Return to play decisions are always difficult especially when there is pressure from uninformed coaches, athletes, or parents.  These decisions are extremely important, so sideline physicians, trainers, and coaches need to be familiar with guidelines for assessment and management of concussion and offer consistent, well thought out treatment plans.  Lack of proper management of concussions can lead to death and permanent brain damage with life changing consequences.

2.  Caution should be taken by coaches, trainers, medical staff because premature return to play before other symptoms resolve could lead to serious conditions such as Second Impact Syndrome.

3.  If neurologic evaluation reveals deterioration in mental status or loss of consciousness, appropriate medical attention should be sought immediately.

4.  An athlete with loss of consciousness (even transient) should not return to play that day.

5.  No athlete should be returned to play until completely asymptomatic, both at rest and during exertion.

6. If athlete shows any signs of deterioration, no matter how "mild" the injury seemed initially, he or she should be admitted to hospital for complete neurologic evaluation.

7.  Following the concussion, the athlete should be observed an evaluated for a minimum of 15 minutes.

8.  Utilize assessment measures such as the SAC (Standardized Assessment of Concussion) to evaluate athletes to give you immediate feedback about the injury.

9.  Establish databases on all athletes with concussions.  This type of longitudinal analysis is useful to assess the risk of future injury and further difficulties.

10.  REMEMBER:  The effects of recurrent concussions may be cumulative!!!