Concussion Management Guidelines

Immediate Removal from Activity

The American Academy of Pediatrics recommends that any person showing signs or symptoms of concussion should be immediately removed from activity and not allowed to return until evaluated by a healthcare professional 1
The American Heart Association suggests that for severe head injury symptoms, emergency medical services should be activated immediately 1
The British Journal of Sports Medicine advises that the phrase "When in doubt, sit them out!" is paramount in concussion management, and under no circumstances should pediatric or adolescent athletes with concussion return to play the same day of their concussion 3, 4

The American Academy of Pediatrics recommends complete physical rest for the first 24-48 hours after concussion, and then a structured stepwise return to physical activity only when asymptomatic at rest 3, 4, 5, 6
The British Journal of Sports Medicine suggests that cognitive rest is essential for recovery, especially in the first 24-48 hours, and recommends limiting activities requiring concentration and attention, including reading, playing video games, using computers, viewing television, and exposure to loud music or bright lights 4
The American Academy of Pediatrics advises considering temporary accommodations for school, including temporary leave of absence, shortened school days, reduced workloads, extended time for assignments and tests, and postponement of standardized testing 4

The British Journal of Sports Medicine recommends a stepwise return to activity protocol, starting with no activity, complete rest until asymptomatic, followed by light aerobic exercise, sport-specific training, non-contact training drills, full contact training after medical clearance, and finally return to normal game play 3, 5, 6
Each step should take a minimum of 24 hours, and if any symptoms recur, the patient should drop back to the previous asymptomatic level and try to progress again after 24 hours of rest 3, 5, 6

The American Academy of Neurological Surgery advises avoiding medications except acetaminophen after injury, and only taking as recommended by a physician, and avoiding alcohol, illicit drugs, or other substances that might interfere with cognitive function and neurological recovery 7
The American Academy of Pediatrics recommends not returning to play while taking any medications for concussion symptoms 2

The American Academy of Neurological Surgery suggests that recovery may take longer in younger athletes compared to older ones, and that younger athletes should be managed more conservatively with stricter return-to-play guidelines 7
The American Academy of Pediatrics advises that parents, coaches, and school staff should be educated about the symptoms and management of concussion 4, 7

The American Heart Association identifies warning signs requiring immediate medical attention, including loss of consciousness, severe or worsening headache, repeated vomiting, altered mental status, seizures, visual changes, and swelling or deformities of the scalp 1

The American Academy of Pediatrics warns against returning to play too soon, inadequate rest, ignoring symptoms, and lack of medical evaluation, as these can worsen outcomes or prolong recovery 1, 3, 4
The American Academy of Neurological Surgery advises against underestimating recovery time, as recovery varies between individuals and may take longer in younger athletes 7

The Journal of Neurosurgery recommends monitoring for persistent symptoms beyond 10 days, which may require multidisciplinary management, and considering graded physical exercise, vestibular rehabilitation, or manual therapy of the neck and spine under professional guidance for persistent symptoms 8, 9
The American Heart Association warns that repeated concussions may lead to long-term difficulties with memory, concentration, fatigue, headache, and other neurological issues 1