Published Online: March 26, 1997

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Neurologists Offer Guide on Athletes' Head Injuries

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A team of neurologists has given school athletic groups a heads-up, urging coaches to take mild concussions more seriously and conduct tests to measure the severity of the players' injuries on the field.

"There's no such thing as a 'minor' concussion," said Dr. James P. Kelly, a neurologist and the lead author of the study published this month in the American Academy of Neurology. "Repeated concussions can cause permanent damage to the brain," he said.

One-fifth of high school football players sustain a concussion each season, according to the report. Among children and adolescents, brain injury is the most common injury in winter sports such as hockey and ice skating. The report defines a concussion as a trauma-induced alteration in mental status that may or may not provoke unconsciousness.

Often, head injuries are not taken as seriously as they should be because the blow may not render an athlete unconscious and there may be no visible scars, the authors say.

In the report, which draws from three decades of research on athletic injuries, the researchers give coaches guidelines to help diagnose the seriousness of a player's condition.

The report divides concussions into three categories and suggests responses for each condition. An athlete with a grade 1 concussion would be confused, but would not lose consciousness. The disorientation would last only 15 minutes. A player with a grade 2 concussion might be confused, have short-term memory loss, or amnesia for more than 15 minutes. An athlete with a grade 3 concussion would lose consciousness.

The guidelines suggest that coaches remove players with a grade 1 concussion from the game and test them every five minutes to determine whether their disorientation has lessened. A player could return to the game if he or she was symptom-free after 15 minutes.

Students with grade 2 concussions should be taken out of the game and not be allowed to return until they've seen a physician and are asymptomatic for one week.

Athletes who sustain grade 3 concussions should be taken to an emergency room immediately, the study says.

Unprepared Coaches

Many sports and health groups, including the National Center for Health Education and the National Institute for Youth Sports Administration, have endorsed the academy's guidelines. And some school athletic associations have said the recommendations could be useful.

"It's good to have these guidelines because in some states you're liable to get somebody who knows nothing, and they're going to put [injured players] back into the ball game," said Bernie Saggau, the executive director of the Iowa High School Athletic Association, which regulates interscholastic sports in the state.

But Mr. Saggau and others are concerned that athletic coaches, many of whom are volunteers with no medical background, might feel ill prepared to make such decisions.

"When it comes to head injuries, I would want someone more qualified than a parent-coach to make medical judgments and assess a student's fitness," said Judith Young, the executive director of the Reston, Va.-based National Association for Sports and Physical Education, which represents 20,000 physical education teachers and coaches.

School sports activities would be much safer if all schools had athletic trainers to make these kinds of decisions, she said.

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