Concussion: When in doubt, out!

An international medical conference in Berlin has issued a consensus recommendation on the treatment of concussion in sports: When in doubt, take the player out.

According to a report in Medscape, there are a variety of diagnostic criteria for concussion, some more clearly objective and easier to ascertain than others:


  • Somatic symptoms (eg, headache), cognitive (eg, feeling as if in a fog), and/or emotional symptoms (eg, lability);
  • Physical signs (eg, loss of consciousness, amnesia, neurologic deficit);
  • Balance impairment (eg, gait unsteadiness);
  • Behavioral changes (eg, irritability);
  • Cognitive impairment (eg, slowed reaction times); and
  • Sleep/wake disturbance (eg, somnolence, drowsiness).

We know that concussions can have effects that range from very short duration to permanent, and that repeated concussions can magnify effects. We also know that a full recovery can take more than a year, if it is even possible. We know that children can suffer concussions whose effects last into adulthood.

What isn’t stated: what to do about non-sports concussions. How soon can a victim return to driving, if at all. If a pilot, a first responder or in some other occupation involving obvious risk, how soon should a victim return to work? How about someone responsible for stock or bond trading — if impaired reaction times can affect clients? Since most people don’t carry disability insurance, who pays them when they can’t work? (Social Security Disability only starts after one is out of work for two years.)

What’s the legal liability for forcing someone with a concussion back to work, when someone else is hurt as a result? Now that we know that forcing a truck driver of police officer back to work with a concussion could result in someone’s death, there should be a liability.  I guess the courts will sort that out.


  1. Bert R. Mandelbaum, MD, “Concussion Consensus Calls for Caution,” MEDSCAPE, 23 MY 2017.



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