Return-to-Play Confusion: Considerations for Sport-Related Concussion

A much debated topic regarding the sideline treatment of concussion in sport is who decides whether an athlete is fit to return to play after a head knock. The case study proposed by Mellifont, Peetz, and Sayers (2012) is a timely stimulus for debate concerning this important and difficult issue. The lack of longitudinal prospective data complicates the area and makes any advice to Rosemary, the mother of the concussed athlete in the case, largely speculative and equivocal. The most objective person present in the case outlined by Mellifont, Peetz, and Sayers (2012), as at almost every sporting event, is the sports medicine professional (SMP). Although the SMP may not be a doctor or a head injury specialist, he or she will have had basic first aid training and should be equipped with standardized sport concussion assessment tools (e.g., the SCAT 2 or ImPACT) and some form of player history, including details of previous injuries and preseason baseline data (McCrory et al. 2005). A parent’s judgement concerning medical treatment is often clouded by mixed feelings of encouragement and parental protectiveness. Similarly, coaches have spent time and effort training players; however, in the moment, their attention is divided amongst the other players on the field. Further, athletes spend years striving toward goals (such as playing professionally) and so may not make sound decisions regarding their ownmedical treatment—especially when it could see them removed from play. Despite these obvious biases, SMPs regularly are disregarded by the athletes, coaches, and parents due to the inter-sport and even inter-club inconsistencies concerning who has the final say, which often sees SMPs conceding to the demands of the athlete. Most symptoms of sport-related concussion resolve within seven to 10 days, although for some athletes the recovery time is longer (McCrory et al. 2005). It is unclear why some athletes suffer adverse and ongoing effects of concussion, while others return to play the following week with no apparent concerns. Our current research team is focused on evaluating the risk factors associated with outcomes of concussion within a prospective longitudinal design. Previous studies have suggested an association between repeated sport-related concussion and long-term cognitive impairment (or “punch drunkenness”). Recent Bioethical Inquiry (2013) 10:127–128 DOI 10.1007/s11673-012-9421-8