The Virginia Neurological Institute developed guidelines for the diagnosis and management of athletes who suffered a concussion after head injury.
Parameters:
(1) loss of consciousness (LOC)
(2) post-traumatic amnesia (PTA)
(3) Glasgow Coma Score (GCS)
|
Loss of Consciousness |
Post-Traumatic Amnesia |
Glasgow Coma Score |
Grade of Concussion |
|
momentary |
< 1 hour |
15 |
1 |
|
momentary |
>= 1 hour but < 24 hours |
15 |
1a |
|
< 5 minutes |
up to 24 hours |
< 15 for 5 minutes or less |
2 |
|
< 5 minutes |
not applicable |
GCS < 15 but > 12 for > 5 minutes and < = 1 hour |
3 |
|
>= 5 minutes but < 60 minutes |
not applicable |
GCS < 12 for > 5 minutes; OR GCS < 15 for > 1 hour |
4 |
where:
• The handling of an athlete with a loss of consciousness > 60 minutes or post-traumatic amnesia > 24 hours is not stated. However, the GCS probably drives grading at that point.
• The table in Polin et al does not provide for (a) GCS = 12 or (b) GCS < 12 for <= 5 minutes.
The minimum period without postconcussive symptoms before return to competition allowed:
|
Grade of Concussion |
First Injury |
Second Injury |
Third Injury |
|
Grade 1 |
minimum 1 day |
minimum 4 days |
terminate season |
|
Grade 1a |
minimum 2 days |
minimum 4 days |
terminate season |
|
Grade 2 |
minimum 4 days |
minimum 7 days |
terminate season |
|
Grade 3 |
minimum 7 days |
minimum 14 days |
terminate season |
|
Grade 4 |
minimum 14 days |
terminate season |
terminate season |
where:
• It does not appear that the grade of previous concussions is tracked, only the number and current grade.
• The grading system does not specify what to do with the athlete whose injury falls below Grade 1 (no loss of consciousness, no amnesia, GCS 15), especially for a third injury.
Specialty: Surgery, orthopedic, Neurology
