Developing Concussion Check


Mayo Clinic’s new remove-from-play protocol is the product of years of research and testing

Mayo Clinic recently released Concussion Check, a new sideline protocol designed to protect youth athletes from the short- and long-term consequences of sports-related concussion. Many recreational and school athletic clubs don’t have access to athletic trainers and medical personnel during practices and games, so Mayo Clinic researchers sought a way to train non-medical personnel to identify the signs and symptoms of concussion. After years of studying youth athletes, Mayo Clinic was able to develop an accessible sideline protocol that can be successfully administered by parents and coaches to help protect athletes from concussion.

Jennifer Wethe, PhD, ABPP-CN, co-director and lead neuropsychologist for the Mayo Clinic Arizona Concussion Program, shares her knowledge of concussion, the importance of having a remove-from-play protocol and how Concussion Check is revolutionizing safety in sports.

What is Concussion Check?

Concussion Check uses three simple steps to provide non-medical personnel with an evidence-based system to accurately identify the signs and symptoms of concussion. The protocol is intended to help quickly remove young athletes from play and prevent further, more serious injuries that may have long-term consequences.

“Up until now, people have followed the idea of ‘when in doubt, sit them out,’” says Dr. Wethe. “While this philosophy is well-intended, it, unfortunately, leaves too much room for error. Concussion Check is the first remove-from-play protocol for non-medical personnel that provides objective guidelines to identify the signs and symptoms of concussion.”

How was Concussion Check developed?

Over the last five years, Mayo Clinic researchers have conducted a large youth athlete study to determine if adult concussion assessment tools could be used on youth athletes. Because athletic programs may not have the means to hire an athletic trainer, researchers explored the possibility of training people who are already at practices and games––parents.

“We looked at whether or not we could train parents on this protocol, asking, ‘Can they watch for the signs of concussion reliably?’ ‘Can they administer the King-Devick Test successfully?’” explains Dr. Wethe. “And they can. Since launching Concussion Check last year within our local ice hockey league, parents have identified at least a dozen concussions that I think would have been missed otherwise.”

In addition to Mayo Clinic’s own research, Concussion Check was informed by a compilation of existing research on concussion, as well as current remove-from-play recommendations.

How does Concussion Check teach non-healthcare personnel to check for concussions?

The Mayo Clinic team developed a comprehensive, hour-long program to train parents and coaches in the Concussion Check protocol. The program first provides participants with an overview of concussion, eliminating misconceptions and outlining common symptoms, as well as a review of relevant research. Participants are then taught to watch the whole field of play––not just the ball or puck––and how to recognize subtle indicators of a head injury. The program then provides a demonstration of the King-Devick Test in association with Mayo Clinic, which participants are taught how to administer.

“Whenever there is pushback on this idea of training non-medical professionals, I always come back to the notion of CPR certification,” say Dr. Wethe. “Almost everyone is trained in CPR, which now typically includes training on the proper use of electrical heart defibrillators. The people we trust to administer electric shocks to our children’s hearts are certainly equipped to read numbers off of an iPad and remove an athlete from play.”

Dr. Wethe noted that Concussion Check does not ask parents to diagnose young athletes with concussion, “but we want them to know the steps to take and be prepared to make important decisions about removing an athlete from play.”

Identifying more concussions

To evaluate the protocol, the research team trained parent volunteers from several youth sports organizations in the Concussion Check protocol. Each time an athlete with a suspected injury was pulled for evaluation, a non-injured athlete from the same team was also evaluated for comparison. The Concussion Check protocol was helpful in distinguishing between injured athletes who should be removed from play and non-injured athletes who can be safely returned to play.

One of the trained parents, who also happened to be a Mayo Clinic physician, estimated that he evaluated about 20% of the athletes on his child’s team over the course of the season. Some of the players were removed from play and referred to a specialist for further evaluation. The experience shows that not only does Concussion Check involve a comprehensive training program, but the protocol itself can be easily and effectively carried out from the sidelines.

“Less than 50% of U.S. high schools have athletic trainers,” Dr. Wethe continues. “Even if you have an athletic trainer, how many places can they be at once? Some practices are held off school grounds and most teams have away games––who’s watching the players then? Concussion Check helps protect young athletes at every practice and every game.”

Mayo Clinic: A state-of-the-art concussion center

Mayo Clinic is at the forefront of concussion science, conducting extensive research to further the field and our understanding of this traumatic brain injury. The team of renowned neurologists, clinicians and scientists are conducting research that includes evaluating advanced diagnostic tools like brain imaging techniques, concussion blood markers and the role of exercise and other oral medications/treatments to minimize the brain injury from a concussion.

Mayo Clinic’s own concussion clinic involves multiple medical specialties, including neurology, physical medicine and rehabilitation, and neuropsychology, among others. Within the clinic, patients are assessed, often within 72 hours, by a doctor skilled in concussion diagnosis and management, as well as a vestibular audiologist and a neuropsychologist. By the time they leave, patients have had a full neurologic evaluation, balance assessment, and an examination of cognition and emotional functioning.

Mayo Clinic understands the severity of concussion and treats each with the same quality of care. “We often say, ‘When you’ve seen one concussion, you’ve seen one concussion,’” Dr. Wethe explains. “There is a lot of variability within concussion symptoms and we are attuned to that, constantly watching for red flags and working closely with each patient to ensure that they return to play safely.”

To learn more about Concussion Check and read articles from the Mayo Clinic team, visit