Concussions in Sports and Recreation

In 2004, 475000 children between 0 and 14 years old sustained a traumatic brain injury, and 90% were treated and released from emergency departments (EDs). Concussions are considered one of the most pressing issues in sports medicine and are challenging to diagnose. The clinician has to rely on gross clinical symptoms and/or the athlete's willingness to admit to clinical symptoms. Computed tomography results are often negative and are therefore not helpful for determining the extent of a child's injury or his or her prognosis. Computerized neuropsychologic assessment programs have made the evaluation of athletes easier and more sensitive and are in fact considered the criterion standard for diagnosing and monitoring sports concussions. All athletes presenting to EDs with suspected concussion should be discharged with careful follow-up. Furthermore, return to play should be guided by a gradual increase in activity as recommended by the Prague conference on concussion. A young athlete should never be allowed to return to his or her sport until asymptomatic. (C) 2007 Elsevier Inc. All rights reserved.