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What advice should we give to athletes postconcussion?
  1. P McCrory
  1. Centre for Sports Medicine Research and Education and the Brain research Institute, University of Melbourne, Melbourne, Australia
  1. Correspondence to:
 Dr McCrory, PO Box 93, Shoreham, Victoria 3916, Australia;
 pmccrory{at}compuserve.com

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Good early management of concussion in athletes is important for recovery outcomes and return to play

The practical management of concussion can be divided into three broad areas where the issues and treatment priorities differ considerably. These areas are immediate, early, and late management. The first of these relates to on field first aid, the second to the early management on the day of the injury, and the third to the issue of return to play at a later date. It is the second of these areas that this paper will focus on.

IMMEDIATE MANAGEMENT

This is where the clinician is in attendance at a sporting event and is called on to manage the acute brain injury. The major priorities at this early stage are the basic principles of first aid. Once these basic aspects of care have been achieved and the patient stabilised, then consideration of removal of the patient from the field to an appropriate facility is necessary. At this time, careful assessment for the presence of a cervical spine or other injury is necessary. The clinical management may involve the treatment of a disorientated, confused, unconscious, uncooperative, or convulsing patient.1 The immediate treatment priorities remain the basic first aid principles of “ABC—airway, breathing, and circulation”. Once this has been established and the patient stabilised, a full medical and neurological assessment exam should follow.

EARLY MANAGEMENT

This refers to the situation where an athlete has been brought to the medical room for assessment or alternatively to an emergency department or medical facility following a concussive injury. Assessment of injury severity is generally best performed in a quiet of a medical room rather than in the middle of a football field in front of 100 000 screaming fans with television cameras following every move of the doctor.

When assessing the acutely concussed …

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