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The Evolution of Our Understanding of Concussion: The Role of the Concussion and Sport Guidelines

Yesterday’s blog began a series of discussions about “The Evolution of Our Understanding of Concussion, otherwise Called Mild Traumatic Brain Injury.” Today I continue to follow the topics of my YouTube videos on this theme. Today’s video is found here:

Today’s subset of this theme deals with the role that the various concussion and sport guidelines played in changing how the medical community and the public looked at concussion. The first set of those guidelines came out of an article written by James Kelly, M.D. in JAMA, the Journal of the American Medical Association: J.P. Kelly et al., Concussion in Sports, Guidelines for the Prevention of Catastrophic Outcome, 266 JAMA 2867, 2868 (1991). Kelly’s article was also really the first to warn of the danger of the “second impact syndrome”. It is concern about the second impact syndrome, where the second concussion leads to a catastrophic increase in intracranial pressure, that fueled much of the early development of these guidelines.

Among the important contributions of that first work on concussion and sport were the no-return to play if a concussion was symptomatic for more than 15 minutes and the requirement that a concussion that was symptomatic for more than 15 minutes would require serial evaluations until the symptoms had cleared. That first guideline, promulgated by the American Academy of Neurology required that symptoms would have to clear for a full seven days before the athlete was allowed to return to play.

The reason this serial evaluation requirement is so significant is that it is not the symptoms that an individual has on the day of that determines the severity of concussion, but how symptomatic they are at 24 hours, 48 hours, 72 hours.

Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice

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