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J Am Acad Orthop Surg, Vol 12, No 3, May/June 2004, 191-195.
© 2004 the American Academy of Orthopaedic Surgeons
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On-the-Field Management of Athletic Head Injuries

Pierre Durand, Jr, MD and Gregory J. Adamson, MD

Dr. Durand is in private practice, Thousand Oaks, CA. Dr. Adamson is Director, Sports Medicine Fellowship Program, Congress Medical Associates, Inc, Pasadena, and Clinical Professor of Orthopaedic Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA.

Reprint requests: Dr. Durand, Suite 200, 375 Rolling Oaks Drive, Thousand Oaks, CA.

Head injuries are prevalent in collision sports. Concussions represent the relatively benign end of the spectrum of injuries. Severe closed head injuries include epidural hematomas, acute subdural hematomas, intracerebral hematomas, intraventricular hematomas, subarachnoid hemorrhages, and diffuse axonal injuries. Second impact syndrome represents a severe cerebral autoregulatory dysfunction that can lead to death in an athlete who sustains a second (often minor) closed head trauma while still symptomatic from a previous head injury. Generally, athletes who have suffered a severe closed head injury should not return to play. Exceptions include athletes asymptomatic for 1 year who return to a noncontact sport and those who recover completely from an epidural hematoma without underlying brain injury. Several guidelines for returning athletes to play have been proposed and are commonly used. The team physician has the responsibility of on-the-field evaluation and management of athletes with head injuries, as well as of advising them when it is safe to return to play.




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