Grade 1 Concussion
Definition: Transient confusion, no loss of consciousness, and concussion symptoms or mental status abnormalities on examination resolve in less than 15 minutes in time. Athletes commonly refer to this state as having their "bell rung" or been "dinged".
Management: Remove athlete from sports activity and examine immediately and at 5-minute intervals. May return to play within 15 minutes if sideline assessment at rest and with exertion is normal. A second Grade 1 in the same contest eliminates the player from competition that day and returns to play only if no symptoms for one week at rest and with activity.
Grade 2 Concussion
Definition: Transient confusion, no loss of consciousness, and concussion symptoms lasting more than 15 minutes.
Management: Remove athlete from sports activity and examine frequently to check for worsening. Do not allow athlete to return to sports activity that day. A trained person should re-examine the athlete to clear for return to play after one week of no symptoms at rest and with exertion. CT/ MRI of brain is recommended if headache/symptoms persist for more than 1 week. Any abnormality on CT/MRI consistent with swelling or bruising terminates the season for the player. If player has a second grade 2 concussion, he/she may return to play after the player has had 2 weeks of no symptoms at rest and with exertion.
Grade 3 Concussion
Definition: Loss of consciousness (LOC) brief or prolonged.
Management: Remove from sports activity and transport patient to the nearest ER by ambulance. Neurologic exam should be performed. Athlete may be admitted or sent home. Frequent neuro checks must be done for first 24 hours. A physician should examine the athlete to clear for return to play after one week of no symptoms at rest and with exertion. Follow same CT/MRI guidelines as grade 2. If brief LOC, no play until symptom free for 1 week. If prolonged LOC, no play for 2 weeks. Second Grade 3 - no play for minimum of 1 month or longer.
Reference: Practice Parameters: The Management of Concussion in Sports, Neurology, 1997; 48: pages 581-585.