Immediate “On-the-Field” Assessment of Concussion

Immediate evaluation of the injured athlete begins with a primary survey to assess airway, breathing, circulation, and determination of consciousness. Evaluation of the conscious athlete for concussion necessitates ruling out a cervical spine injury. The conscious athlete with no associated cervical spine injury should undergo a comprehensive sideline evaluation for concussion using Sport Concussion Assessment Tool 2 to document findings. A concussion sign and symptom severity scale should be performed. The physical exam should include a complete head and neck exam and neurological exam. On-the-field cognitive testing is performed with Standardized Assessment of Concussion (SAC) questions to assess orientation, immediate memory, concentration, and recall. Sideline assessment of postural stability can be performed with Balance-Error Scoring System (BESS) testing. Determining if an athlete has suffered a concussion necessitates analyzing the information obtained from symptom scales, SAC questions, and BESS performance. Use of baseline data is particularly helpful for interpretation if available. Grading of concussion is no longer performed. If an athlete is determined to have suffered a concussion, he/she should be restricted from returning to sports the same day. Transportation to the ER should occur if any signs or symptoms concerning for an intracranial bleed are present. Appropriate guidelines for care of the concussed athlete and appropriate medical follow-up should be arranged.