Replacing the old concussion grading scales is a categorization of concussion as simple or complex. In simple concussion, a sports-related injury resolves without complication over 7-10 days. This is the most common type of concussion and can be treated by the pediatrician alone. The cornerstone of management is rest until all symptoms resolve, then a graded exertion program before returning to sport. All concussions must be evaluated by a physician.

Complex concussions involve any of the features listed at the right. Management in complex concussions goes beyond simple return to play recommendations. Neuropsychologic testing may be required, as well as multidisciplinary involvement by pediatrics, neurology and neurosurgery, among others.
  • persistent symptoms, including those that recur with exertion
  • specific sequelae, e.g. LOC > 1 minute
  • prolonged cognitive impairment following injury
  • cases of repeated or multiple concussions over time


Suspicion of concussion in the injured athlete may involve a combination of clinical symptoms, physical signs and cognitive features. A standardized tool, the SCAT, was developed in Prague for sideline evaluation.



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