Sports concussion management: a review of the evidence

Concussions, a subset of mild traumatic brain injuries (TBI), are common sports-related conditions. Public controversy has aided to the awareness of these head injuries, creating increased concern about their diagnosis and appropriate management. Recent guidelines have brought a change in the way concussions are managed.

We reviewed recent literature on recognizing and managing concussions and other mild, uncomplicated TBI. While randomized controlled studies and well-designed observational trials were preferred, due to the paucity of methodologically sound evidence, relevant systematic reviews, retrospective reviews and observational trials were also included.

Evidenced-base management of concussions, specifically with cognitive and physical rest, is sparse, and the majority of the evidence that does exist is poor. We identified several studies that may contradict the recent guidelines that full physical and cognitive rest is the most beneficial management strategy.

Recent guidelines in post-concussion management and return-to-play are valuable tools to the primary care physician. However, they have not been validated and are not the result of large scale trials showing demonstrable benefit. While the guidelines are useful tools for returning athletes to full activity following an injury, post-concussion management should be individualized based on each patient assessment, symptoms, and response to care.