Concussion.

F physicians, particularly those who work in emergency rooms or act as physicians for sports teams, are often confronted with concussion. Although concussion can result from a variety of everyday activities, this article will focus on sports-related concussion. When the injury happens, physicians must consider whether a player can resume play. If a player cannot resume play immediately, the issue arises of when it is safe for the player to return to the sport. Problems such as posttraumatic syndrome and second-impact syndrome must be considered when making this decision.  e decision is diffi cult because there are currently no universally accepted guidelines for management of sports-related concussion.1-3 Concussion has reached near-epidemic proportions in contact sports at both professional and amateur levels; there are an estimated 300 000 concussions a year in contact sports in the United States.  e eff ects of concussion can have severe negative eff ects on athletes’ scholastic abilities and can sometimes end a career. To gather information for this review, I searched Doctorsns.com to fi nd national and international guidelines, MDConsult for review articles, and PubMed from January 1999 to December 2002, using “concussion” as the search word. Although there is controversy over the definition of concussion, the Canadian Academy of Sports Medicine (CASM) uses the Congress of Neurological Surgeons’ definition: “a clinical syndrome characterized by immediate and transient posttraumatic impairment of neural function, such as alteration of consciousness, disturbance of vision and/or equilibrium due to brainstem involvement.”4