New concussion rules for athletes highlight importance of proper diagnosis

By Deborah Kotz, Globe Staff

With increased awareness about the risks of concussions, athletic coaches and trainers know that they shouldn’t allow any player who sustains one to remain on the field -- but sometimes it’s tough for them to tell. For this reason, the American Academy of Neurology issued new guidelines this week outlining a basic strategy to assess players with head injuries on the field.

It can be summed up in six words: If in doubt, sit it out.

Better to take a dizzy soccer player or linebacker with a headache out of the game after a head bash than leave him or her in if a concussion can’t be ruled out, says the academy. The group of experts urged “state and local policymakers to implement legislation and regulations to minimize the occurrence of sports-related concussion.”

That’s already been done in Massachusetts: A 2010 law requires any public schools that are part of the Massachusetts Interscholastic Athletic Association to follow certain procedures to prevent head injuries and minimize serious damage from concussions. Coaches must be trained to recognize symptoms of concussions and athletes suspected of having one are banned from play and require a doctor’s clearance before they can return to practices and games.

The neurology society recommendations, however, go a bit further. The neurologists would like state health departments to set up sports concussion registries that contain medical records from student-athletes who have been diagnosed with concussions to help physicians and researchers learn more about their impact on long-term brain function and how these injuries affect academic performance.

Instead of just evaluating a player’s symptoms such as headache, nausea, and dizziness, coaches and trainers should be trained in doing a five-minute memory and cognitive skills test that physicians typically do in their offices to evaluate patients for concussions, recommended the panel of neurologists. They may ask patients the date, where they are, what they ate for breakfast, for example.

This sort of test can pick up more subtle brain injuries that don’t cause obvious symptoms such as loss of consciousness, personality changes, or confusion.

“High schools and athletic associations should implement a tool such as the Standardized Assessment of Concussion (SAC), which is designed for use by non physicians on the sidelines of an athletic event,” state the guidelines.