How Useful are "Sideline" Concussion Evaluations?
Like other medical tests, testing after a concussion is only as good as
the person administering (and interpreting) the test
previous post, we looked at the problem of "concussions" in high school athletes
and how these supposedly "mild" brain injuries are now being
understood as contributing to the development of a neurologic condition known asChronic Traumatic Encephalopathy (CTE).
In today's post the sports injury lawyer at the
Doan Law Firm will examine the usefulness of "sideline" exams that are administered
if an athlete has suffered a concussion and
when the athlete can safely return to the playing field.
What is a concussion?
The Centers for Disease Control and Prevention define a concussion to be
"… a type of traumatic brain injury … caused by a bump,
blow, or jolt to the head or by a hit to the body that causes the head
and brain to move rapidly back and forth." From this definition it
can be seen that many concussions occur during amateur and professional
sports events. Concussions are also relatively common in military veterans
who have served in combat zones.
symptoms of a concussion usually depend on the amount of force that was applied
to the brain. Symptoms can, however, range from barely detectible to confusion
to amnesia to loss of consciousness. It must be remembered that, with
a concussion, symptoms may not appear until hours or days after the injury.
Although the majority of
isolated concussion-type injuries will resolve ("heal") themselves within
a day or so from the time of injury, recent research strongly suggests that
repetitive (occurring over and over) concussions
may lead to an earlier onset of neurologic conditions such as Parkinson's
disease or Alzheimer syndrome.
How is a concussion diagnosed?
In the context of sporting events, where many concussions occur, a concussion
is usually diagnosed when an athlete shows one or more of the following:
- loss of consciousness for any period of time
- decreasing level of consciousness, such as going from awake and alert to
drowsy or even becoming unresponsive
- confusion as to the time of day, the day of the week, or where he or she
is at the moment
- amnesia regarding events that occurred in the previous few minutes
- visual disturbances such as blurred vision or "seeing double"
- loss of muscular coordination
- nausea and/or vomiting
The development of
any of the above, when they absent previously, is strongly suggestive of a
concussion and the affected individual
should not be allowed to return to the playing field until their symptom(s) are no
longer present. Since athletes are, by their nature, competitive, it is
sometimes difficult to keep them "out of the game" unless they
can be convinced that the "sideline is safer than the field."
Furthermore, coaches and trainers have a moral duty to protect those who
may not be capable of "informed' decision-making.
"Sideline" concussion tests
In response to the need for a reliable, yet quick, method for evaluating
athletes who are suspected of having a concussion, the sports medicine
community has developed a number of such tests. Although well beyond the
purposes of this page, such tests as the
Acute Concussion Evaluation (ACE) scoresheet and the
Sport Concussion Assessment Tool (SCAT) are freely available online. In addition, proprietary online and/or computerized
concussion evaluation software such as
ImPACT and the
King-Devik system are also available.
Are "sideline" concussion tests reliable?
Generally speaking, sideline concussions testing is most valuable when
used to determine who
should not return to the game rather than who
can do so. As with
any type of medical testing, it must be remembered that the results of such
tests are worthless if they are interpreted by someone who is
not trained in their significance. Since sideline concussion testing is still relatively
new, there are many coaches and coaching staff members who are unfamiliar
with how such tests are administered and how they scored.
Another potential limitation of
any concussion test is that some testing protocols do not require a "baseline"
or "reference" exam that can be used as an athlete-specific
"starting point" with which post-injury results can be compared.
The use of such "no baseline" testing protocols should be restricted
to instances where the examiner is either a physician, or a medical paraprofessional,
that has received additional protocol-specific training.
With that being said, if there is a question regarding the wisdom of returning
an athlete to competition after a concussion or if a sideline concussion
evaluation was properly administered or interpreted, it may be necessary
to consult a sports injury lawyer with experience in these potentially
Discuss your concussion injury case with a sports injury lawyer
Concussion injury during athletic events are relatively common and, thankfully,
most such injuries usually resolve without consequence if properly managed
medically. There are, however, those instances where questions will arise
regarding a decision were an athlete may have been allowed to return to play
before symptoms of an earlier injury had resolved.
If your child 1) suffered a "concussion" while participating
in school-sponsored athletics, 2) was allowed to return to the game
after being "cleared" by a coach or an athletic trainer, and 3) received
or experienced an abrupt change in their behavior and/or physical condition,
we invite you to contact the sports injury lawyer at the
Doan Law Firm, a nationwide personal injury law practice, to discuss the options that
may be available to you.
When you contact our sports injury lawyer, there is never a fee or any
other charge to you if you ask us to evaluate the circumstances of your
child's injury. Should you later decide that you would like to file
a civil lawsuit against those that you feel are responsible for your child's
injury, our firm is usually willing to assume full responsibility for
all aspects of preparing your child's personal injury case for trial in
exchange for a previously-agreed-upon percentage of the final settlement
that we will win for you.