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Concussion grading systems are sets of criteria used in
sports medicine Sports medicine is a branch of medicine that deals with physical fitness and the treatment and prevention of injuries related to sports and exercise. Although most sports teams have employed team physicians for many years, it is only since the ...
to determine the severity, or grade, of a
concussion A concussion, also known as a mild traumatic brain injury (mTBI), is a head injury that temporarily affects brain functioning. Symptoms may include headache, dizziness, difficulty with thinking and concentration, sleep disturbances, a brief ...
, the mildest form of
traumatic brain injury A traumatic brain injury (TBI), also known as an intracranial injury, is an injury to the brain caused by an external force. TBI can be classified based on severity ranging from mild traumatic brain injury (mTBI/concussion) to severe traumati ...
. At least 16 such systems exist, and there is little agreement among professionals about which is the best to use. Several of the systems use
loss of consciousness Unconsciousness is a state in which a living individual exhibits a complete, or near-complete, inability to maintain an awareness of self and environment or to respond to any human or environmental stimulus. Unconsciousness may occur as the re ...
and
amnesia Amnesia is a deficit in memory caused by brain damage or brain diseases,Gazzaniga, M., Ivry, R., & Mangun, G. (2009) Cognitive Neuroscience: The biology of the mind. New York: W.W. Norton & Company. but it can also be temporarily caused by t ...
as the primary determinants of the severity of the concussion.


Uses

The systems are widely used to determine when it is safe to allow an athlete to return to competition. Concern exists that multiple concussions received in a short time may present an added danger, since an initial concussion may leave the brain in a vulnerable state for a time. Injured athletes are prohibited from returning to play before they are symptom-free during rest and exertion and their
neuropsychological test Neuropsychological tests are specifically designed tasks that are used to measure a psychological function known to be linked to a particular brain structure or pathway. Tests are used for cognitive neuropsychology, research into brain function a ...
s are normal again, in order to avoid a risk of cumulative effects such as decline in mental function and second-impact syndrome, which may occur on very rare occasions after a concussion that occurs before the symptoms from another concussion have resolved. It is estimated that over 40% of high school athletes return to action prematurely and over 40,000 youth concussions occur annually. Concussions account for nearly 10% of sport injuries, and are the second leading cause of brain injury for young people ages 15–24.


Particular systems

Three grading systems are followed most widely: the first by neurosurgeon Robert Cantu, another by the Colorado Medical Society, and a third by the
American Academy of Neurology The American Academy of Neurology (AAN) is a professional society representing over 40,000 neurologists and neuroscientists. As a medical specialty society it was established in 1948 by A.B. Baker of the University of Minnesota to advance the a ...
.


Cantu system

The Cantu system has become somewhat outdated. *Grade I Grade one concussions come with no loss of consciousness and less than 30 minutes of
post-traumatic amnesia Post-traumatic amnesia (PTA) is a state of mental confusion, confusion that occurs immediately following a traumatic brain injury (TBI) in which the injured person is Orientation (mental), disoriented and unable to remember events that occur after ...
. *Grade II Grade two concussion patients lose consciousness for less than five minutes or have amnesia for between 30 minutes and 24 hours. *Grade III People with grade three concussions have a loss of consciousness lasting longer than five minutes or amnesia lasts for 24 hours.


Glasgow Coma Scale

Originally developed by Teasdale and Jennett in 1974, the Glasgow Coma Scale (GCS) is a scoring scale for eye opening, motor, and verbal responses that can be administered to athletes on the field to objectively measure their level of consciousness. A score is assigned to each response type for a combined total score of 3 to 15 (with 15 being normal). An initial score of less than 5 is associated with an 80 percent chance of a lasting vegetative state or death. An initial score of greater than 11 is associated with a 90 percent chance of complete recovery. Because most concussed individuals score 14 or 15 on the 15-point scale, its primary use in evaluating individuals for sports-related concussions is to rule out more severe brain injury and to help determine which athletes need immediate medical attention.


Colorado Medical Society guidelines

The guidelines developed by the Colorado Medical Society were published in 1991 in response to the death of a high school athlete due to what was thought to be second-impact syndrome. According to the guidelines, a grade I concussion consists of
confusion In psychology, confusion is the quality or emotional state of being bewildered or unclear. The term "acute mental confusion"
only, grade II includes confusion and
post-traumatic amnesia Post-traumatic amnesia (PTA) is a state of mental confusion, confusion that occurs immediately following a traumatic brain injury (TBI) in which the injured person is Orientation (mental), disoriented and unable to remember events that occur after ...
, and grade III and IV involve a
loss of consciousness Unconsciousness is a state in which a living individual exhibits a complete, or near-complete, inability to maintain an awareness of self and environment or to respond to any human or environmental stimulus. Unconsciousness may occur as the re ...
. By these guidelines, an athlete who has suffered a concussion may return to sports after having been free of symptoms, both at rest and during exercise, as shown in the following table:


American Academy of Neurology guidelines

The guidelines devised in 1997 by the
American Academy of Neurology The American Academy of Neurology (AAN) is a professional society representing over 40,000 neurologists and neuroscientists. As a medical specialty society it was established in 1948 by A.B. Baker of the University of Minnesota to advance the a ...
(AAN) were based on those formulated by the Colorado Medical Society. However, in 2013 the AAN published a revised set of guidelines that moved away from concussion grading, emphasizing more detailed neurological assessment prior to return to play. The guidelines emphasized that younger patients should be managed more conservatively and that risk of recurrent concussion was highest within 10 days following the initial injury. Risk of concussion was also stratified by sport, training time, and player
Body Mass Index Body mass index (BMI) is a value derived from the mass (Mass versus weight, weight) and height of a person. The BMI is defined as the human body weight, body mass divided by the square (algebra), square of the human height, body height, and is ...
. The guideline also called into question the existence of the " second impact syndrome", proposing instead that athletes with a previous concussion may be more vulnerable to severe injury due to decreased reaction time and coordination, symptoms of the initial injury.


See also

*
Sports injury Sports injuries occur during participation in sports or exercise in general. Globally, around 40% of individuals engage in some form of regular exercise or organized sports, with upwards of 60% of US high school students participating in one or ...
*
Head injury criterion The head injury criterion (HIC) is a measure of the likelihood of head injury arising from an impact. The HIC can be used to assess safety related to vehicles, personal protective gear, and sport equipment. Normally the variable is derived from t ...
*
Sport-related concussion Concussion, a type of mild traumatic brain injury that is caused by a direct or indirect hit to the head, body,neck, or face. Concussions can be caused by various mechanisms, is a common injury associated with sports and can affect people of al ...
*
Chronic traumatic encephalopathy Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease linked to repeated trauma to the head. The encephalopathy symptoms can include behavioral problems, mood problems, and problems with thinking. The disease often gets wor ...
*
Frontotemporal dementia Frontotemporal dementia (FTD), also called frontotemporal degeneration disease or frontotemporal neurocognitive disorder, encompasses several types of dementia involving the progressive degeneration of the brain's frontal lobe, frontal and tempor ...


References

*“Concussion Grading Scale: Brain Injury Lawyers.” Pines Salomon Injury Lawyers, APC., https://seriousaccidents.com/concussion-grading-scale/. *“Leclerc, Suzanne, et al. “Recommendations for Grading of Concussion in Athletes - Sports Medicine.” SpringerLink, Springer International Publishing, 13 Nov. 2012, https://link.springer.com/article/10.2165/00007256-200131080-00007. *NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK185341/. *Bodin, Doug, et al. “Definition and Classification of Concussion.” SpringerLink, Springer New York, 1 Jan. 1970, https://link.springer.com/chapter/10.1007/978-0-387-89545-1_2. *Concussion Grading Scale - Centennial Valley Pediatrics. https://cvpeds.com/getattachment/f88498a8-9b7c-43d9-a670-be609de9d192/Concussion-Grading-Scale.aspx.


External links


Heads Up: Concussion in Youth Sports
{{DEFAULTSORT:Concussion Grading Systems Neurotrauma Concussions