Dr. Waeckerle: When should you seek out a concussion clinic?

NFL Health Playbook will feature a guest columnist on Wednesdays, each with a different viewpoint of player health and safety from the youth level to pro football.

By Dr. Joseph F. Waeckerle, NFL Health Playbook columnist

Recognition of a potential concussion should lead to an immediate evaluation by the most qualified person available. Ideally, this is a health care professional with formal training and experience in the initial evaluation of the student-athlete with head trauma. Whether on the field, on the sideline, in the locker room or in the office, that person's first and foremost responsibility is to evaluate the injured individual to exclude any life-threatening injury while protecting the patient from further injury.

Student-athletes who have any of the following indicators require further evaluation by a health care provider who is experienced in assessing and treating traumatic injuries including brain and spinal injuries:

-- The injured student-athlete is not alert and oriented or able to communicate or cooperate.

-- The injured student-athlete suffers from a painful injury that is so distracting that they can't cooperate or appreciate other injuries.

-- The student-athlete demonstrates any signs or symptoms indicating brain or spinal cord injury.

-- The student-athlete has seizure activity on the field or later.

-- The student-athlete loses consciousness or displays persistent amnesia.

-- The student-athlete reports persistent or worsening symptoms/signs associated with trauma to the central nervous system, especially worsening headache, nausea/vomiting, confusion, lethargy, other alterations in level or content of consciousness or noticeable balance disturbances.

-- The student-athlete reports any new or worsening symptom associated with trauma to other bodily systems, including neck or back pain, chest/abdominal pain, cardiovascular complaints or respiratory complaints.

-- The student-athlete demonstrates any symptoms/signs indicating a perceptible change in personality or behavior that concern the family member, friend or attending health care professional.

-- There is concern that the student/athlete has taken any substance that might alter their neurological status.

A comprehensive emergency evaluation is best conducted in the emergency department by specialists who are trained, experienced and accustomed to such responsibilities.

If none of the above indicators is present, the potentially concussed or concussed student-athlete should undergo further evaluation by a health care professional trained in the evaluation and management of concussion. Health care professionals can attain special competency in concussion care through their formal educational curriculum, post-graduate programs or fellowships, and clinical practice experience.

Concussion specialists offer their services either in a practice setting or as a member of a concussion clinic. These specialists are particularly beneficial to patients with other complicating medical problems or medications, recurrent injury, a prolonged or difficult course of recovery, or concern regarding short- or long-term complications. The choice of a concussion specialist and the practice setting is determined, in part, by family preference, availability, convenience, cost and the patient's course of recovery.

Dr. Joseph F. Waeckerle is clinical professor of emergency medicine at the University of Missouri-Kansas City School of Medicine. He also is editor emeritus of Annals of Emergency Medicine. He has practiced Emergency Medicine and Sports Medicine and has been a team physician at the grade school, high school, college, and profession level for over 30 years. He currently serves on the NFL Head, Neck, and Spine Injury Committee and the Mackey White Brain Injury Committee of the NFL Players Association.

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