On-field management and
return-to-play in sports-related concussion in children: Are children managed

HP., Bressan S., Oakley E., Davis GA., Anderson V., Babl FE. Journal of Science
and Medicine in Sport. Epub ahead of print.

Take Home Message: Only
58% of concussed children were managed according to recommended guidelines and
13% returned to play while symptomatic. Additionally, 93% of parents and 96% of
players were unaware of their organization’s return-to-play guidelines
following a concussion.

percent of all sport-related head injuries presenting to emergency departments
are children ages 5 to 18 years. Children who return to play while still
recovering from a concussion have an increased risk of recurrent injury and related
complications. It remains unclear if players and parents are knowledgeable
about the general or sport-specific guidelines for concussion management as
well as if these guidelines are being deployed in youth sports. Therefore, the
authors assessed parent and player awareness of return-to-play guidelines as
well as parent and player compliance with on-field management and
return-to-play guidelines. The authors collected data from 93 children (5-18
years) who presented with a sport-related concussion at a pediatric emergency
department at the Royal Children’s Hospital Melbourne. Data were collected
between May 2013 and November 2013 and included both organized and unorganized
sports. The hospital provided all families with a return-to-sports factsheet that
outlined a graduated return-to-play protocol. The research team followed up
with the parents and players between 3 weeks and 3 months after the visit to
the emergency department. Forty-two percent of children in an organized sport
were not managed properly immediately following the concussion:
  • 19% were not removed from play
  • 27% were not assessed by qualified personnel
  • 29% were allowed to return to play on the same
  • 8% returned to play within 30 minutes
the follow-up calls, 65 out of 85 children reported experiencing
post-concussive symptoms. None of the patients followed the full return-to-play
progression. Seventy percent followed at least two steps within the step-wise
return-to-play progression. Twenty-nine percent sought medical clearance before
return to play; however, 15% returned to play while still symptomatic. Parents
reported that prior to this study 48% knew some concussion information;
however, 93% of parents and 96% of players involved in organized sport were
unaware of concussion return-to-play guidelines from their own organization.

study highlights that while many sports adopt concussion guidelines they often inadequately
implement or explain the guidelines to parents and players. This study also illustrates
alarming deficiencies in the acute management of a concussion; including, not
immediately removing the athlete from play, allowing the athlete to return to
play on the same day, and not being assessed by qualified personnel. The compliance
with return-to-play progression was also poor, while almost 75% of the players
completed some part of the return-to-play progression it is evident that only
completing 2 steps is not sufficient since 15% returned to play while still
symptomatic. These practices potentially expose children to a greater risk of
further brain injury. Sports medicine professionals should offer talks to their
local youth leagues about recognizing and managing a concussion so that
parents, coaches, and players can be better informed. These findings are
similar to a study in the United States where parents of 5-15 year-old athletes
lacked knowledge in regards to concussion definition, mechanisms, and
signs/symptoms (common content in the CDC Heads-Up; Mannings et al., 2014). Sports associations
need to improve the transfer of information about the best practice of on-field
management and return to play progression plan following a head injury.

Questions for
Discussion: How can we improve our concussion education program? Would verbal
communication or concussion workshops for parents, coaches, and players be

Written by: Jane McDevitt, PhD
by: Jeff Driban


Predicting the Persistence of Concussion-Related Impairments

Haran, H., Bressan, S., Oakley, E., Davis, G., Anderson, V., & Babl, F. (2015). On-field management and return-to-play in sports-related concussion in children: Are children managed appropriately? Journal of Science and Medicine in Sport DOI: 10.1016/j.jsams.2015.02.009