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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

In a 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 as Chronic 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 to detect 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.

The 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 complex cases.

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 another injury 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.

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  1. After an accident, the responsible party's insurance company may try to reduce the claim amount. Commonly, insurance adjusters are trained to get information from the injured to assist in reducing the claim. Though some insurers are less guilty of this practice than others, it is important to realize that insurance companies are profit-oriented corporations and reducing claims results in increased profits for shareholders. This can create a situation for the injured in which they are offered a settlement that does not truly reflect the damages suffered. If you accept this settlement, you lose the ability to get more money should your injuries require further medical treatments. It is critical that victims get legal assistance in any personal injury case, and The Doan Law Firm is prepared to fight relentlessly for your rights.
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