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Current Grading Systems

More than 15 grading systems and return-to-play parameters have been published to guide the team physician, trainer, and coach in the evaluation and management of concussion. However, because of a lack of scientific foundation, these recommendations and grading systems are relatively arbitrary guides.

For example, most concussion grading systems determine return-to-play decisions based on the […]

Management of Concussion

The management of concussion has three crucial considerations. First, immediate neurologic emergencies must be identified. Second, the devastating scenario of second-impact syndrome must be prevented, and the risk of recurrent concussive episodes should be minimized.

Finally, the cumulative effects of repeated concussion, which may lead to CTBI, must be avoided. The identification of neurologic emergencies […]

Diagnosis of Concussion

The signs and symptoms of concussion vary, but any change in an athlete’s behavior should be recognized as an indication of altered neurologic functioning. Typical features of concussion are headache, disorientation, blank stare, slurred speech, delayed verbal responses to questions, slow and uncoordinated motor function, dizziness, emotional lability, and short-term memory deficits; any head trauma […]


Overall, it is estimated that approximately 300,000 sports-related concussive events occur in the United States annually. It has been estimated that 3.9% to 7.7% of high school and college athletes sustain a concussion each year.

Contact sports in particular place athletes at risk for head trauma. Football is recognized as having the highest risk; however, […]

Spectrum of Head Injuries

Intracranial hemorrhage can be divided into three types: epidural, subdural, and subarachnoid. Each type of intracranial hemorrhage is potentially devastating, so prompt, accurate assessment and appropriate treatment must be instituted. The initial presentation ranges from headache to neurologic deficits to loss of consciousness. Blood is an irritant to brain tissue and may precipitate a seizure.


Head Injuries and Concussion

Key Points

Traumatic events can lead to both primary injuries [e.g., scalp lacerations, intracranial bleeds, skull fractures, concussion, and diffuse axonal injury, (DAI)] and later, secondary injuries (e.g., herniation syndromes, diffuse edema, and hypoxic/ischemic injuries). Initial evaluation and treatment should progress through the ABCs (airway, breathing, and circulation) of trauma resuscitation. Glasgow Coma Scale is […]

Management of Cervical Spine Injuries-Scenario 2: Altered Mental Status without Cardiorespiratory Compromise

Care of the cervical spine in the collision athlete with altered mental status presents a challenging problem for the sports medicine physician. After a rapid primary survey, a brief neurological assessment is performed to determine the athlete’s level of consciousness.

Important aspects of the on-field neurological examination include assessment of mental status (i.e., Glasgow Coma […]

Abdominal injuries

Rupture of the spleen The spleen is located in the upper left part of the abdomen , and its rupture is the most common cause of death among athletes with abdominal injuries. The injury may result from a direct blow to the abdomen, e.g. when a cyclist falls and the handlebar strikes the upper left […]

Head injuries

Head injuries Head injuries occur in most sports, particularly in contact sports and in riders, downhill skiers, and boxers. There is also a risk of injury when heading a soccer ball, especially if faulty technique is used. A kicked ball in flight can reach a speed of 100 km/h (60 mph) and weigh about 450 […]