22 JAAPA • MAY 2007 • 20(5) • www.jaapa.com EARN CATEGORY I CME CREDIT by reading this article and the article beginning on page 42 and successfully completing the posttest on page 47. Successful completion is defined as a cumulative score of at least 70% correct. This material has been reviewed and is approved for 1 hour of clinical Category I (Preapproved) CME credit by the AAPA. The term of approval is for 1 year from the publication date of May 2007. LEARNING OBJECTIVES ● Describe the signs and symptoms of a concussion ● Know what instructions should be given regarding follow-up care and symptom monitoring ● Review the information needed when consulting with other medical professionals ● Discuss how evaluation is related to guidelines for clearing an athlete to full-participation status CME Guidelines for treatment of sport-related concussions Proper recognition, initial management, and long-term clinical decision making are important aspects of treating concussive injury and allowing for a safe return to play. Chad Martineau, PA-C, ATC; Jackie J. Kingma, MS, ATC, PA-C, PT; Laura Bank, PhD, PA-C; Tamara C. Valovich McLeod, PhD, ATC S port-related concussion is a growing concern among health care providers in all specialties. The CDC reports approximately 300,000 sport-related concus- sions each year, 1 and some research suggests that these rates may underestimate the actual number of injuries by as much as 50%. 2-4 Several definitions of concussion exist within the literature. The Committee on Head Injury Nomenclature defined concussion as a clinical syndrome characterized by immediate and transient impairment of neural functions due to brain stem involvement. 5 However, this definition is vague and does not precisely describe the mechanism, onset, or resolu- tion of a concussive injury. An evidence-based definition, proposed at the International Conference on Concussion in Sport in 2001, is more comprehensive in identifying clinical, pathologic, and biomechanical features of concussion 6 (see Table 1, page 24). Recognizing and diagnosing a concussion can be difficult for a variety of reasons. The signs and symptoms are often vague and inconsistent. Also, symptoms may not appear immediately. 7 ,8 This delayed onset may put athletes at greater risk for a more serious injury, such as second-impact syn- drome, if they are allowed to return to play too soon. Second-impact syndrome occurs when the athlete sustains a second concussive injury while still recovering from the ini- tial injury or while the athlete is still experiencing symptoms. Athletes are more susceptible to second-impact syndrome because of the inherent risk of a second injury when they return to play. This second injury can occur days or weeks following the primary concussion and can lead to acute brain © Associated Press