Management of concussion in sports.

To the Editor: The Quality Standards Subcommittee of the American Academy of Neurology has endorsed guidelines for management of concussion in sports.1 This practice parameter represented a consolidation and modification of previous concussion guidelines in sports.2,3 A major limitation and criticism of most management guidelines for concussion in sports has been that the determination of criteria for return to play has been arbitrarily established, based on theoretical considerations and limited clinical investigation. In the absence of loss of consciousness, clinical grading scales for concussion in sports have focused on amnesia or confusion as possible criteria for assessing the severity of concussion. During the evaluation of concussion on the athletic field, the clinical distinction between amnesia and confusion is not practical. Posttraumatic amnesia is a clinical entity that features normal immediate recall and the inability to learn new material.4 During posttraumatic amnesia, there is relatively well-preserved retrieval of previously learned information except in cases associated with retrograde amnesia. Confusion is characterized by impaired immediate recall; reduced ability to learn new information; inability to retrieve already learned information; and incoherence secondary to inattention, distractibility, …