Skip to main content
Top
Published in: Sports Medicine 8/2001

01-07-2001 | Injury Clinic

Recommendations for Grading of Concussion in Athletes

Authors: Dr Suzanne Leclerc, Maryse Lassonde, J. Scott Delaney, Vincent J. Lacroix, Karen M. Johnston

Published in: Sports Medicine | Issue 8/2001

Login to get access

Abstract

Mild sports-related concussions, in which there is no loss of consciousness, account for >[75% of all sports-related brain injury. Universal agreement on concussion definition and severity grading does not exist. Grading systems represent expertise of clinicians and researchers yet scientific evidence is lacking. Most used loss of consciousness and post-traumatic amnesia as markers for grading concussion. Although in severe head injury these parameters may have been proven important for prognosis, no study has done the same for sport-related concussion. Post-concussion symptoms are often the main features to help in the diagnosis of concussion in sport. Neuropsychological testing is meant to help physicians and health professionals to have objective indices of some of the neurocognitive symptoms. It is the challenge of physicians, therapists and coaches involved in the care of athletes to know the symptoms of concussion, recognise them when they occur and apply basic neuropsychological testing to help detect this injury. It is, therefore, recommended to be familiar with one grading system and use it consistently, even though it may not be scientifically validated. Then good clinical judgement and the ability to recognise post-concussion signs and symptoms will assure that an athlete never returns to play while symptomatic.
Literature
1.
go back to reference Thurman DJ, Branche CM, Sneizek JE. The epidemiology of sports-related traumatic brain injuries in the United States: recent developments. J Head Trauma Rehabil 1998; 13: 1–8PubMed Thurman DJ, Branche CM, Sneizek JE. The epidemiology of sports-related traumatic brain injuries in the United States: recent developments. J Head Trauma Rehabil 1998; 13: 1–8PubMed
2.
go back to reference Klein M, Houx PJ, Jolles J. Long-term persisting cognitive sequelae of traumatic brain injury and the effect of age. J Nerv Ment Dis 1996; 184: 459–67PubMedCrossRef Klein M, Houx PJ, Jolles J. Long-term persisting cognitive sequelae of traumatic brain injury and the effect of age. J Nerv Ment Dis 1996; 184: 459–67PubMedCrossRef
3.
go back to reference Cremona-Meteyard SL, Geffen GM. Persistent visuospatial attention deficits following mild head injury in Australian rules football players. Neuropsychologia 1994; 32: 649–62PubMedCrossRef Cremona-Meteyard SL, Geffen GM. Persistent visuospatial attention deficits following mild head injury in Australian rules football players. Neuropsychologia 1994; 32: 649–62PubMedCrossRef
4.
go back to reference Leininger BE, Gramling SE, Farrell AD, et al. Neuropsychological deficits in symptomatic minor head injury patients after concussion and mild concussion. J Neuro Neurosurg Psychiatry 1990; 53: 293–6CrossRef Leininger BE, Gramling SE, Farrell AD, et al. Neuropsychological deficits in symptomatic minor head injury patients after concussion and mild concussion. J Neuro Neurosurg Psychiatry 1990; 53: 293–6CrossRef
5.
go back to reference Matser JT, Kessels AG, Lezak MD, et al. Chronic traumatic brain injury in professional soccer players. Neurology 1998; 51: 791–6PubMedCrossRef Matser JT, Kessels AG, Lezak MD, et al. Chronic traumatic brain injury in professional soccer players. Neurology 1998; 51: 791–6PubMedCrossRef
7.
go back to reference Collins MW, Grindel SH, Lovell MR, et al. Relationship between concussion and neuropsychological performance in College football players. JAMA 1999; 282: 964–70PubMedCrossRef Collins MW, Grindel SH, Lovell MR, et al. Relationship between concussion and neuropsychological performance in College football players. JAMA 1999; 282: 964–70PubMedCrossRef
8.
go back to reference Albright JP, Mc Auley E, Martin RK, et al. Head and neck injuries in college football: an eight-year analysis. Am J Sports Med 1985; 13: 147–52PubMedCrossRef Albright JP, Mc Auley E, Martin RK, et al. Head and neck injuries in college football: an eight-year analysis. Am J Sports Med 1985; 13: 147–52PubMedCrossRef
9.
go back to reference Zemper E. Analysis of cerebral concussion frequency with the most common models of football helmets. J Athletic Train 1994; 29: 44–50 Zemper E. Analysis of cerebral concussion frequency with the most common models of football helmets. J Athletic Train 1994; 29: 44–50
10.
go back to reference Delaney SJ, Lacroix VJ, Leclerc S, et al. Concussions during the 1997 Canadian Football League season. Clin J Sport Med 2000; 10: 9–14PubMedCrossRef Delaney SJ, Lacroix VJ, Leclerc S, et al. Concussions during the 1997 Canadian Football League season. Clin J Sport Med 2000; 10: 9–14PubMedCrossRef
11.
go back to reference Cantu RC. Guidelines for return to contact sports after cerebral concussion. Physician Sports Med 1986; 14: 75–83 Cantu RC. Guidelines for return to contact sports after cerebral concussion. Physician Sports Med 1986; 14: 75–83
12.
13.
go back to reference Wojtys EM, Hovda D, Landry G, et al. Concussion in sports. Am J Sports Med 1999; 27: 676–87PubMed Wojtys EM, Hovda D, Landry G, et al. Concussion in sports. Am J Sports Med 1999; 27: 676–87PubMed
14.
go back to reference McCrory PR. The eighth wonder of the world: the mythology of concussion management. Br J Sports Med 1999; 33: 136–7PubMedCrossRef McCrory PR. The eighth wonder of the world: the mythology of concussion management. Br J Sports Med 1999; 33: 136–7PubMedCrossRef
15.
go back to reference McCrory PR. Where you knocked out? A team physician’s approach to initial concussion management. Med Sci Sports Exerc 1997; 29 (7 Suppl.): S207-S12 McCrory PR. Where you knocked out? A team physician’s approach to initial concussion management. Med Sci Sports Exerc 1997; 29 (7 Suppl.): S207-S12
16.
go back to reference Leblanc KE. Concussion in sport: diagnosis, management, return to competition. Compr Ther 1999; 25: 39–44PubMedCrossRef Leblanc KE. Concussion in sport: diagnosis, management, return to competition. Compr Ther 1999; 25: 39–44PubMedCrossRef
17.
go back to reference Canadian Academy of Sport Medicine Concussion Committee, Guidelines for assessment and management of sport-related concussion. Clin J Sports Med 2000; 10: 209–11CrossRef Canadian Academy of Sport Medicine Concussion Committee, Guidelines for assessment and management of sport-related concussion. Clin J Sports Med 2000; 10: 209–11CrossRef
18.
go back to reference Committee on Head Injury Nomenclature of the Congress of neurological surgeons: glossary of head injury, including some definitions of injury to the cervical spine. Clin Neurosurg 1966; 12: 386–94 Committee on Head Injury Nomenclature of the Congress of neurological surgeons: glossary of head injury, including some definitions of injury to the cervical spine. Clin Neurosurg 1966; 12: 386–94
19.
go back to reference Binder LM. Persisting symptoms after mild head injury: a review of the postconcussive syndrome. J Clin Exp Neuropsychol 1986; 8: 323–46PubMedCrossRef Binder LM. Persisting symptoms after mild head injury: a review of the postconcussive syndrome. J Clin Exp Neuropsychol 1986; 8: 323–46PubMedCrossRef
20.
go back to reference Evans RW. The postconcussion syndrome and the sequelae of mild head injury. Neurol Clin 1992; 10: 815–47PubMed Evans RW. The postconcussion syndrome and the sequelae of mild head injury. Neurol Clin 1992; 10: 815–47PubMed
21.
go back to reference Kelly JP, Nichols JS, Filley CM, et al. Concussion in sports: guidelines for the prevention of catastrophic outcome. JAMA 1991; 266: 2867–9PubMedCrossRef Kelly JP, Nichols JS, Filley CM, et al. Concussion in sports: guidelines for the prevention of catastrophic outcome. JAMA 1991; 266: 2867–9PubMedCrossRef
22.
go back to reference Maddocks DL, Dicker GD, Saling MM. The assessment of orientation following concussion in athletes. Clin J Sport Med 1995; 5: 32–5PubMedCrossRef Maddocks DL, Dicker GD, Saling MM. The assessment of orientation following concussion in athletes. Clin J Sport Med 1995; 5: 32–5PubMedCrossRef
23.
go back to reference Macciocchi SN, Barth JT, Alves W, et al. Neuropsychological functioning and recovery after mild head injury in Collegiate athletes. Neurosurgery 1996; 39: 510–4PubMed Macciocchi SN, Barth JT, Alves W, et al. Neuropsychological functioning and recovery after mild head injury in Collegiate athletes. Neurosurgery 1996; 39: 510–4PubMed
24.
go back to reference Alves WA, Macciocchi SN, Barth JT. Postconcussive symptoms after mild head injury. J Head Trauma Rehabil 1993; 3: 48–59CrossRef Alves WA, Macciocchi SN, Barth JT. Postconcussive symptoms after mild head injury. J Head Trauma Rehabil 1993; 3: 48–59CrossRef
25.
go back to reference Alves WM, Colohan ART, O’Leary TJ, et al. Understanding post-traumatic symptoms after minor head injury. J Head Trauma Rehabil 1986; 1: 1–12CrossRef Alves WM, Colohan ART, O’Leary TJ, et al. Understanding post-traumatic symptoms after minor head injury. J Head Trauma Rehabil 1986; 1: 1–12CrossRef
26.
go back to reference Barth JT, Alves WM, Ryan TV, et al. Mild head injury in sports: Neuropsychological sequelae and recovery of function. In: Levin HS, Eisenberg HM, Benton AL, editors. Mild head injury. New York: Oxford University press, 1989: 257–75 Barth JT, Alves WM, Ryan TV, et al. Mild head injury in sports: Neuropsychological sequelae and recovery of function. In: Levin HS, Eisenberg HM, Benton AL, editors. Mild head injury. New York: Oxford University press, 1989: 257–75
27.
go back to reference McCrory PR, Ariens M, Berkovic SF. The nature of acute concussive symptoms in Australian football. Clin J Sport Med 2000; 10: 235–8PubMedCrossRef McCrory PR, Ariens M, Berkovic SF. The nature of acute concussive symptoms in Australian football. Clin J Sport Med 2000; 10: 235–8PubMedCrossRef
29.
go back to reference Jennett B, Bond M. Assessment of outcome after severe brain damage: a practical scale. Lancet 1975; I: 480–4CrossRef Jennett B, Bond M. Assessment of outcome after severe brain damage: a practical scale. Lancet 1975; I: 480–4CrossRef
30.
go back to reference Ommaya AK, Gennarelli TA. Cerebral concussion and traumatic unconsciousness: correlation of experimental and clinical observations of blunt head injuries. Brain 1974; 97: 633–54PubMedCrossRef Ommaya AK, Gennarelli TA. Cerebral concussion and traumatic unconsciousness: correlation of experimental and clinical observations of blunt head injuries. Brain 1974; 97: 633–54PubMedCrossRef
31.
go back to reference Schneider RC, Kriss FC. First aid and diagnosis - the treatment of head injuries. In: Schneider RC, editor. Head and neck injuries in football: mechanisms, treatment and prevention. Baltimore (MA): Williams and Wilkins Co., 1973: 163–87 Schneider RC, Kriss FC. First aid and diagnosis - the treatment of head injuries. In: Schneider RC, editor. Head and neck injuries in football: mechanisms, treatment and prevention. Baltimore (MA): Williams and Wilkins Co., 1973: 163–87
32.
go back to reference Maroon JC. Football head and neck injuries: an update. Clin Neurosurg 1980; 27: 414–29PubMed Maroon JC. Football head and neck injuries: an update. Clin Neurosurg 1980; 27: 414–29PubMed
33.
go back to reference Kulund D. Athletic injuries to the head, neck and face. In: Kulund D, editors. The injured athlete. Philadelphia (PA): J.B. Lippincott, 1982: 225–57 Kulund D. Athletic injuries to the head, neck and face. In: Kulund D, editors. The injured athlete. Philadelphia (PA): J.B. Lippincott, 1982: 225–57
34.
go back to reference Hugenholtz H, Richard MT. Return to athletic competition following concussion. Can Med Assoc J 1982; 127: 827–9PubMed Hugenholtz H, Richard MT. Return to athletic competition following concussion. Can Med Assoc J 1982; 127: 827–9PubMed
35.
go back to reference Nelson WE, Jane JA, Gieck JH. Minor head injury in sports: a new system of classification and management. Physician Sports Med 1984; 12: 103–7 Nelson WE, Jane JA, Gieck JH. Minor head injury in sports: a new system of classification and management. Physician Sports Med 1984; 12: 103–7
36.
go back to reference Wilberger JE, Maroon JC. Head injuries in athletes: emergency management of the injured athlete. Clin Sports Med 1989; 8: 1–9PubMedCrossRef Wilberger JE, Maroon JC. Head injuries in athletes: emergency management of the injured athlete. Clin Sports Med 1989; 8: 1–9PubMedCrossRef
37.
go back to reference Ommaya A. Biomechanical aspects of head injuries in sports. In: Jordan B, Tsaris P, Warren R, editors. Sports neurology. Rockville (MD): Aspen Publishers, 1990: 84–97 Ommaya A. Biomechanical aspects of head injuries in sports. In: Jordan B, Tsaris P, Warren R, editors. Sports neurology. Rockville (MD): Aspen Publishers, 1990: 84–97
39.
go back to reference Gersoff W. Head and neck injuries. In: Reider B, editors. Sports medicine: the school age athlete. Philadelphia (PA): W.B. Saunders, 1991: 45–72 Gersoff W. Head and neck injuries. In: Reider B, editors. Sports medicine: the school age athlete. Philadelphia (PA): W.B. Saunders, 1991: 45–72
40.
go back to reference Roberts W. Who plays? Who sits? Managing concussions in sports. Physician Sports Med 1992; 20: 66–72 Roberts W. Who plays? Who sits? Managing concussions in sports. Physician Sports Med 1992; 20: 66–72
41.
go back to reference Vegso JJ, Torg JS. Field evaluation and management of intra cranial injuries. In: Torg JS, editor. Athletic injuries to the head, neck and face. 2nd ed. St Louis (MO): Mosby Year Book, 1991: 225–31 Vegso JJ, Torg JS. Field evaluation and management of intra cranial injuries. In: Torg JS, editor. Athletic injuries to the head, neck and face. 2nd ed. St Louis (MO): Mosby Year Book, 1991: 225–31
42.
go back to reference Report of the quality standards subcommittee. Practice parameter: the management of concussion in sports [summary statement]. Neurology 1997; 48: 581–5CrossRef Report of the quality standards subcommittee. Practice parameter: the management of concussion in sports [summary statement]. Neurology 1997; 48: 581–5CrossRef
43.
go back to reference Cantu RC. Reflections on head injuries in sport and the concussion controversy. Clin J Sports Med 1997; 7: 83–4CrossRef Cantu RC. Reflections on head injuries in sport and the concussion controversy. Clin J Sports Med 1997; 7: 83–4CrossRef
44.
go back to reference McCrory PR. You can run but you can’t hide: the role of concussion severity scales in sport. Br J Sports Med 1999; 33: 297–8PubMedCrossRef McCrory PR. You can run but you can’t hide: the role of concussion severity scales in sport. Br J Sports Med 1999; 33: 297–8PubMedCrossRef
45.
go back to reference Leninger B, Gramling S, Farrel A, et al. Neuropsychological deficits in symptomatic minor head injury patients after concussion and mild concussion. J Neurol Neurosurg Psychiatry 1990; 53: 293–6CrossRef Leninger B, Gramling S, Farrel A, et al. Neuropsychological deficits in symptomatic minor head injury patients after concussion and mild concussion. J Neurol Neurosurg Psychiatry 1990; 53: 293–6CrossRef
46.
go back to reference Lovell MR, Iverson GL, Collins MW, et al. Does loss of consciousness predict neuropsychological decrements after concussion? Clin J Sport Med 1999; 9: 193–8PubMedCrossRef Lovell MR, Iverson GL, Collins MW, et al. Does loss of consciousness predict neuropsychological decrements after concussion? Clin J Sport Med 1999; 9: 193–8PubMedCrossRef
47.
go back to reference Leclerc S, Lassonde M, Dupuis F, et al. Concussion in the elite athlete: new evaluation, grading system and return to play guidelines [abstract 2053]. Med Sci Sports Exerc 1999; 31 Suppl. 5: S400 Leclerc S, Lassonde M, Dupuis F, et al. Concussion in the elite athlete: new evaluation, grading system and return to play guidelines [abstract 2053]. Med Sci Sports Exerc 1999; 31 Suppl. 5: S400
48.
go back to reference Kelly JP, Rosenberg JH. Diagnosis and management of concussion in sports. Neurology 1997; 48: 575–80PubMedCrossRef Kelly JP, Rosenberg JH. Diagnosis and management of concussion in sports. Neurology 1997; 48: 575–80PubMedCrossRef
49.
go back to reference Mesulam MM. Principles of behavioural neurology. Philadelphia (PA): FA Davis, 1985 Mesulam MM. Principles of behavioural neurology. Philadelphia (PA): FA Davis, 1985
50.
go back to reference Shores A, Marosszek J, Sandanam J, et al. Preliminary validation of a clinical scale for measuring the duration of posttraumatic amnesia. Med J Aust 1986; 144: 569–72PubMed Shores A, Marosszek J, Sandanam J, et al. Preliminary validation of a clinical scale for measuring the duration of posttraumatic amnesia. Med J Aust 1986; 144: 569–72PubMed
51.
go back to reference Yarnell PR, Lynch S. The ’ding’: amnestic states in football trauma. Neurology 1973; 23: 196–7PubMedCrossRef Yarnell PR, Lynch S. The ’ding’: amnestic states in football trauma. Neurology 1973; 23: 196–7PubMedCrossRef
52.
go back to reference Maroon JC, Lovell MR, Norwik J, et al. Cerebral concussion in athletes: evaluation and neuropsychological testing. Neurosurgery 2000; 47: 659–72PubMed Maroon JC, Lovell MR, Norwik J, et al. Cerebral concussion in athletes: evaluation and neuropsychological testing. Neurosurgery 2000; 47: 659–72PubMed
53.
go back to reference Levin HS, Mattis S, Ruff RM, et al. Neurobehavioral outcome following minor head injury: a three-center study. J Neurosurg 1987; 66: 234–43PubMedCrossRef Levin HS, Mattis S, Ruff RM, et al. Neurobehavioral outcome following minor head injury: a three-center study. J Neurosurg 1987; 66: 234–43PubMedCrossRef
54.
go back to reference King NS, Crawford S, Wenden FJ, et al. The Rivermead post concussion symptoms questionnaire: a measure of symptoms commonly experienced after head injury and its reliability. J Neurol 1995; 242: 587–92PubMedCrossRef King NS, Crawford S, Wenden FJ, et al. The Rivermead post concussion symptoms questionnaire: a measure of symptoms commonly experienced after head injury and its reliability. J Neurol 1995; 242: 587–92PubMedCrossRef
55.
go back to reference Lovell MR, Collins MW. Neuropsychological assessment of the college football player. J Head Trauma Rehabil 1998; 13: 9–26PubMedCrossRef Lovell MR, Collins MW. Neuropsychological assessment of the college football player. J Head Trauma Rehabil 1998; 13: 9–26PubMedCrossRef
56.
go back to reference Gronwall D, Head injury in rugby. N Z J Sports Med 1992; 20: 19–21 Gronwall D, Head injury in rugby. N Z J Sports Med 1992; 20: 19–21
57.
go back to reference Echemendia RJ, Putukian M, Mackin RS, et al. Neuropsychological test performance prior to and following sports related mild traumatic brain injury. Clin J Sport Med 2001; 11: 23–31PubMedCrossRef Echemendia RJ, Putukian M, Mackin RS, et al. Neuropsychological test performance prior to and following sports related mild traumatic brain injury. Clin J Sport Med 2001; 11: 23–31PubMedCrossRef
58.
go back to reference McCrea M, Kelly JP, Randolph C, et al. Standardized assessment of concussion (SAC): on-site mental status evaluation of the athlete. J Head Trauma Rehabil 1998; 13: 27–35PubMedCrossRef McCrea M, Kelly JP, Randolph C, et al. Standardized assessment of concussion (SAC): on-site mental status evaluation of the athlete. J Head Trauma Rehabil 1998; 13: 27–35PubMedCrossRef
59.
go back to reference Gronwall D, Wrightson P. Memory and information processing capacity after closed head injury. J Neurol Neurosurg Psychiatry 1981; 44: 889–95PubMedCrossRef Gronwall D, Wrightson P. Memory and information processing capacity after closed head injury. J Neurol Neurosurg Psychiatry 1981; 44: 889–95PubMedCrossRef
60.
go back to reference Maddocks D, Dicker G. An objective measure of recovery from concussion in Australian rules footballers. Sport Med News 1989; 7: 6–7 Maddocks D, Dicker G. An objective measure of recovery from concussion in Australian rules footballers. Sport Med News 1989; 7: 6–7
61.
go back to reference Johnston KM, Chankowsky JC, Guerin M, et al. Neuroimaging in concussion. Neuroimage Bull 2001; 17: 2–5 Johnston KM, Chankowsky JC, Guerin M, et al. Neuroimaging in concussion. Neuroimage Bull 2001; 17: 2–5
62.
go back to reference Dupuis F, Johnston KM, Lavoie M, et al. Concussions in athletes produce brain dysfunction as revealed by event related potentials. Neuroreport 2000; 11: 4087–92PubMedCrossRef Dupuis F, Johnston KM, Lavoie M, et al. Concussions in athletes produce brain dysfunction as revealed by event related potentials. Neuroreport 2000; 11: 4087–92PubMedCrossRef
63.
go back to reference Johnston KM, Ptito A, Chankowsky JC, et al. New frontiers in diagnostic imaging in concussive head injury. Clin J Sport Med. In press Johnston KM, Ptito A, Chankowsky JC, et al. New frontiers in diagnostic imaging in concussive head injury. Clin J Sport Med. In press
Metadata
Title
Recommendations for Grading of Concussion in Athletes
Authors
Dr Suzanne Leclerc
Maryse Lassonde
J. Scott Delaney
Vincent J. Lacroix
Karen M. Johnston
Publication date
01-07-2001
Publisher
Springer International Publishing
Published in
Sports Medicine / Issue 8/2001
Print ISSN: 0112-1642
Electronic ISSN: 1179-2035
DOI
https://doi.org/10.2165/00007256-200131080-00007

Other articles of this Issue 8/2001

Sports Medicine 8/2001 Go to the issue