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Review
. 2018 Feb;8(1):40-47.
doi: 10.1212/CPJ.0000000000000424.

Medical retirement from sport after concussions: A practical guide for a difficult discussion

Cecilia Davis-Hayes  1 , David R Baker  1 , Thomas S Bottiglieri  1 , William N Levine  1 , Natasha Desai  1 , James D Gossett  1 , James M Noble  1
Affiliations
Review

Medical retirement from sport after concussions: A practical guide for a difficult discussion

Cecilia Davis-Hayes et al. Neurol Clin Pract. 2018 Feb.

Abstract

Purpose of review: In patients with a considerable history of sports-related concussion, the decision of when to discontinue participation in sports due to medical concerns including neurologic disorders has potentially life-altering consequences, especially for young athletes, and merits a comprehensive evaluation involving nuanced discussion. Few resources exist to aid the sports medicine provider.

Recent findings: In this narrative review, we describe 10 prototypical vignettes based upon the authors' collective experience in concussion management and propose an algorithm to help clinicians navigate retirement discussions. Issues for consideration include absolute and relative contraindications to return to sport, ranging from clinical or radiographic evidence of lasting neurologic injury to prolonged concussion recovery periods or reduced injury threshold to patient-centered factors including personal identity through sport, financial motivations, and navigating uncertainty in the context of long-term risks.

Summary: The authors propose a novel treatment algorithm based on real patient cases to guide medical retirement decisions after concussion in sport.

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Figures

Figure 1
Figure 1. Considerations for concussed athletes leading to medical care or return to sport (RTS)
The circled numbers included in the boxes at many of the endpoints correspond to the patient case numbers described in the prior section. LOC = loss of consciousness; RTL = return to learn; SRC = sports-related concussion.
Figure 2
Figure 2. Provider decision algorithm: Considerations in retirement discussion and recommendation
The circled numbers included in the boxes at many of the endpoints correspond to the patient case numbers described in the prior section. aIdeally, athlete is asymptomatic at time of discussion. bReference the “Rule out preexisting” box located at the top right of the figure. BPPV = benign paroxysmal positional vertigo; RTS = return to sport; TBI = traumatic brain injury.
See this image and copyright information in PMC

Comment in

  • Neurol Clin Pract. 8(1):6.

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