Key change: No same-day return-to-play

A collaborative effort by the AAOS, American College of Sports Medicine (ACSM), American Academy of Family Physicians, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine has resulted in an updated team physician consensus statement on concussion (mild traumatic brain injury). The new guidelines recommend that an athlete suspected of, or diagnosed with, a concussion not be allowed to return to play on the day of the injury under any circumstances.

Before returning to play, athletes should have no symptoms (at rest or with cognitive effort), should not be taking any medications to mask concussion symptoms, and should be back at baseline with their neurological examinations and neuropsychologic (NP) testing if available.

Although not intended as a standard of care, “Concussion (mild traumatic brain injury) and the team physician: A consensus statement—2011 update” reflects the shift in treatment that has occurred since the original statement was released in 2005. Other changes of note include the following:

• Physicians should use standardized concussion assessment tools, such as the NFL Baseline and Sideline Tools, for pre-season and post-injury evaluation. Neurologic assessments should emphasize cognitive function, cranial nerve, and balance testing.
• Physicians should use the preseason to develop an emergency medical action plan, including a specific plan for concussion management, and they should also assemble a concussion management team.
• NP testing is one component of the evaluation process, and it should not be used as a stand-alone tool to diagnose, manage, or make return-to-play decisions in concussion.
• Physicians should understand their states’ laws regarding concussion as well as the rules and regulations from their sports’ governing bodies.

W. Benjamin Kibler, MD, was one of the primary authors of the document; John A. Bergfeld, MD; Peter A. Indelicato, MD; and Walter Lowe, MD, served on the expert panel.

The team physician consensus statement appears in the December 2011 issue of Medicine & Science in Sports & Exercise®, the official journal of the ACSM.