Concussion_management_guidelines
Concussion grading systems
Criteria used to determine the severity of a concussion
Concussion grading systems are sets of criteria used in sports medicine to determine the severity, or grade, of a concussion, the mildest form of traumatic brain injury. At least 16 such systems exist,[1] and there is little agreement among professionals about which is the best to use.[2] Several of the systems use loss of consciousness and amnesia as the primary determinants of the severity of the concussion.[2]
The systems are widely used to determine when it is safe to allow an athlete to return to competition. Concern exists that multiple concussions received in a short time may present an added danger, since an initial concussion may leave the brain in a vulnerable state for a time. Injured athletes are prohibited from returning to play before they are symptom-free during rest and exertion and their neuropsychological tests are normal again, in order to avoid a risk of cumulative effects such as decline in mental function and second-impact syndrome, which may occur on very rare occasions after a concussion that occurs before the symptoms from another concussion have resolved.
It is estimated that over 40% of high school athletes return to action prematurely[3] and over 40,000 youth concussions occur annually.[4] Concussions account for nearly 10% of sport injuries, and are the second leading cause of brain injury for young people ages 15–24.[5]
Three grading systems are followed most widely: the first by neurosurgeon Robert Cantu, another by the Colorado Medical Society, and a third by the American Academy of Neurology.[6] The Cantu system has become somewhat outdated. Grade I Grade one concussions come with no loss of consciousness and less than 30 minutes of post-traumatic amnesia. Grade II Grace two concussion patients lose consciousness for less than five minutes or have amnesia for between 30 minutes and 24 hours. Grade III People with grade three concussions have a loss of consciousness lasting longer than five minutes or amnesia lasts for 24 hours. Originally developed by Teasdale and Jennett (1974), the Glasgow Coma Scale (GCS) (see Table C-1) is a scoring scale for eye opening, motor, and verbal responses that can be administered to athletes on the field to objectively measure their level of consciousness. A score is assigned to each response type for a combined total score of 3 to 15 (with 15 being normal). An initial score of less than 5 is associated with an 80 percent chance of a lasting vegetative state or death. An initial score of greater than 11 is associated with a 90 percent chance of complete recovery (Teasdale and Jennett, 1974). Because most concussed individuals score 14 or 15 on the 15-point scale, its primary use in evaluating individuals for sports-related concussions is to rule out more severe brain injury and to help determine which athletes need immediate medical attention (Dziemianowicz et al., 2012).