Table 2.

Guidelines for the Management of Sport-Related Concussion. These guidelines reflect the latest consensus opinion and are not evidence based. Adapted from the American Academy of Neurology guidelines²⁴ where newer guidelines are expected to be published in the future. (http://www.aan.com)

Symptoms	First Concussion	Second Concussion
Grade 1: No loss of consciousness, transient confusion, resolution of symptoms and mental abnormalities in <15 min See also Appendix.	Remove from play. Examine at 5-min intervals. May return to play if symptoms disappear and results of mental-function exam return to normal within 15 min	Allow return to play after 1 week if there are no symptoms at rest or with exertion.
Grade 2: as above, but with mental symptoms for >15 min	Remove from play and disallow play for rest of day. Examine for signs of intracranial lesion at sidelines and obtain further exam by a trained person the same day. Allow return to play after 1 week if neurological exam is normal.	Allow return to play after 2-week period of no symptoms at rest or with exertion. Remove from play for season if imaging shows abnormality.
Grade 3: any loss of consciousness	Perform thorough neurological exam in hospital and obtain imaging studies when indicated. Assess neurologic status daily until post-concussive symptoms resolve or stabilize. Remove from play for 1 week if LOC lasts seconds; for 2 weeks if it lasts minutes; must be asymptomatic at rest and with exertion to return to play.	Withhold from play until symptoms have been absent for at least 1 month.

LOC, loss of consciousness.