helpful.