title: Retirement-from-sport considerations following pediatric sports-related concussion: case illustrations and institutional approach.
abstract: The decision to advise an athlete to retire from sports following sports-related concussion (SRC) remains a persistent challenge for physicians. In the absence of strong empirical evidence to support recommendations, clinical decision making must be individualized and should involve a multidisciplinary team of experts in concussion and traumatic brain injury. Although previous authors have advocated for a more conservative approach to these issues in child and adolescent athletes, there are few reports outlining considerations for this process among this unique population. Here, the authors use multiple case illustrations to discuss 3 subgroups of clinical considerations for sports retirement among pediatric SRC patients including the following: those with structural brain abnormalities identified on neuroimaging, those presenting with focal neurological deficits and abnormalities on physical examination, and those in whom the cumulative or prolonged effects of concussion are suspected or demonstrated. The authors' evolving multidisciplinary institutional approach to return-to-play and retirement decision making in pediatric SRC is also presented.
authors.affiliation: Departments of 1 Surgery.|Pediatrics and Child Health.|Section of Neurosurgery, University of Manitoba;|Pan Am Concussion Program;|Children's Hospital Research Institute of Manitoba;|Canada North Concussion Network, Winnipeg, Manitoba;
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Ellis
authors.affiliation: Children's Hospital Research Institute of Manitoba;|Canada North Concussion Network, Winnipeg, Manitoba;|Division of Neurosurgery, British Columbia Children's Hospital; and.|University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: McDonald
authors.affiliation: Pan Am Concussion Program;|Canada North Concussion Network, Winnipeg, Manitoba;
authors.forename: Dean
authors.initials: D
authors.lastname: Cordingley
authors.affiliation: Neurology and Neuro-ophthalmology, and.|Pan Am Concussion Program;|Canada North Concussion Network, Winnipeg, Manitoba;
authors.forename: Behzad
authors.initials: B
authors.lastname: Mansouri
authors.affiliation: Diagnostic Radiology.|Pan Am Concussion Program;|Canada North Concussion Network, Winnipeg, Manitoba;
authors.forename: Marco
authors.initials: M
authors.lastname: Essig
authors.affiliation: Clinical Health Psychology, and.|Pan Am Concussion Program;|Canada North Concussion Network, Winnipeg, Manitoba;
authors.forename: Lesley
authors.initials: L
authors.lastname: Ritchie
mesh_terms: D000293:Adolescent; D001265:Athletic Injuries / Q000453:epidemiology*; D001924:Brain Concussion / Q000175:diagnosis* / Q000503:physiopathology; D003657:Decision Making / Q000502:physiology*; D006801:Humans; D059906:Neuroimaging / Q000379:methods; D012179:Retirement; D013177:Sports
keywords: CTE = chronic traumatic encephalopathy; PCS = postconcussion syndrome; RTP = return to play; SCI = spinal cord injury; SCIWORA = SCI without radiographic abnormality; SRC = sports-related concussion; TBI = traumatic brain injury; concussion; neuroimaging; neuropsychology; retirement; return to play; traumatic brain injury