Any athlete who has a suspected concussion should be evaluated by a licensed healthcare professional.1 If your sports organization is fortunate enough to have a medical professional on the sidelines, they will likely perform a complete concussion assessment. That assessment will include a targeted history and physical examination. If a medical professional is not available during play, the player should be removed from the field of play and taken for evaluation.
The medical provider would try to determine the mechanism of injury (e.g., was the injury to the front, back, or the side of the head?).
- An injury to the front of the brain (frontal lobe) causes irritability and emotionality, like cheerfulness or inappropriate sadness.
- An injury to the back of the brain (occipital lobe and cerebellum) usually causes dizziness, problems with balance, and visual disturbances.
- Injuries to the side of the head (parietal lobe) are often associated with headache and nausea
Some helmets include accelerometers that measure the amount of force affecting a player’s head. When players experience forces greater than 100 G (100 times the force of gravity), the likelihood of concussion is increased.2Unfortunatelythis measure is not always a good predictor of whether or not a concussion occurred. In other words, there is “cut off” or minimum threshold force for concussion. Therefore, this measurement is only moderately helpful in sideline concussion management.
The medical professional will then perform a focused physical/neurological examination. The provider will look for signs of dizziness or poor coordination, poor attention, confusion, emotionality, or difficulty following instructions. They may also perform cranial nerve testing (there are 12 cranial nerves that control sensory and motor function in the head and neck). The professional may perform strength and sensation testing and perform tests of balance.
Even after this full assessment, it is not always possible to make an accurate diagnosis of concussion. In borderline cases or in cases where the diagnosis is questionable, neuropsychological testing may be needed (though uncommonly used and essentially never done on the sidelines. Though it is becoming more common in the office and companies are working on apps that might be a tool in diagnosing concussion on the sideline).
When evaluation takes place on the sideline, the medical provider may use one or more concussion screening instruments. There are nearly a dozen different questionnaires that may be used for concussion assessment. These assessments take as little as a minute to up to 10 minutes or more to perform. The more common concussion evaluation tests include:
- Maddocks Questions
- Concussion Assessment & Response: Sport Version (CARE)
- Standardized Assessment of Concussion (SAC)
- Balance Error Scoring System (BESS) or modified BESS
- NFL Sideline Concussion Assessment Tool
- Sport Concussion Assessment Tool 3 (SCAT3)
The final two tools listed are actually combinations of various other tools and assessments. While these tools can be helpful when used appropriately, no single concussion evaluation instrument is perfect. They will not detect all cases of concussion. Likewise, they may indicate a diagnosis of concussion when it actually does not exist. Regardless, it is always best to err on the side of caution. This means preventing the player with suspected or diagnosed concussion from returning to the field of play until symptoms have fully resolved.
- Harmon KG, Drezner JA, Gammons M, et al. American Medical Society for Sports Medicine position statement: concussion in sport. Br J Sports Med. Jan 2013;47(1):15-26.
- Broglio SP, Eckner JT, Kutcher JS. Field-based measures of head impacts in high school football athletes. Curr Opin Pediatr. Dec 2012;24(6):702-708.