title: Summary of evidence-based guideline update: evaluation and management of concussion in sports [RETIRED]: report of the Guideline Development Subcommittee of the American Academy of Neurology.
abstract: To update the 1997 American Academy of Neurology (AAN) practice parameter regarding sports concussion, focusing on 4 questions: 1) What factors increase/decrease concussion risk? 2) What diagnostic tools identify those with concussion and those at increased risk for severe/prolonged early impairments, neurologic catastrophe, or chronic neurobehavioral impairment? 3) What clinical factors identify those at increased risk for severe/prolonged early postconcussion impairments, neurologic catastrophe, recurrent concussions, or chronic neurobehavioral impairment? 4) What interventions enhance recovery, reduce recurrent concussion risk, or diminish long-term sequelae? The complete guideline on which this summary is based is available as an online data supplement to this article.
  
  
  
  We systematically reviewed the literature from 1955 to June 2012 for pertinent evidence. We assessed evidence for quality and synthesized into conclusions using a modified Grading of Recommendations Assessment, Development and Evaluation process. We used a modified Delphi process to develop recommendations.
  
  
  
  Specific risk factors can increase or decrease concussion risk. Diagnostic tools to help identify individuals with concussion include graded symptom checklists, the Standardized Assessment of Concussion, neuropsychological assessments, and the Balance Error Scoring System. Ongoing clinical symptoms, concussion history, and younger age identify those at risk for postconcussion impairments. Risk factors for recurrent concussion include history of multiple concussions, particularly within 10 days after initial concussion. Risk factors for chronic neurobehavioral impairment include concussion exposure and APOE ε4 genotype. Data are insufficient to show that any intervention enhances recovery or diminishes long-term sequelae postconcussion. Practice recommendations are presented for preparticipation counseling, management of suspected concussion, and management of diagnosed concussion.
authors.affiliation: Division of Pediatric Neurology, Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Giza
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Kutcher
authors.forename: Stephen
authors.initials: S
authors.lastname: Ashwal
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Barth
authors.forename: Thomas S D
authors.initials: TS
authors.lastname: Getchius
authors.forename: Gerard A
authors.initials: GA
authors.lastname: Gioia
authors.forename: Gary S
authors.initials: GS
authors.lastname: Gronseth
authors.forename: Kevin
authors.initials: K
authors.lastname: Guskiewicz
authors.forename: Steven
authors.initials: S
authors.lastname: Mandel
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Manley
authors.forename: Douglas B
authors.initials: DB
authors.lastname: McKeag
authors.forename: David J
authors.initials: DJ
authors.lastname: Thurman
authors.forename: Ross
authors.initials: R
authors.lastname: Zafonte
mesh_terms: D000047:Academies and Institutes / Q000592:standards*; D001265:Athletic Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D001924:Brain Concussion / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D019468:Disease Management; D019317:Evidence-Based Medicine / Q000379:methods / Q000592:standards*; D006801:Humans; D009462:Neurology / Q000379:methods / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D058028:Research Report / Q000592:standards*; D014481:United States