Jan 29, 2015Heads Up
In “Sport-Related Concussions: Navigating the Latest Research Findings and Clinical Recommendations,” Kevin Guskiewicz of UNC-Chapel Hill discussed sideline assessment protocols being researched that will lead to stronger prognoses for the 1.6 million to 3.8 million U.S. athletes concussed each year.
What makes it difficult for team physicians and athletic trainers to determine safe return-to-play decisions for these athletes is that there is no universal agreement on what constitutes a concussion, Dr. Guskiewicz said. Approximately 90 percent of injured players do not sustain a loss of consciousness or amnesia. Furthermore, the effects of even a Grade 1 concussion (a player “whose bell was rung”) sometimes don’t appear until 36 to 48 hours after the concussion was sustained, which increases odds of re-injuring the brain 1.5 times more when the athlete returns to activity.
To prevent serious or catastrophic side effects, Guskiewicz and researcher Steve Broglio of the University of Illinois-Urbana-Champaign suggested athletic trainers implement on-field sideline assessments with follow-up evaluations throughout the succeeding 48 hours. The severity of the neurological damage being evaluated during this time period is measured by rating the injured player’s answers to a series of questions that cover physiological symptoms, recall/concentration tasks, coordination, range of motion, and palpitation. The ratings are based on a scale of zero to six, with six being the worst. Administering the evaluations require as little as pen and paper or can be as detailed as undergoing a BESS or SCAT 2 test.
One of the first questions commonly asked in sideline assessments focuses on “How do you feel?” type questions, rather than “Do you feel?” questions. The reason for this, Broglio says, is that players with a Grade 1 concussion often brush aside dull headaches, telling their athletic trainers they’re fine and ready to return to the field.
To make sure the athlete is telling the truth or just not ignoring the pain, an athletic trainer should ask, “How is your headache?” By restating the question, the player is more likely to focus on the injury instead of the game because the question asked cannot be answer by a simple yes or no. The player has to provide the ATC with a description, leading to a more honest answer. Even an answer of “Not bad,” confirms a headache exists and is enough reason to sit a player.