Sports participation is the second most common cause of head injury, behind motor vehicle accidents, among 15- to 24-year-olds. Traumatic brain injury (TBI) has become a major public health concern, and it is the responsibility of the medical community to protect athletes from suffering permanent brain damage. In the field of sports medicine, there remains confusion regarding the term “concussion.” Our main goal is to recognize when head trauma has resulted in a TBI.
In our opinion, the most sensitive indicator as to when a TBI has occurred is a sudden change in mental status. When there is any indication that an athlete has suffered a head injury, the athlete should immediately undergo a medical evaluation, and if there is a suspicion of a TBI or concussion, then the athlete should not return to play on the same day.
Grade 1 – Athletes can return to play as soon as the physical injury has healed.
Grade 2 – Athletes can return to play once they are asymptomatic and have completed a return-to-play protocol, which is a five-stage gradual increase in activity. We also recommend that athletes with Grade 2 injuries or higher undergo neurocognitive testing after injury.
Grade 3 – We recommend that athletes wait at least 10 days before they participate in any activity that can result in head trauma. They also must be asymptomatic and successfully complete the five-day return-to-play activity protocol.
Grade 4 – We recommend a 30-day break with a first injury, 90-day break with a second injury, and a 180-day break after a third injury.
Grade 5 – Athletes may be able to return to play after six months if an MRI indicates that there was no evidence of structural damage inside the brain. This would include athletes who were unconscious for more than five minutes or had amnesia for more than one day and have a normal neurologic exam.(brighamhealthhub.org)