July 8, 2013

Guideline Title

Summary of evidence-based guideline update: evaluation and management of concussion in sports. Report of the Guideline Development Subcommittee of the American Academy of Neurology.

Bibliographic Source(s)

Giza CC, Kutcher JS, Ashwal S, Barth J, Getchius TS, Gioia GA, Gronseth GS, Guskiewicz K, Mandel S, Manley G, McKeag DB, Thurman DJ, Zafonte R. Summary of evidence-based guideline update: evaluation and management of concussion in sports: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2013 Jun 11;80(24): 2250-7. [40 references] PubMed External Web Site Policy

Guideline Status

This is the current release of the guideline.
This guideline updates a previous version: American Academy of Neurology, Quality Standards Subcommittee. Practice parameter: the management of concussion in sports (summary statement). Neurology 1997 Mar;48(3):581-5. [66 references]

Summary of evidence-based guideline update: Evalua... [Neurology. 2013] - PubMed - NCBI

2013 Jun 11;80(24):2250-2257. Epub 2013 Mar 18.

Summary of evidence-based guideline update: Evaluation and management of concussion in sports: Report of the Guideline Development Subcommittee of the American Academy of Neurology.

Giza CC, Kutcher JS, Ashwal S, Barth J, Getchius TS, Gioia GA, Gronseth GS, Guskiewicz K, Mandel S, Manley G, McKeag DB, Thurman DJ, Zafonte R.

Source

From the Division of Pediatric Neurology (C.C.G.), Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Neurology (J.S.K.), University of Michigan Medical School, Ann Arbor; Departments of Pediatrics and Neurology (S.A.), Loma Linda University, Loma Linda, CA; Department of Psychiatry and Neurobehavioral Sciences (J.B.), University of Virginia, Charlottesville; Center for Health Policy (T.S.D.G.), American Academy of Neurology, Minneapolis, MN; Department of Pediatrics and Psychiatry (G.A.G.), George Washington University School of Medicine, Washington, DC; Department of Neurology (G.S.G.), University of Kansas Medical Center, Kansas City; Matthew Geller Sport-Related Traumatic Brain Injury Research Center (K.G.), University of North Carolina, Chapel Hill; Neurology and Neurophysiology Associates, PC (S.M.), Philadelphia, PA; Neurological Surgery (G.M.), UCSF Medical Center, San Francisco, CA; Department of Family Medicine (D.B.M.), Indiana University Center for Sports Medicine, Indianapolis; Department of Neurology (D.J.T.), Emory University School of Medicine, Atlanta, GA; and Department of Physical Medicine and Rehabilitation (R.Z.), Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Cambridge.

Abstract

OBJECTIVE:

To update the 1997 American Academy of Neurology (AAN) practice parameter regarding sports concussion, focusing on 4 questions: 1) What factors increase/decrease concussion risk? 2) What diagnostic tools identify those with concussion and those at increased risk for severe/prolonged early impairments, neurologic catastrophe, or chronic neurobehavioral impairment? 3) What clinical factors identify those at increased risk for severe/prolonged early postconcussion impairments, neurologic catastrophe, recurrent concussions, or chronic neurobehavioral impairment? 4) What interventions enhance recovery, reduce recurrent concussion risk, or diminish long-term sequelae? The complete guideline on which this summary is based is available as an online data supplement to this article.

METHODS:

We systematically reviewed the literature from 1955 to June 2012 for pertinent evidence. We assessed evidence for quality and synthesized into conclusions using a modified Grading of Recommendations Assessment, Development and Evaluation process. We used a modified Delphi process to develop recommendations.

RESULTS:

Specific risk factors can increase or decrease concussion risk. Diagnostic tools to help identify individuals with concussion include graded symptom checklists, the Standardized Assessment of Concussion, neuropsychological assessments, and the Balance Error Scoring System. Ongoing clinical symptoms, concussion history, and younger age identify those at risk for postconcussion impairments. Risk factors for recurrent concussion include history of multiple concussions, particularly within 10 days after initial concussion. Risk factors for chronic neurobehavioral impairment include concussion exposure and APOE ε4 genotype. Data are insufficient to show that any intervention enhances recovery or diminishes long-term sequelae postconcussion. Practice recommendations are presented for preparticipation counseling, management of suspected concussion, and management of diagnosed concussion.