Experts issue new guidance on treatment of concussions

concussion
Among youth team sports, girls' lacrosse has a relatively high concussion rate, despite rules prohibiting players' contact.

A refined definition of concussion, new guidance on rest versus activity, and collaborative treatment highlight the 2017 Consensus Statement on Concussion in Sports, published (abstract) April 26 in the British Journal of Sports Medicine. The quadrennial statement informs the medical community about how to best identify and respond to concussions.

The statement’s authors, international concussion and head injury experts, include UW Medicine physicians Stanley Herring, director of the Sports Health and Safety Institute, and Richard Ellenbogen, chairman of neurological surgery.

“The sports and activities that children love have risks, but they can also enhance a child’s physical, mental and social health now and long into the future. This report confirms that kids who are active get hurt and that most get well,” said Herring, who also is medical director of Sports, Spine and Orthopedic Health at UW Medicine. “It’s important we have a realistic appreciation of the risks, and do the work to make sports safe, including following these new concussion recommendations. It is equally important that we do everything we can to keep children active.”

Key new findings:

  • New definition of concussion. Do the patient’s symptoms stem from a concussion or something else? The new document refines the definition of concussion, adding that the signs and symptoms cannot be readily attributed to drug, alcohol or medication use or other injuries and medical problems, including psychological conditions. That’s important for delivering the right care and speeding recovery.
  • New guidance on rest versus activity after a concussion, including return-to-learn and return-to-play recommendations. Putting your child to bed in a dark room for days may not be the best path forward. The new report recommends resting for a day or two and, as symptoms improve, gradually returning to normal daily activities. With guidance from a healthcare professional, an athlete can progress to more demanding activities if the current activities do not worsen cognitive or physical symptoms.
  • New collaborative approach to treatment. Examining what the athlete brings to the concussion and actions parents should take if the symptoms continue for much longer than 10 days. The new report notes that persistent symptoms after concussion may be linked to a broad range of factors, including coexisting conditions such as migraine headaches or depression or other injuries sustained at the time of the concussion. One good way to get better may be to take a multispecialty, collaborative approach to treatment that incorporates cognitive behavioral therapy and pharmacological treatment to reduce psychological symptoms and improve quality of life.

Last October, Herring and Ellenbogen took part in the 5th International Consensus Conference on Concussion in Sport held in Berlin, Germany, and served as coauthors of the report.

UW Medicine’s Sports Health and Safety Institute provides athletes and families with evidence-based resources to identify and manage concussions, information on the benefits of physical activity, training tips, summaries of current research and information for athletes who may want to enroll in medical research studies.