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To provide athletic trainers and team physicians with updated recommendations to the 2014 National Athletic Trainers' Association (NATA) concussion position statement regarding concussion management, specifically in the areas of education, assessment, prognostic factors, mental health, return to academics, physical activity, rest, treatment, and return to sport. Athletic trainers have benefited from the 2 previous NATA position statements on concussion management, and although the most recent NATA position statement is a decade old, knowledge gains in the medical literature warrant updating several (but not all) recommendations. Furthermore, in various areas of the body of literature, current evidence now exists to address items not adequately addressed in the 2014 statement, necessitating the new recommendations. This document therefore serves as a bridge from the 2014 position statement to the current state of concussion evidence, recommendations from other organizations, and discrepancies between policy and practice. These recommendations are intended to update the state of the evidence concerning the management of patients with sport-related concussion, specifically in the areas of education; assessment advances; prognostic recovery indicators; mental health considerations; academic considerations; and exercise, activity, and rehabilitation management strategies. [ABSTRACT FROM AUTHOR]

The article offers information on advances in concussion assessment, treatment, and management since the National Athletic Trainers' Association (NATA) published its 2014 position statement. Topics include updates to the NATA's recommendations in key areas such as education, assessment, mental health considerations, and rehabilitation management strategies.

To estimate scale scores for patient-reported outcome (PRO) measures that classify patients as improved or unimproved at days 3 and 10 post-concussion. Data from 187 adolescent patients who sustained a concussion (150 males, 32 females, 5 not reported) were analyzed. Patients completed the Pediatric Quality of Life Inventory (PedsQL), PedsQL Multidimensional Fatigue Scale (MFS), Headache Impact Test (HIT-6), and Global Rating of Change (GROC) on days 3 and 10 post-concussion. Dependent variables: PedsQL total score, 3 MFS subscale scores [general (MFS-GF), sleep (MFS-SLF), cognitive (MFS-CF) fatigue], and HIT-6 total score. Higher scores on PedsQL and MFS indicate better health; lower scores on HIT-6 indicate less impact on headache-related health. GROC ascertained patient-perceived magnitude of change in health status since concussion. Receiver Operating Characteristic Curve analyses estimated PRO cut-point scores that classified patients as improved or unimproved. Day 3 PRO cut-points: PedsQL total = 90; MFS-GF = 73; MSF-CF = 85; MFS-SLF = 81; and HIT-6 total = 54. Day 10 PRO cut-points: PedsQL total = 91; MFS-GF = 85; MFS-CF = 85; MFS-SLF = 90; and HIT-6 total = 51. Our results define PedsQL, MFS, and HIT-6 scores as they relate to perceived improvement following concussive injuries. Cut-point scale scores help clinicians interpret concussion PROs and make informed decisions during the management of patients with concussion. [ABSTRACT FROM AUTHOR]

Clinical Scenario: Concussions are one of the most common sport-related injuries affecting athletes participating at all levels across a variety of sports. It has been reported that up to 3.8 million concussive events occur per year that are sports-related. One significant issue with identifying concussions is that a clinical diagnosis is based on the presence of signs and symptoms, which are self-reported by the patient. In the adolescent population, injury to the brain is possible with even the slightest insult, which can affect recovery and predispose them to subsequent concussions. Recent legislative efforts have included athlete education as a means to improve concussion reporting. More specifically, all 50 US states and the District of Columbia have implemented concussion legislation that includes some type of concussion education protocol, but there is still little evidence to suggest that enhanced knowledge levels result in behavior changes, including improved concussion-reporting practices. It is unclear what factors make an adolescent athlete more or less likely to report the symptoms of a concussion. Focused Clinical Question: What factors positively or negatively influence secondary school athletes' likelihood of reporting symptoms of sport-related concussions? [ABSTRACT FROM AUTHOR]

Context: Accurate assessment of health-related quality of life (HRQoL) is important for quality patient care. Evaluation of HRQoL typically occurs with patient self-report, but some instruments, such as the Pediatric Quality of Life Inventory (PedsQL), allow for proxy reporting. Limited information exists comparing patient and proxy reports of HRQoL after sport-related injury in adolescent athletes. Objective: To compare patient ratings and parent-proxy ratings of HRQoL in adolescent athletes who suffer musculoskeletal injuries requiring orthopedic consultation. The authors hypothesized poor agreement between patient and parent-proxy ratings of HRQoL. Design: Cross-sectional study. Setting: Orthopedic practice. Patients: Thirteen adolescent patients with a sport-related musculoskeletal injury requiring orthopedic consultation and 1 of their parents participated. Interventions: During the initial visit to the physician's office, each patient was asked to complete the PedsQL, and the patient's parent was asked to complete the parent-proxy version of the PedsQL. Main Outcome Measurements: The PedsQL is a pediatric generic outcome measure that consists of a total score and 4 subscale scores: physical, emotional, social, and school functioning. Means and standard deviations were calculated for all scores, and comparisons between patient-self report and parent-proxy ratings of HRQoL were made for the PedsQL total score and subscale scores using Pearson product-moment correlations (r). Results: Pearson product-moment correlations showed little to fair insignificant relationships between patient self-report and parent-proxy report of the PedsQL for the total score (r = -.1) and all subscales (range r = .1 to .4). Conclusions: Our results suggest a lack of agreement between patient and parent-proxy ratings of HRQoL, with patients rating their HRQoL lower than their parent. Patient perception of HRQoL may be more accurate than proxy report, which supports the use of patient-rated HRQoL in patient evaluation. Assessments of HRQoL made by proxies, even those close to the patient, may not represent patient health status. [ABSTRACT FROM AUTHOR]

Context: Patient-oriented outcome measures such as the Medical Outcomes Short Form (SF-36) and the Pediatric Outcomes Data Collection Instrument (PODCI) are important tools for determining the impact of events like sport-related injury on health-related quality of life (HRQoL). Unfortunately, there are no published studies using these instruments that compare adolescent athletes with their nonathlete peers, making interpretations of these measures in this population difficult. Objective: To compare HRQoL in adolescent athletes and nonathletes using 2 common instruments. Design: Cross-sectional. Setting: 7 high schools. Participants: 219 athletes and 106 nonathletes. Intervention: None. Main Outcome Measures: The SF-36 and the PODCI were completed in a counterbalanced manner during 1 session. Dependent variables included the 8 subscale and 2 composite scores of the SF-36 and the 5 subscale scores and 1 global score of the PODCI. Results: On the SF-36, athletes reported higher scores on the physical function, general health, social functioning, and mental health subscales and the mental composite score and lower scores on the bodily pain subscale than nonathletes. On the PODCI,athletes reported higher scores on the sport and physical function and happiness subscales and lower scores on the pain/comfort subscale. Conclusions: Athletes reported higher scores on a number of SF-36 and PODCI subscales related to mental, emotional, and physical well-being than nonathletes. Our findings suggest that athletic involvement may be a benefit to the overall health status of adolescents and imply that athletes may be a distinct adolescent group requiring their own normative values when using the SF-36 and PODCI. [ABSTRACT FROM AUTHOR]

Objectives: To describe the patient, injury, assessment and treatment characteristics, as well as return-to-play timelines and clinical findings at discharge for adolescent patients after sport-related concussion. Design: Retrospective analysis of electronic medical records. Setting: Athletic training facilities of secondary school members of the Athletic Training Practice-Based Research Network (AT-PBRN). Patients: In total, 1886 patient records were reviewed. [1204 (63.8%) male, 682 (36.2%) female, age = 15.3 ± 1.9 years, height = 169.5 ± 13.5 cm, mass = 70.3 ± 17.0 kg]. Patients were diagnosed with a concussion by an athletic trainer or team/directing physician. Interventions: None. Main Outcome Measures: Descriptive analysis of patient, injury, assessment, treatment, and participation status characteristics, as well as discharge information. Results: Injury demographic forms were completed for 1886 concussion cases. A concussion-specific evaluation form was completed for 55.9% (n = 1054) of cases. Treatment documentation was completed on 829 patients (44.0% of initial documented cases). Discharge forms were completed for 750 patients (40.0% of initial documented cases). Most cases were coded as 850.9-Concussion (85.5%, n = 642) and occurred during an in-season game (49.4%, n = 308). Time lost from competition was 24.9 ± 39.9 days. Conclusions: Most concussion cases documented in this study were not on-field emergencies, as indicated by their normal clinical examinations and the lack of immediate referral to an emergency department. However, certain aspects of the clinical examination were often not assessed during the initial evaluation. These findings describe concussion assessment and recovery in adolescents and reinforce the need for a standardized approach to concussion assessment and appropriate documentation. [ABSTRACT FROM AUTHOR]

Concussion symptoms are important self-reported indicators of recovery. The purpose of this study was to describe the symptom burden in the first 3 weeks postconcussion and estimate the strength of relationship between symptomatology and days postconcussion. Headache was the most commonly endorsed symptom during weeks 1 (71.1%), 2 (37.6%), and 3 (32.6%). Severity scores were negatively correlated with days postconcussion, p <.01. While headache is commonly reported following a concussion, and decreases with time, it was still endorsed 3 weeks postinjury. Clinicians should be aware that lingering symptoms may suggest a prolonged recovery that requires an active treatment approach. [ABSTRACT FROM AUTHOR]

Sport-related concussion is a significant injury sustained by athletes and physically active individuals. The traditional management of concussion has been through the use of cognitive, balance, and symptom assessments following injury and throughout recovery. A recent emphasis on whole-person health care that includes psychological and mental health aspects has begun to be studied in patients following concussion. The current study aimed to outline existing evidence regarding concussion and mental health to offer health care providers the best evidence recommendations for clinical practice. An overview of these findings, examples of outcome measures, and specific recommendations for clinical practice are discussed. [ABSTRACT FROM AUTHOR]

Background: Concussions present significant public health concerns and associated medical costs, especially for those with persisting concussion symptoms. Purpose: To compare direct costs of care for adolescent patients managed within the secondary school setting with and without persisting concussion symptoms. Methods: Our study was a retrospective analysis of medical records using the Athletic Training Practice-Based Research Network which included records from 59 secondary schools in the United States. Participants included 282 adolescent patients following a concussion (male=199, female=83, age=15.5 years, 95% CI:15.3, 15.6). Complete patient cases were identified using International Classification of Diseases and Related Health Problems diagnostic codes for concussion between 2010-2017. We calculated summary statistics for common services and direct costs of care, calculated based on reimbursement rates for Current Procedural Terminology codes. Patients were grouped as with (symptoms experienced 28 days; n=38) and without (symptoms experienced <28 days; n=238) persisting concussion-related symptoms. A Mann-Whitney U test was used to determine if direct cost of care differed between groups (n=276, α=0.05). We used a linear regression to determine cost for each additional day of care. Results: The most common service was an athletic trainer re-evaluation (n=1012/1560, 64.9%). The average total direct costs of care was US $286.30 per adolescent patient (95% CI: US $260.14-312.45). Significantly higher direct costs of care were reported for patients with persisting symptoms (p <0.001; persisting: median=US $471.07, IQR=US $281.21-564.93, 95% CI: US $367.05-528.11; without persisting: median=US $210.95; IQR=US $117.45-337.52, 95% CI: US $234.28-286.82). The concussion base price was US $174.42 (95%CI: US $129.75-219.10) and each additional day cost US $5.99 (95% CI: $3.99-7.99). Conclusions: Our findings provide insight to potential costs associated with adolescent patients who are managed within the secondary school setting following a concussion. These results highlight the potential economic value of sports medicine professionals within the school setting. Other health care professionals not in the school setting may advise patients to first be evaluated and managed by the site athletic trainer if able and in accordance with state law, prior to an office visit to also reduce care costs as many athletic trainers do not charge for their services. Future research should examine how to decrease the economic burden for patients. [ABSTRACT FROM AUTHOR]

Aim or Objective: The aim of this study is to consolidate studies of physiological measures following sport-related concussion (SRC) to determine if a time course of postinjury altered neurobiology can be outlined. This biological time course was considered with respect to clinically relevant outcomes such as vulnerability to repeat injury and safe timing of return to physical contact risk.Design: Systematic review.Data Sources: PubMed, CINAHL, Cochrane Central, PsychINFO.Eligibility Criteria For Selecting Studies: Studies were included if they reported original research on physiological or neurobiological changes after SRC. Excluded were cases series <5 subjects, reviews, meta-analyses, editorials, animal research and research not pertaining to SRC.Results: A total of 5834 articles were identified, of which 80 were included for full-text data extraction and review. Relatively few longitudinal studies exist that follow both physiological dysfunction and clinical measures to recovery.Summary/conclusions: Modalities of measuring physiological change after SRC were categorised into the following: functional MRI, diffusion tensor imaging, magnetic resonance spectroscopy, cerebral blood flow, electrophysiology, heart rate, exercise, fluid biomarkers and transcranial magnetic stimulation. Due to differences in modalities, time course, study design and outcomes, it is not possible to define a single 'physiological time window' for SRC recovery. Multiple studies suggest physiological dysfunction may outlast current clinical measures of recovery, supporting a buffer zone of gradually increasing activity before full contact risk. Future studies need to use generalisable populations, longitudinal designs following to physiological and clinical recovery and careful correlation of neurobiological modalities with clinical measures. [ABSTRACT FROM AUTHOR]

Objective: To systematically review the literature regarding rest and return to activity after sport-related concussion. Data Sources: The search was conducted in the Cochrane Central Register of Controlled Trials, CINAHL, SPORTDiscus, Educational Resources Information Center, Ovid MEDLINE, and PubMed using terms related to concussion, mild traumatic brain injury, physical and cognitive rest, and return to activity. Study Selection: Studies were included if they were published in English; were original research; and evaluated the use of, compliance with, or effectiveness of physical or cognitive rest or provided empirical evidence supporting the graded return-to-activity progression. Data Extraction: The study design, patient or participant sample, interventions used, outcome measures, main results, and conclusions were extracted, as appropriate, from each article. Data Synthesis: Articles were categorized into groups based on their ability to address one of the primary clinical questions of interest: use of rest, rest effectiveness, compliance with recommendations, or outcome after graded return-toactivity progression. A qualitative synthesis of the results was provided, along with summary tables. Conclusions: Our main findings suggest that rest is underused by health care providers, recommendations for rest are broad and not specific to individual patients, an initial period of moderate physical and cognitive rest (eg, limited physical activity and light mental activity) may improve outcomes during the acute postinjury phase, significant variability in the use of assessment tools and compliance with recommended return-toactivity guidelines exists, and additional research is needed to empirically evaluate the effectiveness of graded return-to-activity progressions. Furthermore, there is a significant need to translate knowledge of best practices in concussion management to primary care providers. [ABSTRACT FROM AUTHOR]

The article discusses research being done on evidence-based studies which examined concussions in athletes. It references the study "The Effects of Rest and Treatment Following Sport-Related Concussion: A Systematic Review of the Literature," by K. J. Schneider et al. in the 2013 issue of the "British Journal of Sports Medicine." The factors considered include criteria used in study selection, data extraction and final article selection.

Background: Little is known about the relationship between post-concussion impairments and health-related quality-of-life (HRQoL). The primary purpose of this study was to determine the relationship between traditional concussion assessments and HRQoL in adolescent athletes post-concussion. The secondary purpose was to determine the association between HRQoL deficits and time lost. Methods: In total, 1134 athletes completed a baseline assessment battery. HRQoL measures included the Pediatric Quality of Life Inventory (PedsQL), Multidimensional Fatigue Scale (MFS) and Headache Impact Test-6. In total, 122 athletes sustained a concussion and underwent follow-up testing at 3 and 10 days post-injury. Results: The strongest relationships were between symptom severity and HRQoL. For concurrent regression analyses at Day 3, PedsQL-Physical accounted for 17.9% of the variance in time lost beyond that accounted for by traditional measures. At Day 10, PedsQL-School accounted for 15.2% and symptom severity for 7.1% of this variance. In predictive analyses, at Day 3, PedsQL-Physical accounted for 3.9% and MFS-General for 3.3% of the variance in time lost beyond that accounted for by traditional measures. At Day 10, MFS-Cognitive accounted for 12.0% of this variance. Conclusions: HRQoL appears to play a role in time lost post-concussion and should be measured in combination with traditional concussion assessments. [ABSTRACT FROM PUBLISHER]

Concussions resulting from sports and recreational activities are a significant concern in the pediatric population. The number of children and adolescents sustaining sport-related concussions is increasing and, as a result, legislation has been passed in all 50 states to ensure appropriate recognition and referral of pediatric athletes following concussion. The developing brain may make the diagnosis, assessment, and management of concussion more challenging for health care providers and requires the use of specific age-appropriate assessment tools. Concussion management must also include considerations for cognitive and physical rest, a collaborative concussion management team that includes medical and school personnel, and more conservative stepwise progressions for returning to school and to physical activity. [ABSTRACT FROM AUTHOR]

Primary objective: To review relevant literature regarding the effect of concussion on vestibular function, impairments, assessments and management strategies. Reasoning: Dizziness and balance impairments are common following sport-related concussion. Recommendations regarding the management of sport-related concussion suggest including tests of balance within the multifactorial assessment paradigm for concussive injuries. Analysis: The literature was searched for guidelines and original studies related to vestibular impairments following concussion, oculomotor and balance assessments and treatment or rehabilitation of vestibular impairments. The databases searched included Medline, CINAHL, Sport Discus and the Cochrane Database of Systematic Reviews through October 2013. Main outcomes and results: Dizziness following concussion occurs in ∼67-77% of cases and has been implicated as a risk factor for a prolonged recovery. Balance impairments also occur after concussion and last 3-10 days post-injury. Assessments of balance can be done using both clinical and instrumented measures with success. Vestibular rehabilitation has been shown to improve outcomes in patients with vestibular impairments, with one study demonstrating success in decreasing symptoms and increasing function following concussion. Conclusions: Best practices suggest that the assessment of vestibular function through cranial nerve, oculomotor and balance assessments are an important aspect of concussion management. Future studies should evaluate the effectiveness of vestibular rehabilitation for improving patient outcomes. [ABSTRACT FROM AUTHOR]

Background: To improve and standardize the sideline evaluation of sports-related concussion, the Sport Concussion Assessment Tool 2 (SCAT2) was developed. This tool assesses concussion-related signs and symptoms, cognition, balance, and coordination. This newly published assessment tool has not established representative baseline data on adolescent athletes.Hypothesis: Representative baseline SCAT2 scores in adolescent athletes will differ by gender, grade in school, and self-reported concussion history.Study Design: Descriptive epidemiology study.Methods: Interscholastic athletes were administered the SCAT2 during a preseason concussion baseline testing session. The SCAT2 total score ranges from 0 to 100 points, with lower scores indicating poorer performance. Overall, representative values were calculated using descriptive statistics. Separate independent-samples t tests, with gender and concussion history as the independent variables, and a 1-way analysis of variance, with grade as the independent variable, were conducted to assess differences in SCAT2 total score (P < .05).Results: There were 1134 high school athletes (872 male and 262 female) who participated. The SCAT2 total score across all participants was 88.3 ± 6.8 (range, 58-100); skewness was −0.86 ± 0.07, and kurtosis was 0.73 ± 0.14. Male athletes scored significantly lower on the SCAT2 total score (P = .03; 87.7 ± 6.8 vs 88.7 ± 6.8), and 9th graders (86.9 ± 6.8) scored significantly lower than 11th (88.7 ± 7.0) and 12th (89.0 ± 6.6) graders (P < .001). Athletes with a self-reported concussion history scored significantly lower on the SCAT2 total score than those with no concussion history (P < .001; 87.0 ± 6.8 vs 88.7 ± 6.5).Conclusion: These data provide representative scores on the SCAT2 in adolescent athletes and show that male athletes, 9th graders, and those with a self-reported concussion history scored significantly lower than their female, upperclassmen, or nonconcussed peers.Clinical Relevance: These results suggest that healthy adolescent athletes display variability on the SCAT2 at baseline. Therefore, clinicians should administer baseline assessments of the SCAT2 because assuming a perfect baseline score of 100 points is not appropriate in an adolescent athlete population. [ABSTRACT FROM PUBLISHER]

Abstract: There is a discrepancy between males and females in regards to lower extremity injury rates, particularly at the knee []. Gender differences in neuromuscular recruitment characteristics of the muscles that stabilize the knee are often implicated as a factor in this discrepancy. There is considerable research in the area of gender differences in regards to neuromuscular characteristics of the lower extremity in response to perturbation; however, most studies have been performed on the adult population only. Additionally, there is no consensus as to the gender differences that have been demonstrated. The purpose of this study was to compare muscular preactivation of selected lower extremity muscles (vastus medialis, rectus femoris, and medial/lateral hamstrings) in adolescent female basketball athletes, male basketball athletes, and female non-athletes in response to a drop landing. Subjects in the female non-athlete group recruited rectus femoris significantly slower than both the female athlete and male athlete groups (619.9=588.5>200.1ms prior to ground contact). The female non-athlete group also demonstrated a significantly slower vastus medialis compared to the female athlete group (127.1 vs 408.1ms), but not significantly slower than the male athlete group (127.1 vs 275.7ms). There were no differences between female athletes and male athletes for time to initial contraction of any muscle groups. No differences were found among the groups for medial or lateral hamstring activation. This study demonstrates that physical conditioning due to basketball participation appears to affect neuromuscular recruitment in adolescents and reveals a necessity to find alternate methods of training the hamstrings for improved neuromuscular capabilities to prevent injury. [Copyright &y& Elsevier]

The article aims to evaluate the concussion history of young athletes using three questions on the questions on the pre-participation screening (PPS) and a concussion symptom survey (CSS). Results show that there was little agreement among the three PPS questions, with kappa coefficients. The study concludes that identification of concussion history may depend on the phrasing of questions on the PPS. Detailed discussion of the results and information on the study's design, setting, participants, interventions and main outcome measures are provided.

Context: Establishing psychometric and measurement properties of concussion assessments is important before these assessments are used by clinicians. To date, data have been limited regarding these issues with respect to neurocognitive and postural stability testing, especially in a younger athletic population. Objective: To determine the test-retest reliability and reliable change indices of concussion assessments in athletes participating in youth sports. A secondary objective was to determine the relationship between the Standardized Assessment of Concussion (SAC) and neuropsychological assessments in young athletes. Design: We used a repeated-measures design to evaluate the test-retest reliability of the concussion assessments in young athletes. Correlations were calculated to determine the relationship between the measures. All subjects underwent 2 test sessions 60 days apart. Setting: Sports medicine laboratory and school or home environment. Patients or Other Participants: Fifty healthy young athletes between the ages of 9 and 14 years. Main Outcome Measure(s): Scores from the SAC, Balance Error Scoring System, Buschke Selective Reminding Test, Trail Making Test B, and Coding and Symbol Search subsets of the Wechsler Intelligence Scale for Children were used in the analysis. Results: Our test-retest indices for each of the 6 scores were poor to good, ranging from r = .46 to .83. Good reliability was found for the Coding and Symbol Search tests. The reliable change scores provided a way of determining a meaningful change in score for each assessment. We found a weak relationship (r < .36) between the SAC and each of the neuropsychological assessments; however, stronger relationships (r > .70) were found between certain neuropsychological measures. Conclusions: We found moderate test-retest reliability on the cognitive tests that assessed attention, concentration, and visual processing and the Balance Error Scoring System. Our results demonstrated only a weak relationship between performance on the SAC and the selected neuropsychological tests, so it is likely that these tests assess somewhat different areas of cognitive function. Our correlational findings provide more evidence for using the SAC along with a more complex neuropsychological assessment battery in the evaluation of concussion in young athletes. [ABSTRACT FROM AUTHOR]

Reference/Citation: Koh JO, Cassidy JD, Watkinson EJ. Incidence of concussion in contact sports: a systematic review of the evidence. Brain Inj. 2003;17:901-917. Clinical Question: What is the incidence of concussion in various contact sports? Data Sources: Studies for the review were found through a MEDLINE search (1985-2000) and by gathering and reviewing older articles referenced in the searched articles. The main terms that were included in the search were brain injuries, brain concussion, and incidence. Text words that were also included were mild traumatic brain injury, concussion, incidence, injury, and head injury, along with the names of 8 contact sports (American football, boxing, ice hockey, judo, karate, tae kwon do, rugby, and soccer). Study Selection: For this review, concussion was defined as "a mild brain injury resulting from a direct blow to the head resulting in physiological changes in brain function." Cohort studies with documented incidence of concussion in athletes from 8 identified contact sports were the target of the search. All studies of male and female athletes in any of the 8 contact sports, including practices and games and regardless of level of competition, were included in the study search. Possible articles for review were identified through a 3-step screening process. Article titles were initially screened by one of the authors. If the title seemed to be relevant to the purpose of the review, the abstract of the article was then screened for inclusion/exclusion criteria as the second step. To be included, studies had to relate to the incidence of injury to the head and brain, report results relevant to concussion, involve 1 of the 8 identified contact sports, and be published between 1985 and 2000. All systematic reviews about mild traumatic brain injury (TBI) or concussion were also included. Studies were excluded if they discussed concussion due to whiplash injury or concussion associated with spinal cord injury, facial bone fracture, or soft tissue injuries; if they reported prevalence, rather than incidence, of concussion; if they addressed chronic TBI; if they comprised case reports or letters to the editor; or if they lacked a denominator to determine risk rates. Finally, relevant and unknown articles from the abstract screening were reviewed again for the inclusion and exclusion criteria by an independent, outside party. Data Extraction: A general methodologic criteria design was used to critically appraise all articles that met the inclusion and exclusion criteria. This design appraised 11 study design and reporting criteria. In order for an article to be accepted into the systematic review, it had to meet at least the 5 mandatory criteria: description of the source population, appropriate description of inclusion and exclusion criteria, verifiable results from the raw data, differentiation of the incidence of injury between practice and game settings, and adequately measured denominator of population or person-time at risk. For each individual study, the 5 mandatory criteria listed above were rated with regard to whether they were included or addressed in the paper (yes), were missing from the paper (no), or were included but not described fully or in a way characterized by sound quality (substandard ). If any of the 5 mandatory criteria were rated no, the article was not evaluated any further. Data taken from these articles included sex, types of sessions in which concussion occurred, and numbers defining incidence of concussion within a contact sport. In some studies, rates were recalculated from the raw data in order to check accuracy, or if they were not presented in the published material, rates were calculated. These rates were recalculated with the denominator presented in the original study, athletes at risk for injury or time at risk for injury.… [ABSTRACT FROM AUTHOR]

Provides information on the management of sport-related concussion recommended for certified athletic trainers (ATC), physicians and other medical professionals caring for athletes as detailed under the position statement of the National Athletic Trainers' Association of the U.S. Factors that attributed to the decrease in number of incidence of fatalities and nonfatal catastrophic injuries among high school and collegiate football players between 1976 and 1980 in the country; Mechanisms and presentation of traumatic brain injury; Action that should be taken by ATC to detect deteriorating signs and symptoms that may indicate a more serious head injury.