The million dollar question: When should an athlete retire after concussion?
Management of acute concussions is guided by consensus statement, and the return-to-play process begins when an athlete's symptoms and examination return to baseline. This process may be relatively clear if symptoms resolve within the normal time frame following a first or second concussion. This decision-making process is more complicated in an athlete with prolonged unresolved symptoms, multiple concussions both with and without prolonged recovery, or a structural brain injury. In these situations, determining when to retire an athlete after concussion is a complex decision, without available evidence-based guidelines. This article will discuss absolute and relative contraindications to returning an athlete to contact sport following a concussion in three separate scenarios: following potentially life-threatening brain injury, persistent clinical symptoms or signs of prolonged postconcussion syndrome, and multiple concussions but without residual symptoms or signs.
1Department of Rehabilitation Medicine, University of Washington, Seattle, WA; 2Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA; 3Department of Neurological Surgery, University of Washington, Seattle, WA; 4Seattle Seahawks, Renton, WA; and 5Seattle Mariners, Seattle, WA.
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Stanley A
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D056352:Athletes; D001265:Athletic Injuries / Q000150:complications* / Q000523:psychology; D001924:Brain Concussion / Q000150:complications* / Q000523:psychology; D003289:Convalescence; D003657:Decision Making; D006801:Humans; D009483:Neuropsychological Tests; D038223:Post-Concussion Syndrome / Q000209:etiology; D020127:Recovery of Function; D012008:Recurrence; D012179:Retirement; D013345:Subarachnoid Hemorrhage / Q000209:etiology