The Legal Landscape of Concussion

Abstract

Context:Concussion legislation has been enacted in all 50 of the United States, aiming to prevent mild traumatic brain injuries and the potential long-term sequelae of these injuries in youth athletics. Sports medicine providers, in addressing this major public health concern, are tasked with adhering to the established standards of medical care while also considering the legal implications.Evidence Acquisition:The PubMed (2011-2016) database was searched using the following search terms: concussion, sports concussion, legislation, and concussion legislation. References from consensus statements, review articles, and book chapters were also utilized.Study Design:Clinical review.Level of Evidence:Level 4.Results:The Lystedt law and its progeny have increased awareness of the signs and symptoms of sports concussion, but adherence to state legislation can pose some challenges.Conclusion:The presence of concussion legislation places a responsibility on the sports medicine provider to have a firm understanding of the legality of concussion management in the state(s) in which they practice.

Surveying Argentine healthcare providers’ knowledge, attitude, and practice about diagnosis and management of sports-related concussions

“…For example, after the implementation of concussion legislation in all 50 United States Sports, the rates of treated concussions were higher than PR legislation trends. 3 It is important to link knowledge transfer and action plans to achieve impact at individual, organizational, community, national, and international levels. Unfortunately, standards for permanent education on these issues are not yet standardized in all settings.…”

Concussion management in general practice: a survey of general practitioners in primary care in the Republic of Ireland

“…Many sports governing bodies and some governments mandate a medical review prior to clearance for return to play following a concussion [7,8]. SCAT5 contains return to play guidelines, as do many sporting (World Rugby, IRFU, FIFA) and medical organizations (AMSSM, AAP) [9][10][11][12][13] .…”

Role of the Neurologist in the Care of Athletes With Head Injuries

“…3 These state laws differ regarding which health care providers can perform these evaluations and make the return to play decisions. 3 We neurologists certainly possess the attributes necessary to play an integral role in this process and should make this well known to our fellow health care providers, local educators and parents, and legislators who make these rules. In addition, all the recent evidence-based and consensus guidelines regarding the evaluation of MTBI in athletes "assume or specifically recommend … completion of a thorough neurologic examination."…”

“…All 50 US states legally require that student scholastic athletes who sustain a possible concussion be removed from play and not allowed to return to play until cleared by a “health-care provider.” 3 These state laws differ regarding which health care providers can perform these evaluations and make the return to play decisions. 3 We neurologists certainly possess the attributes necessary to play an integral role in this process and should make this well known to our fellow health care providers, local educators and parents, and legislators who make these rules.…”

“…All 50 US states legally require that student scholastic athletes who sustain a possible concussion be removed from play and not allowed to return to play until cleared by a “health-care provider.” 3 These state laws differ regarding which health care providers can perform these evaluations and make the return to play decisions. 3 We neurologists certainly possess the attributes necessary to play an integral role in this process and should make this well known to our fellow health care providers, local educators and parents, and legislators who make these rules. In addition, all the recent evidence-based and consensus guidelines regarding the evaluation of MTBI in athletes “assume or specifically recommend … completion of a thorough neurologic examination.” 4 For example, the 2016 Berlin guideline states, “It is recommended that all athletes should have a clinical neurological assessment … as part of their overall management.” 5 The AAN endorses the position that “the neurologic physical examination is a key part of the evaluation of a patient with concussion and is required in all clinical settings.” 4 As a result of our training and experience, we neurologists are clearly the most qualified physicians to perform these services.…”