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November 27, 1991, Vol 266, No. 20 >
ARTICLE | November 27, 1991

Concussion in Sports: Title and subTitle BreakGuidelines for the Prevention of Catastrophic Outcome FREE

James P. Kelly, MD; John S. Nichols, MD, PhD; Christopher M. Filley, MD; Kevin O. Lillehei, MD; David Rubinstein, MD; B. K. Kleinschmidt-DeMasters, MD
[+] Author Affiliations

Reprint requests to Department of Neurology, University of Colorado Health Sciences Center, Box B-183, 4200 E Ninth Ave, Denver, CO 80262 (Dr Kelly).


JAMA. 1991;266(20):2867-2869. doi:10.1001/jama.1991.03470200079039
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References

Concussion (defined as a traumatically induced alteration in mental status, not necessarily with loss of consciousness) is a common form of sports-related injury too often dismissed as trivial by physicians, athletic trainers, coaches, sports reporters, and athletes themselves. While head injuries can occur in virtually any form of athletic activity, they occur most frequently in contact sports, such as football, boxing, and martial arts competition, or from high-velocity collisions or falls in basketball, soccer, and ice hockey. The pathophysiology of concussion is less well understood than that of severe head injury, and it has received less attention as a result. We describe a high school football player who died of diffuse brain swelling after repeated concussions without loss of consciousness. Guidelines have been developed to reduce the risk of such serious catastrophic outcomes after concussion in sports.

(JAMA. 1991;266:2867-2869)

REFERENCES

1 +
Goldstein M.  Traumatic brain injury: a silent epidemic. Ann Neurol . 1990;;27:327.
2 +
Cantu RC.  When to return to contact sports after a cerebral concussion. Sports Med Digest . 1988;;10:1-2.
3 +
Torg JS, Vegso JJ, Sennett B, Das M.  The national football head and neck injury registry: 14-year report on cervical quadriplegia, 1971 through 1984. JAMA . 1985;;254:3439-3443.
4 +
Gerberich SG, Priest JD, Boen JR, Straub CP, Maxwell RE.  Concussion incidences and severity in secondary school varsity football players. Am J Public Health . 1983;;73:1370-1375.
5 +
Jordan BD, Zimmerman RD.  Computed tomography and magnetic resonance imaging comparisons in boxers. JAMA . 1990;;263:1670-1674.
6 +
Unterharnscheidt F.  About boxing: review of historical and medical aspects. Tex Rep Biol Med . 1970;;28:421-495.
7 +
Gronwall D, Wrightson P.  Cumulative effect of concussion. Lancet . 1975;;2:995-997.
8 +
McQuillen JB, McQuillen EN, Morrow P.  Trauma, sports, and malignant cerebral edema. Am J Forensic Med Pathol . 1988;;9:12-15.
9 +
Saunders RL, Harbaugh RE.  The second impact in catastrophic contact-sports head trauma. JAMA . 1984;;252:538-539.
10 +
Colorado Medical Society. Report of the Sports Medicine Committee: Guidelines for the Management of Concussion in Sports (revised) . Denver: Colorado Medical Society; 1991;.
11 +
Bruce DA, Alavi A, Bilaniuk L, Dolinskas C, Obrist W, Uzzell B.  Diffuse cerebral swelling following head injuries in children: the syndrome of 'malignant brain edema.' J Neurosurg . 1981;;54:170-178.
12 +
Fekete JF.  Severe brain injury and death following minor hockey accidents: the effectiveness of the 'safety helmets' of amateur hockey players. Can Med Assoc J . 1968;;99:1234-1239.
13 +
Moody RA, Ruamsuke S, Mullan SF.  An evaluation of decompression in experimental head injury. J Neurosurg . 1968;;29:586-590.
14 +
Langfitt TW, Weinstein JD, Kassell NF.  Cerebral vasomotor paralysis produced by intracranial hypertension. Neurology . 1965;;15:622-641.
15 +
Fishman RA.  Brain edema . N Engl J Med . 1975;;293:706-711.
16 +
Gentry LR, Godersky JC, Thompson B, Dunn VD.  Prospective comparative study of intermediate-field MR and CT in the evaluation of closed head trauma. Am J Neuroradiol . 1988;;150:673-682.
17 +
Levin HS, Amparo EG, Eisenberg HM, et al.  Magnetic resonance imaging and computerized tomography in relation to the neurobehavioral sequelae of mild and moderate head injuries. J Neurosurg . 1987;;66:706-713.
18 +
Jenkins A, Teasdale G, Hadley MDM, Mac-Phearson P, Rowan JO.  Brain lesions detected by magnetic resonance imaging in mild and severe head injuries. Lancet . 1986;;2:445-446.
19 +
Levi L, Guilburd JN, Lemberger A, Soustiel JF, Feinsod M.  Diffuse axonal injury: analysis of 100 patients with radiological signs. Neurosurgery . 1990;;27:429-432.
20 +
Geisler FH, Greenberg J.  Management of the acute head-injury patient.  In: Salcman M, ed. Neurologic Emergencies . 2nd ed. New York, NY: Raven Press; 1990;:135-165.
21 +
 Report of the Ad Hoc Committee to Study Head Injury Nomenclature: Proceedings of the Congress of Neurological Surgeons in 1964. Clin Neurosurg . 1966;;12:386-394.
22 +
Fisher CM.  Concussion amnesia. Neurology . 1966;;16:826-830.
23 +
Ommaya AK, Gennarelli TA.  Cerebral concussion and traumatic unconsciousness: correlation of experimental and clinical observations on blunt head injuries. Brain . 1974;;97:633-654.
24 +
Povlishock JT, Kontos HA.  Continuing axonal and vascular change following experimental brain trauma. J Cent Nerv Syst Trauma . 1985;;2:285-298.
25 +
Yarnell PR, Lynch S.  Retrograde memory immediately after concussion. Lancet . 1970;;1:863-864.
26 +
Cantu RC.  Guidelines for return to contact sports after a cerebral concussion. Physician Sports Med . 1986;;14:75-83.
27 +
Nelson WE, Jane JA, Gieck JH.  Minor head injury in sport: a new system of classification and management. Physician Sports Med . 1984;;12:103-107.
28 +
Wilberger JE, Maroon JC.  Head injuries in athletes. Clin Sports Med . 1989;;8:1-9.

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Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Goldstein M.  Traumatic brain injury: a silent epidemic. Ann Neurol . 1990;;27:327.
2 +
Cantu RC.  When to return to contact sports after a cerebral concussion. Sports Med Digest . 1988;;10:1-2.
3 +
Torg JS, Vegso JJ, Sennett B, Das M.  The national football head and neck injury registry: 14-year report on cervical quadriplegia, 1971 through 1984. JAMA . 1985;;254:3439-3443.
4 +
Gerberich SG, Priest JD, Boen JR, Straub CP, Maxwell RE.  Concussion incidences and severity in secondary school varsity football players. Am J Public Health . 1983;;73:1370-1375.
5 +
Jordan BD, Zimmerman RD.  Computed tomography and magnetic resonance imaging comparisons in boxers. JAMA . 1990;;263:1670-1674.
6 +
Unterharnscheidt F.  About boxing: review of historical and medical aspects. Tex Rep Biol Med . 1970;;28:421-495.
7 +
Gronwall D, Wrightson P.  Cumulative effect of concussion. Lancet . 1975;;2:995-997.
8 +
McQuillen JB, McQuillen EN, Morrow P.  Trauma, sports, and malignant cerebral edema. Am J Forensic Med Pathol . 1988;;9:12-15.
9 +
Saunders RL, Harbaugh RE.  The second impact in catastrophic contact-sports head trauma. JAMA . 1984;;252:538-539.
10 +
Colorado Medical Society. Report of the Sports Medicine Committee: Guidelines for the Management of Concussion in Sports (revised) . Denver: Colorado Medical Society; 1991;.
11 +
Bruce DA, Alavi A, Bilaniuk L, Dolinskas C, Obrist W, Uzzell B.  Diffuse cerebral swelling following head injuries in children: the syndrome of 'malignant brain edema.' J Neurosurg . 1981;;54:170-178.
12 +
Fekete JF.  Severe brain injury and death following minor hockey accidents: the effectiveness of the 'safety helmets' of amateur hockey players. Can Med Assoc J . 1968;;99:1234-1239.
13 +
Moody RA, Ruamsuke S, Mullan SF.  An evaluation of decompression in experimental head injury. J Neurosurg . 1968;;29:586-590.
14 +
Langfitt TW, Weinstein JD, Kassell NF.  Cerebral vasomotor paralysis produced by intracranial hypertension. Neurology . 1965;;15:622-641.
15 +
Fishman RA.  Brain edema . N Engl J Med . 1975;;293:706-711.
16 +
Gentry LR, Godersky JC, Thompson B, Dunn VD.  Prospective comparative study of intermediate-field MR and CT in the evaluation of closed head trauma. Am J Neuroradiol . 1988;;150:673-682.
17 +
Levin HS, Amparo EG, Eisenberg HM, et al.  Magnetic resonance imaging and computerized tomography in relation to the neurobehavioral sequelae of mild and moderate head injuries. J Neurosurg . 1987;;66:706-713.
18 +
Jenkins A, Teasdale G, Hadley MDM, Mac-Phearson P, Rowan JO.  Brain lesions detected by magnetic resonance imaging in mild and severe head injuries. Lancet . 1986;;2:445-446.
19 +
Levi L, Guilburd JN, Lemberger A, Soustiel JF, Feinsod M.  Diffuse axonal injury: analysis of 100 patients with radiological signs. Neurosurgery . 1990;;27:429-432.
20 +
Geisler FH, Greenberg J.  Management of the acute head-injury patient.  In: Salcman M, ed. Neurologic Emergencies . 2nd ed. New York, NY: Raven Press; 1990;:135-165.
21 +
 Report of the Ad Hoc Committee to Study Head Injury Nomenclature: Proceedings of the Congress of Neurological Surgeons in 1964. Clin Neurosurg . 1966;;12:386-394.
22 +
Fisher CM.  Concussion amnesia. Neurology . 1966;;16:826-830.
23 +
Ommaya AK, Gennarelli TA.  Cerebral concussion and traumatic unconsciousness: correlation of experimental and clinical observations on blunt head injuries. Brain . 1974;;97:633-654.
24 +
Povlishock JT, Kontos HA.  Continuing axonal and vascular change following experimental brain trauma. J Cent Nerv Syst Trauma . 1985;;2:285-298.
25 +
Yarnell PR, Lynch S.  Retrograde memory immediately after concussion. Lancet . 1970;;1:863-864.
26 +
Cantu RC.  Guidelines for return to contact sports after a cerebral concussion. Physician Sports Med . 1986;;14:75-83.
27 +
Nelson WE, Jane JA, Gieck JH.  Minor head injury in sport: a new system of classification and management. Physician Sports Med . 1984;;12:103-107.
28 +
Wilberger JE, Maroon JC.  Head injuries in athletes. Clin Sports Med . 1989;;8:1-9.

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