American Academy of Neurology Concussion Guidelines: Introduction
At a press conference held at the American Academy of Neurology's (AAN's) 2013 Annual Meeting, the release of new AAN guidelines for the evaluation and management of sports-related concussion (SRC) were announced. The recommendations update the 1997 AAN sports concussion practice parameter and were published online in Neurology on March 18, 2013. The new guidelines attempt to address uncertainty and inconsistency in the management of concussion and mild traumatic brain injury (TBI) by addressing 4 clinical questions:
1. For athletes, what factors increase or decrease concussion risk?
2a. For athletes suspected of having sustained concussion, what diagnostic tools are useful in identifying those with concussion?
2b. For athletes suspected of having sustained concussion, what diagnostic tools are useful in identifying those at increased risk for severe or prolonged early impairments, neurologic catastrophe, or chronic neurobehavioral impairment?
3. For athletes with concussion, what clinical factors are useful in identifying those at increased risk for severe or prolonged early postconcussion impairments, neurologic catastrophe, recurrent concussions, or chronic neurobehavioral impairment?
4. For athletes with concussion, what interventions enhance recovery, reduce the risk for recurrent concussion, or diminish long-term sequelae?
The new AAN recommendations -- divided into preparticipation counseling; assessment, diagnosis, and management of suspected concussion; and management of diagnosed concussion -- were nicely summarized at the press event by lead authors Christopher C. Giza, MD, and Jeffrey S. Kutcher, MD. However, some areas of the guideline are open to interpretation, particularly when it comes to deciding when it is acceptable to allow an athlete with a suspected concussion to return to play. The following summary serves as a guide to the new report, highlighting the major recommendations and providing additional clarification based on comments from Drs. Giza and Kutcher.
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Cite this: Bret S. Stetka, Andrew N. Wilner. New Concussion Guidelines: An Analysis - Medscape - Apr 17, 2013.