'If in doubt, sit it out,' concussion guide advises

Coaches should pull athletes with a suspected head injury immediately until a health professional trained in concussions checks them out, according to new medical guidelines.

The American Academy of Neurology updated its guidelines on Monday for evaluating and managing athletes with concussion. It’s the group's first update since 1997.

"If in doubt, sit it out," said Dr. Jeffrey Kutcher with the University of Michigan Medical School in Ann Arbor and a member of the academy, in a release.

"Being seen by a trained professional is extremely important after a concussion. If headaches or other symptoms return with the start of exercise, stop the activity and consult a doctor. You only get one brain; treat it well."

Players should return to the rink, field or pitch slowly and only after acute signs and symptoms, such as headache, sensitivity to light and sound or changes in memory and judgment, are gone.

For ice hockey, the guidelines said bodychecking is likely to increase the risk of sport-related concussion. In peewee hockey, bodychecking is likely to be a risk factor for a more severe concussion that prolongs the return to play.

Athletes of high school age or younger who are diagnosed with concussion should be managed more conservatively on returning to play than older athletes, the neurologists said.

The guidelines also include:

• Among the sports in the studies evaluated, the greatest risk of concussion for men and boys was in football and rugby followed by hockey and soccer. The risk of concussion for young women and girls was greatest in soccer and basketball.
• An athlete who has a history of one or more concussions is at greater risk for being diagnosed with another concussion.
• The first 10 days after a concussion appears to be the period of greatest risk for being diagnosed with another concussion.
• There is no clear evidence that one type of football helmet can better protect against concussion over another kind of helmet.
• Helmets should fit properly and be well maintained.

Licensed health professionals trained in treating concussion should look for ongoing symptoms (especially headache and fogginess), history of concussions and younger age in the athlete. Each of these factors has been linked to a longer recovery. The panel said there's currently insufficient evidence to support absolute rest after concussion.

The new guideline is endorsed by the National Football League Players Association, the American Football Coaches Association, the Child Neurology Society, the National Association of Emergency Medical Service Physicians, the National Academy of Neuropsychology, the National Association of School Psychologists, the National Athletic Trainers Association and the Neurocritical Care Society.

Last week, another group of brain injury experts updated their guidelines based on the latest research in sports such as boxing, skating, hockey, horseback riding, rugby, and football. Their conclusions said, among other things, that wearing helmets and mouthguards may encourage players to take greater risks.