of legislation and other interventions in reducing the incidence of sports-related concussions in youth.

Recommendation 1. The Centers for Disease Control and Prevention, taking account of existing surveillance systems and relevant federal data collection efforts, should establish and oversee a national surveillance system to accurately determine the incidence of sports-related concussions, including those in youth ages 5 to 21. The surveillance data collected should include, but not be limited to, demographic information (e.g., age, sex, race and ethnicity), preexisting conditions (e.g., attention deficit hyperactivity disorder, learning disabilities), concussion history (number and dates of prior concussions), the use of protective equipment and impact monitoring devices, and the qualifications of personnel making the concussion diagnosis. Data on the cause, nature, and extent of the concussive injury also should be collected, including

  • Sport or activity
  • Level of competition (e.g., recreational or competitive level)
  • Event type (e.g., practice or competition)
  • Impact location (e.g., head or body) and nature (e.g., contact with playing surface, another player, equipment)
  • Signs and symptoms consistent with a concussion


  • Research involving animals and individuals with more severe head injuries has provided a limited understanding of neurophysiological changes that take place following a concussion and of potential biomarkers of concussion. As the diagnosis of concussion is currently based primarily on symptoms, there is a major need for objective diagnostic markers of concussion as well as for objective markers of recovery. Neuropsychological tests used alone will not be appropriate for the identification of concussions or for diagnosis until better studies are conducted that can provide more accurate and valid information about the relation of test scores to cognitive impairment after a concussion.
  • Existing guidelines for the treatment and management of concussions and their short- and long-term sequelae in youth are based primarily on clinical experience rather than on scientific evidence. Additional prospective studies that include children and adolescents are needed in order to be able to define typical and atypical recovery from sports-related concussion. Randomized controlled trials or

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