National American University
The United States Medical Society has developed guidelines to treat concussions received playing contact sports. The guidelines for treating concussions that occur during sports competition include three grades of concussion. Patients with grade 1 concussions have confusion without amnesia or loss of consciousness. They should be checked for amnesia or other symptoms every five minutes for 20 minutes, and allowed to resume playing if no symptoms develop. Grade 2 patients have confusion with amnesia and no loss of consciousness. They should be removed from competition and examined for symptoms immediately after the injury and again the day after. If no symptoms develop within one week, they should be allowed to participate in sports again. Grade 3 patients lose consciousness and should be taken immediately to the hospital for neurological evaluation. They should be admitted if any abnormalities are seen. Even patients who suffer from concussions without loss of consciousness should be carefully monitored. They can die from brain swelling if another concussion occurs.
An estimated 300,000 sports related traumatic brain injuries, of mild to moderate severity, most of which can be classified as concussions, (i.e., conditions of temporary altered mental status as a result of head trauma, occur in the United States each year. The proportion of these concussions that are repeat injuries is unknown; however, there is an increased risk for subsequent traumatic brain injuries among persons who have had at least one previous traumatic brain injury. In today’s competitive sports environment, large numbers of athletes participate in a wide variety of youth, high school, collegiate, professional, and recreational sports.(2) Whereas some sports (eg, football) have maintained a consistent number of participants, others have increasing participation. For the younger participants, the sport experience provides an environment in which they can grow and develop physically, mentally, and socially. For college and professional athletes, sports offer an opportunity for personal success and future employment. For recreational athletes, sports provide opportunities for maintaining a healthier lifestyle and an outlet for relieving the tensions of modern life. As sports programs continue to flourish, it is the responsibility of the sponsors of these programs to provide an environment that minimizes the risk of injury.
Repeated mild brain injuries occurring over an extended period (i.e., months or years can result in cumulative neurologic and cognitive deficits, but repeated mild brain injuries occurring within a short period (i.e., hours, days, weeks) can be catastrophic or fatal. The latter phenomenon, termed "second impact syndrome" has been reported more frequently since it was first characterized in 1984. Second Impact Syndrome, results from acute, usually fatal, brain swelling that occurs when a second concussion is sustained before complete recovery from a previous concussion that causes vascular congestion and increased intracranial pressure, which may be difficult or impossible to control.(4) Neurologists say once a person suffers a concussion, he is as much as four times more likely to sustain a second one. Moreover, after several concussions, it takes less of a blow to cause the injury and requires more time to recover. Certain sports such as football, rugby, ice hockey and martial arts are considered to be more prone to incidences of concussion; other forms of recreational sports, such as horseback riding, soccer, bicycling, and skiing also carry a significant risk of concussion. Many concussions cause only temporary disruption of brain function and resulting problems fade within a week or two. However, fully 60% of people who sustain a concussion still encounter neurological problems one-month...