title: On-field management and return-to-play in sports-related concussion in children: Are children managed appropriately?
abstract: OBJECTIVE
  On-field management and return-to-play guidelines aim to ensure the identification and appropriate management of the concussed athlete. Compliance with current guidelines in many settings is unknown. We assessed whether key components of current concussion guidelines are being followed in child athletes.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Data were collected from children (5-18 years) presenting to a paediatric emergency department with sport-related concussion via researcher-administered surveys in the emergency department and during a follow up phone call. On hospital discharge all patients received a return to sports fact sheet based on the International Concussion in Sports Group.
  
  
  RESULTS
  Ninety-three had sustained a concussion (mean age 12.7 (±0.27) years, 83% male). Sports played included Australian Football (47%), soccer (12%), rugby (9%) basketball (8%), other (25%). 82% participated in organised sports. Concussive signs or symptoms included loss of consciousness (41%), disorientation (36%), vomiting (23%), amnesia (30%), headache (60%). For concussive injury in organised sports (n=76), overall 42% were not managed according to recommended guidelines: 19% were not immediately removed from play, 29% were allowed to return to play on the same day and 27% were not assessed by qualified personnel. 93% of parents and 96% of patients were unaware of concussion or return-to-play guidelines from their organisations. Overall, 72% were compliant with provided return-to-play guidelines.
  
  
  CONCLUSIONS
  Many children with sports related-concussion are not formally assessed on-field and continue to play. On-field concussion management and return to play practices are often suboptimal. Awareness and education of coaches, teachers, parents and children need to be improved.
authors.affiliation: Emergency Department, Royal Children's Hospital Melbourne, Victoria, Australia; Murdoch Childrens Research Institute, Melbourne, Victoria, Australia; Monash University, Clayton, Victoria, Australia.
authors.forename: Harini P
authors.initials: HP
authors.lastname: Haran
authors.affiliation: Emergency Department, Royal Children's Hospital Melbourne, Victoria, Australia; Murdoch Childrens Research Institute, Melbourne, Victoria, Australia; University of Padova, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Bressan
authors.affiliation: Emergency Department, Royal Children's Hospital Melbourne, Victoria, Australia; Murdoch Childrens Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia.
authors.forename: Ed
authors.initials: E
authors.lastname: Oakley
authors.affiliation: Murdoch Childrens Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia.
authors.forename: Gavin A
authors.initials: GA
authors.lastname: Davis
authors.affiliation: Murdoch Childrens Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia.
authors.forename: Vicki
authors.initials: V
authors.lastname: Anderson
authors.affiliation: Emergency Department, Royal Children's Hospital Melbourne, Victoria, Australia; Murdoch Childrens Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia. Electronic address: Franz.babl@rch.org.au.
authors.forename: Franz E
authors.initials: FE
authors.lastname: Babl
mesh_terms: D000293:Adolescent; D001265:Athletic Injuries / Q000175:diagnosis* / Q000628:therapy; D001924:Brain Concussion / Q000175:diagnosis* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D000068958:Return to Sport / Q000592:standards*; D000067009:Youth Sports / Q000293:injuries*
keywords: Child; Concussion; Head injury; Return to play; Sport; Traumatic brain injury