Mayo Clinic Announces New Sideline Protocol for Non-Medical Personnel: Concussion Check

While a great number of medical resources are devoted to elite-level and professional athletic organizations, youth and recreational sports—at which the vast majority of sports are played—are operating under a vastly different set of safety standards.

Of the 40 million youth athletes in the United States, over half are not supervised by trained medical professionals during practice or games. As a result, children and young adults are oftentimes unprotected when it comes to identifying and treating concussion, putting a large number of children at risk for injury or—in rare cases—death each time they step out on the playing field.

Concussion Check, the Mayo Clinic’s new remove-from-play protocol, provides parents, coaches and teachers with the tools they need to protect young athletes and keep sports safe—even when a medical professional isn’t on hand.

What is Concussion Check?

Concussion Check is a standardized, three-step protocol that can be used by individuals without medical training to identify the signs and symptoms of concussion. The protocol was created to protect youth athletes by empowering parents to make informed decisions about removing young athletes from play when a trained medical professional is not available.

Concussion Check is like a three-legged stool: if one leg is broken, the stool falls. If a young athlete fails any one of the three steps, they should be removed from play immediately and further evaluated by a medical professional.

Mayo Clinic Concussion Check Steps

Step 1: Recognize and Remove

Parents and other individuals watch for signs and symptoms of concussion during practices and games, keeping an eye out for hits that could be of concern. If they notice anything, they will remove the injured athlete from play.

Step 2: Memory Assessment

A parent will then ask the athlete some basic orientation questions, such as “Is it before or after lunch?” and “What’s your coach’s name?” The protocol’s questions were formulated with youth in mind, and the wrong answer is a strong indicator that something’s off.

Step 3: King-Devick Test in association with Mayo Clinic

Lastly, the parent will administer the King-Devick Test in Association with Mayo Clinic. This portable, two-minute assessment is a sensitive sideline measurement for concussion that evaluates an individual’s eye movements, attention and language. Athletes will need to complete the K-D Test during the pre-season to establish a baseline performance, which will be compared to post-injury test performance.

If the individual fails any of these three steps, they should immediately be removed from play and directed to a healthcare professional—ideally one who specializes in concussion treatment. To learn more about Concussion Check and read articles from Mayo Clinic’s team of concussion experts, visit mayoclinic.org/concussioncheck.

King-Devick Test Proves Useful in Outpatient Concussion Assessment

University at Buffalo researchers further validate King-Devick Concussion Test in adolescents

With 90% of sports-related concussions occurring without loss of consciousness, it’s important that sideline tests be as accurate as possible to prevent an athlete from continuing play with a traumatic brain injury. The King-Devick Test in association with Mayo Clinic (K-D Test) is a common sideline concussion test used by medical professionals, as well as trained parents and coaches. The test compares a subject’s baseline with repeated test results to identify worsening physical and functional conditions that may indicate a concussion.

A new study conducted by researchers at the University at Buffalo, including John Leddy, MD, FACSM, FACP, President of the International Concussion Society, sought to evaluate the effectiveness of the K-D Test in young athletes and kids.

What is the King-Devick Test?

The K-D Test is a portable, two-minute assessment of an individual’s eye movements, attention and language. The K-D Test evaluates saccadic eye movements, or rapid movements with both eyes, as well as processing speed and visual tracking. The test times each patient and tracks their errors as they read single-digit numbers displayed on an electronic tablet.

After first establishing a baseline prior to the start of the season, trained parents and coaches can conduct the K-D Test as part of their concussion protocol. The test software will then compare the results with the baseline, searching for any declined saccadic function–a common indicator of concussion.

King-Devick test quote from concussion.org

The Study

The University at Buffalo researchers studied adolescent patients–kids age 10-19–who were diagnosed by a doctor with a sport-related concussion within ten days of injury. Patients of the same age without concussions served as a comparison control group. Across two clinical visits a week apart, patients received K-D testing before and after exercising on a graded treadmill test to their symptom limitation (the Buffalo Concussion Treadmill Test).

The young patients with concussions performed significantly worse than their counterparts on the pre-exercise K-D Test, demonstrating that the K-D test is a useful tool in distinguishing healthy controls from concussed patients in an outpatient clinical setting.

After exercising on the treadmill, concussed patients who performed better on the K-D test when compared with their pre-exercise times had a typical concussion recovery time of seven to ten days and were recovered by the second visit. Conversely, concussed patients with delayed recovery–who required more than two weeks to recover–showed no significant difference in their K-D Test results after exercising when compared with their pre-exercise performance. The authors concluded that a lack of improvement on K-D Test scores after exercising on the Buffalo Concussion Treadmill Test predicted which adolescent patients would have a delayed recovery from a sport-related concussion.

“Not only does the study support the utility of the K-D test as part of outpatient concussion assessment, lack of improvement in K-D test performance after exercise may be an indicator of delayed recovery.”

What this Means

The study’s results indicate that the K-D Test is a useful component in concussion management by helping to identify those patients who are at risk of delayed recovery after sport-related concussion. The ability to help predict how long a child’s recovery from sport-related concussion has the potential to help doctors, parents, teachers and coaches plan for the child’s return to school, not to mention a safe return to sports. This is groundbreaking insight for patients and their support systems.

For more breaking news and resources in the field of concussion, make sure to follow Concussion.Org on social media.

CDC Releases Guideline for Youth Concussion

This is the first evidence-based guidance for treating concussion in children

In September 2018, the Centers for Disease Control and Prevention released clinical recommendations for health care providers treating children with concussion. The CDC Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children was published in JAMA Pediatrics, and is based on a comprehensive review of pediatric mTBI.

The guideline, which includes 19 sets of recommendations on the diagnosis, treatment and management of mTBI, is the first of its kind and seeks to improve the way parents, coaches and doctors care for a vulnerable population. According to CDC Director Deb Houry, MD, MPH, more than 800,000 children seek treatment for TBI every year. The CDC developed the new guideline in response to health care providers’ need for consistent, evidence-based guidance for diagnosing and managing mTBI in their young patients.

“The guideline couldn’t have come sooner,” said International Concussion Society President John Leddy, MD, FACSM, FACP. “The concussion community is looking forward to seeing how it will inform diagnosis and treatment, as well as help children get back to their normal lives.”

The CDC guideline featured several practice-changing recommendations. Most notably, it recommends against routine imaging tests to diagnose concussion. X-rays and CT scans are not effective for determining youth concussions, and children should not be unnecessarily exposed to radiation. The guideline also encourages health care providers to “use validated, age-appropriate symptom scales to diagnose mTBI.”

The CDC guidelines include some practice-changing recommendations related to post-concussion care as well. Within the first few days after a concussion diagnosis, children should refrain from physical and mental activities, including school and sports, before gradually returning to their regular activities. Rest is recommended for only the first three days because inactivity beyond that may worsen symptoms. The CDC reassures parents that most children’s symptoms clear up within one to three months of injury.

In cases where a patient’s recovery is prolonged, the guideline also outlines symptoms that warrant further medical attention. These include changes in personal characteristics, such as learning difficulties, as well as severe physical symptoms like worsening headaches, dizziness, sensitivity to light or noise, and sleep problems.

To help health care providers implement the recommendations, the CDC developed supporting tools and materials. The resources can be downloaded on the CDC website and include screening forms to assess young patients, discharge instructions and recovery tips for parents.

The International Concussion Society is optimistic that these guidelines will inform and support health care providers, parents and coaches looking to keep children safe and healthy.