No athlete under 18 years who experiences a concussion should be allowed to return to play on the same day, according to recent consensus recommendations arising from the Third International Conference on Concussion in Sport.
This position is solidly based on evidence that the still-developing brains of adolescents and children are slower to heal, Michael W. Collins, Ph.D., said at the annual meeting of the American Orthopaedic Society for Sports Medicine.
“The younger you are, the longer it takes to recover from the injury. The data [are] unquestionable that kids are different,” explained Dr. Collins, assistant director of the University of Pittsburgh sports concussion program.
The guidelines state that athletes under age 18 years must be carefully monitored with their activities restricted until they have fully recovered. That means no exertion—physical or mental. Neurocognitive testing while the young athlete still is symptomatic is recommended as useful in assisting physicians in planning regarding school and home management (J. Clin. Neurosci.2009;16:755-63).
The concussion conference, hosted by FIFA (the Federation Internationale de Football Associations, sponsor of soccer's World Cup), took place in Zurich late last year. The consensus guidelines urge moving away from concussion severity grading scales.
“We know the grading scales are not effective,” he said. “You will never hear a grade of concussion come out of my mouth. It doesn't predict anything in terms of prognostic outcomes.”
The consensus report states there is little role for neuroimaging except when a structural lesion is suspected, a view shared by Dr. Collins. “Concussion is not a structural brain injury; it's a metabolic crisis. You can't see it on CT or MRI,” he stressed.