Sideline Management

When attending to an athlete on the field with a suspected concussion, attention must first be given to basic first aid. Airway, breathing, and circulation (ABCs) and level of consciousness should be initially assessed, followed by an evaluation for potential cervical spine injuries. If loss of consciousness has occurred, the duration of unconsciousness should be determined. A brief loss of consciousness is generally defined as less than 30 to 60 seconds. If a player is unconscious for more than 30 to 60 seconds or still unconscious by the time a physician reaches the athlete on the field, most would consider this "prolonged." Patients with concussions involving prolonged loss of consciousness, suspected cervical spine injuries, or gross neurologic impairment should be stabilized and transported to a hospital for further evaluation (see Cervical Spine Injuries: On-the-Field Assessment).

After it is determined that the athlete is stable and safe to be moved, further assessment can take place on the sideline. Physical examination should include evaluation of cranial nerves, pupillary dilation and reactivity, balance and coordination, motor strength, and cognitive function. Orienta tion to time, place, and person is an incomplete assessment of cognitive function in the sports setting. Memory and recall testing, serial 7s (counting backward by 7 from 100), serial 3s (counting backward by 3 from 100), and listing the months of the year backward and forward are simple sideline tests of cognitive function. Several sideline assessment tools exist to aid medical professionals in the evaluation of an athlete with concussion. The Standardized Assessment of Concussion (SAC) is a validated sideline assessment tool, and the most recent consensus conference on concussion recommended a modified and expanded tool, the Sport Concussion Assessment Tool (SCAT2) (McCrea et al., 1997; McCrory et al., 2009). This includes a symptom scale, standard cognitive assessment, and guided physical examination. Such standardized examinations are useful for serial follow-up and if different medical personnel will be evaluating the athlete. It is important to reassess concussed athletes frequently to monitor for resolution of symptoms or signs of deterioration.

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