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Post-Sideline Evaluation and Assessment Sport-Related Concussion

Evaluation in hospital emergency room or doctor's office typically follows sideline assessment for concussion


Once an athlete has been removed from play and the initial assessment on the sports sideline fails to rule out suspected concussion, they should be evaluated medically in the hospital emergency room or a doctor's office. (1)  
The key features of this examination should include: 
  1.  A medical assessment, including the taking of a comprehensive medical and concussion history; (1,3)
  2. A detailed neurological examination including a thorough assessment of mental status, cognitive functioning, gait and balance;
  3. A determination of the clinical status of the patient, including whether there has been improvement or deterioration since the time of injury, by seeking additional information from parents, coaches, teammates, and eyewitnesses to the injury; and
  4. A determination of the need for emergency neuroimaging (CT or MRI) in order to exclude a more severe brain injury. 
In large part, these points are included in the SCAT3 assessment (2) 

Neuropsychogical testing

The 2013 Zurich consensus statement on sport-related concussion (1) states that  "neuropsychological (NP) testing in  concussion has been shown to be of clinical value and contributes significant information in concussion evaluation."  But the authors of the Zurich statement emphasize that, while assessment of cognitive function - which largely overlaps with the time course of symptom recovery in most cases but may occasionally precede or more commonly follow symptom resolution - is an "important component in the overall assessment of concussion and, in particular any [return-to-play protocol], ... NP assessment should not be the sole basis of management decisions, [but] rather, it should be seen as as an aid to the clinical decision-making process in conjunction with a range of assessments of different clinical domains and investigational results."

1. McCrory P, et al. Concussion statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012.  Br J Sports Med 2013;47:250-258.

2. SCAT3.  Br J Sports Med 2013;47:259

3. Harmon K, et al. American Medical Society for Sports Medicine position statement: concussion in sport. Br J Sports Med 2013;47:15-26.