Physician referral checklist

*Requires the athlete be transported immediately to the nearest emergency department.
Day of injury referral
    1. Loss of consciousness on the field
    2. Amnesia lasting longer than 15 minutes
    3. Deterioration of neurological function*
    4. Decreasing level of consciousness*
    5. Decrease or irregularity in respirations*
    6. Decrease or irregularity in pulse*
    7. Increase in blood pressure
    8. Unequal, dilated, or unreactive pupils*
    9. Cranial nerve deficits
    10. Any signs or symptoms of associated injuries, spine or skull fracture, or bleeding*
    11. Mental status changes: lethargy, difficulty maintaining arousal, confusion, agitation*
    12. Seizure activity*
    13. Vomiting
    14. Motor deficits subsequent to initial on-field assessment
    15. Sensory deficits subsequent to initial on-field assessment
    16. Balance deficits subsequent to initial on-field assessment
    17. Cranial nerve deficits subsequent to initial on-field assessment
    18. Post-concussion symptoms that worsen
    19. Additional post-concussion symptoms as compared with those on the field
    20. Athlete is still symptomatic at the end of the game (especially at high school level)
Delayed referral (after the day of injury)
    1. Any of the findings in the day of injury referral category
    2. Post-concussion symptoms worsen or do not improve over time
    3. Increase in the number of post-concussion symptoms reported
    4. Post-concussion symptoms begin to interfere with the athlete’s daily activities (sleep disturbances, cognitive difficulties)