Concussion Management

In September 2011, Texas enacted a new concussion law (HB 2038), affecting all schools within the Texas University Interscholastic League (UIL) system.  Some of the requirements of this law include the creation of a concussion oversight team for every school district, which must include at least one physician and the athletic trainer (if one is employed by the school district or charter school ), and may include other members as outlined in the law.  The law requires the concussion oversight team to establish a return to play protocol, based on peer reviewed scientific evidence. The legislation also establishes required education for coaches, athletic trainers, and licensed health care professionals (except physicians) on concussions.

While the law does not require concussion-specific CME for treating physicians who are not part of a concussion management team, the law DOES require that every student athlete suspected of having a concussion be evaluated and obtain signed consent from a treating physician prior to return to athletic activity, including practice. Treating physicians are liable for the medical services and decisions provided to student athletes in their care.

Because of this legislation and advances in concussion management in recent years, TPS is striving to improve the knowledge of primary care physicians who care for these athletes.  An excellent resource for treating physicians is the Texas UIL website, which has more information on the new concussion law and all of its requirements. This site also includes a FAQ page, which provides easy access to important facts. The CDC website is a great resource for education on the diagnosis, management, and prevention of concussions. In the coming year, the TPS Committee on Adolescence and Sports Medicine will be developing more materials and tools to help treating physicians understand this legislation, provide appropriate care for patients with concussions, and communicate effectively with coaches/trainers and other individuals involved in the treatment of these athletes.

RESOURCES

Clinical Tools:
SCAT2 (Sports Concussion Assessment Tool - Version 2): http://links.lww.com/JSM/A11
CDC Physicians Tool Kit: http://www.cdc.gov/concussion/headsup/physicians_tool_kit.html
ACE (Acute Concussion Evaluation) Physician Office Version:
http://www.cdc.gov/concussion/headsup/pdf/ACE-a.pdf
ACE Care Plan: http://www.cdc.gov/concussion/headsup/pdf/ACE_care_plan_school_versio...

Concussion Education:
CDC: http://www.preventingconcussions.org
UIL Website: http://www.uiltexas.org/health/info/concussions

Videos:
ESPN Second Impact Syndrome (Plevretes): http://espn.go.com/video/clip?id=6589399
ESPN High School Football Death: http://espn.go.com/video/clip?id=5847823
Children's Website: http://www.childrens.com/specialties/sports-medicine/for-providers/

Articles:
McCrory P, et al. Consensus Statement on Concussion in Sport, 3rd International Conference on Concussion in Sport “Zurich Guidelines”, Clin J Sport Med. 19(3):2009

Halstead M, Walter K. Sport-Related Concussion in Children and Adolescents, Pediatrics Vol. 126, No. 3 September 2010, pp. 597-615 Team Physician Consensus Statement

Herring et al, in press, Med Sci Sports Exerc http://www.amssm.org/ - Statement on Concussion in Athletes in review