Clinical Evaluation of the Concussed Athlete: A View From the Sideline

Abstract

The sideline assessment of sport-related concussion is challenging given the elusiveness and variability of presentation, reliance on athlete-reported symptoms, and the varying specificity and sensitivity values of sideline assessment tools. In addition, the recognition of injury and assessment often occur in a time-pressured environment, requiring rapid disposition and decision making. Clinicians should begin the evaluation by assessing for cervical spine injury, intracranial bleeding, and other injuries that can present in a similar fashion or in addition to concussion. The sideline concussion evaluation should consist of a symptom assessment and a neurologic examination that addresses cognition (briefly), cranial nerve function, and balance. Emerging tools that assess visual tracking may provide additional information. The sensitivity and specificity of commonly implemented sideline assessment tools are generally good to very good, especially for symptom scores and cognitive evaluations performed within 48 hours of injury, and they are improved when a baseline evaluation is available for comparison. Serial assessments are often necessary as objective signs and symptoms may be delayed. A standardized assessment is paramount in evaluating the athlete with a suspected concussion, but there is no replacement for being familiar with the athlete and using clinical judgment when the athlete seems "not right" despite a "normal" sideline assessment. Ultimately, the clinician should err on the side of caution when making a return-to-play decision.

Concussion incidence and recovery in Swedish elite soccer — Prolonged recovery in female players

“…These data are in contrast to our present 2017 prospective study, where 3.4% of the players sustained a concussion. This discrepancy might be due to recall errors and difficulties in concussion diagnosis in the retrospective study, resulting in too liberal interpretation of a soccer‐related concussion. More likely, there may be some underreporting in our present prospective results due to factors discussed below.…”

Reliable sideline ocular-motor assessment following exercise in healthy student athletes

“…In the United States, initial sideline assessment for suspected concussion after an athlete has sustained an injury is often performed by an athletic trainer and decisions regarding return-to-play can be extremely challenging. [12][13][14] Interpretation of post-injury performance measures may be challenging if baseline testing comparators were insincere or if repeated assessments resulted in a learning effect. To avoid variability in performance measures that may complicate trainers' decision-making, there is a critical need for objective sideline measures to assess concussion and guide decisions regarding return-to-play.…”

An Objective Balance Error Scoring System for Sideline Concussion Evaluation Using Duplex Kinect Sensors

“…Failure of early recognition and removal of the concussed athlete from play may put the individual at risk for potential complications and long-term consequences [ 4 ]. This often requires a rapid and accurate sideline assessment in the midst of competition by certified athletic trainers and team physicians [ 5 ].…”

“…Since 1997, a multidimensional approach consisting of the systematic assessment of cognition, balance and symptoms has been recommended for the diagnosis and management of sports concussion (SC) [ 2 , 6 , 7 ]. The multidimensional approach emphasizes multiple diagnostic elements including a physical examination, a survey of post-concussion symptoms, performance-based measures of acute mental status and postural stability, and careful consideration of clinical history [ 5 , 8 ]. Unfortunately, this approach is neither time- nor cost-effective, making them difficult to employ at varying levels of sport.…”