ever, the vast majority of young athletes practice and play in circumstances where trained personnel are not routinely available to make sideline injury assessments, and the responsibility for determining whether to remove an athlete from play falls on coaches, parents, players, and, perhaps, officials. A further impediment to identification is that symptoms may not become apparent for several hours after injury, and one result of this is that a large number of concussions are not identified until 24 hours or more after the injury (Duhaime et al., 2012; McCrory et al., 2013b). The Centers for Disease Control and Prevention (CDC) Heads Up campaign is designed to educate coaches, parents, and athletes about the prevention and recognition of and response to concussions (CDC, 2012a). A central feature of the campaign is the dissemination of information about the signs and symptoms of concussion (see Table 3-1) along with the message that players suspected of having sustained a concussion should be removed from play for the remainder of the day, referred to a health care provider for evaluation, and not permitted to return to play until they have been cleared by a health professional trained in concussion diagnosis and management (CDC, 2012a).

The sideline evaluation of a player’s symptoms may be complicated by the tendency of athletes to underreport their symptoms (Anderson et al., 2013; Dziemianowicz et al., 2012; McCrea et al., 2004). A 2004 study

TABLE 3-1 Signs and Symptoms of Concussions Relevant to Sideline Assessment

    Signs Observed     Symptoms Reported by Athlete
  • Appears dazed or stunned (such as glassy eyes)
  • Is confused about assignment or position
  • Forgets an instruction or play
  • Is unsure of score or opponent
  • Moves clumsily or has poor balance
  • Answers questions slowly
  • Loses consciousness (even briefly)
  • Shows mood, behavior, or personality changes
  • Cannot recall events prior to hit or fall
  • Cannot recall events after hit or fall
  • Headache or “pressure” in head
  • Nausea or vomiting
  • Balance problems or dizziness
  • Double or blurry vision
  • Sensitivity to light or noise
  • Feeling sluggish, hazy, foggy, or groggy
  • Concentration or memory problems
  • Confusion
  • Feeling more emotional, nervous, or anxious
  • Does not “feel right” or is “feeling down”

SOURCE: Based on CDC, 2012b.

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