Joint Committee Offers Recommendations for Postconcussion Return to Play

Privacy laws can present a challenge to physicians managing athletes with concussion, particularly if those athletes want to return to play against the physician’s advice, according to a position paper on sports-related concussion published online ahead of print July 9 in Neurology. Waivers may help physicians avoid this challenge, however.

“Evaluating and managing sports-related concussion raises a variety of distinctive ethical and legal issues for physicians, especially relating to return-to-play decisions,” said Matthew P. Kirschen, MD, PhD, a neurologist at the Children’s Hospital of Philadelphia, and his colleagues. The official position paper was written by the Ethics, Law, and Humanities Committee, a joint committee of the American Academy of Neurology, the American Neurological Association, and the Child Neurology Society.

Lack of appropriate physician training is also a major concern in sports-related concussion. A survey by the American Academy of Neurology found that although most neurologists see patients with sports-related concussion, few have had formal or informal training on managing concussion.

Potential Role for Waivers
One of the most challenging aspects of managing sports-related concussion is the decision about when the athlete can return to play, which can be problematic if he or she wants to return to play prematurely. Athletes may ignore their physician’s advice or seek a physician who will approve their return to play, which may bring the original physician into conflict with privacy laws that restrict the sharing of personal health information without the patient’s consent.

“The evaluating physician could find himself or herself in the difficult position of being legally restricted from sharing a concussion evaluation with the athlete’s coaches and school personnel, even though making such a disclosure might be in the best interest of the athlete’s health,” said the authors.

In response to this problem, some institutions now require athletes to sign waivers that allow personal health information to be shared between the physician affiliated with the school department and the coaches and other team or school staff.

Youth Sports Concussion Laws Vary by State
All 50 states have adopted youth sports concussion laws that address questions related to education, removal from play, and return to play. Statutes differ, however, about which individuals are authorized to clear an athlete to return to the field. Some statutes specify that a physician must make this determination, while others allow athletic trainers, nurse practitioners, and physician assistants to do so. “States do not uniformly require that individuals providing clearance be trained in the evaluation and management of concussion,” said the authors.

Physicians responsible for the care of athletes, either on or off the sidelines, should ensure that they have appropriate training and experience in recognizing, evaluating, and managing concussion and potential brain injury, the authors of the report advised. State-based youth sports concussion laws generally have a low removal-from-play threshold to protect young athletes from harm, which may encourage coaches, parents, and athletes to take the risks of concussion seriously.

A Concussion Registry Could Aid Understanding
Discussion of sports-related concussion is timely, said Ellen Deibert, MD, a neurologist at Wellspan Neurology in York, Pennsylvania, in an accompanying editorial. The Centers for Disease Control and Prevention recently estimated that from 1.6 to 3.8 million sports and recreation-related concussions occur each year. The previous annual estimate was 300,000 such concussions per year.

“Overall, the article is a refreshing reminder of the issues surrounding the treatment of sports-related concussion and the need for continued education and research on this topic,” said Dr. Deibert.

The position paper’s authors call for the establishment of a concussion registry to improve understanding of concussion. Such a registry “would need to be interdisciplinary and in collaboration with other subspecialists already involved in concussion management,” said Dr. Deibert. “The role the neurologist plays will eventually be defined during that process. However, in 2014, there remains an immediate need for providers to treat concussion patients. The only question you need to answer is what your role will be in supporting this effort.”

—Bianca Nogrady

Privacy laws can present a challenge to physicians managing athletes with concussion, particularly if those athletes want to return to play against the physician’s advice, according to a position paper on sports-related concussion published online ahead of print July 9 in Neurology. Waivers may help physicians avoid this challenge, however.

“Evaluating and managing sports-related concussion raises a variety of distinctive ethical and legal issues for physicians, especially relating to return-to-play decisions,” said Matthew P. Kirschen, MD, PhD, a neurologist at the Children’s Hospital of Philadelphia, and his colleagues. The official position paper was written by the Ethics, Law, and Humanities Committee, a joint committee of the American Academy of Neurology, the American Neurological Association, and the Child Neurology Society.

Lack of appropriate physician training is also a major concern in sports-related concussion. A survey by the American Academy of Neurology found that although most neurologists see patients with sports-related concussion, few have had formal or informal training on managing concussion.

Potential Role for Waivers
One of the most challenging aspects of managing sports-related concussion is the decision about when the athlete can return to play, which can be problematic if he or she wants to return to play prematurely. Athletes may ignore their physician’s advice or seek a physician who will approve their return to play, which may bring the original physician into conflict with privacy laws that restrict the sharing of personal health information without the patient’s consent.

“The evaluating physician could find himself or herself in the difficult position of being legally restricted from sharing a concussion evaluation with the athlete’s coaches and school personnel, even though making such a disclosure might be in the best interest of the athlete’s health,” said the authors.

In response to this problem, some institutions now require athletes to sign waivers that allow personal health information to be shared between the physician affiliated with the school department and the coaches and other team or school staff.

Youth Sports Concussion Laws Vary by State
All 50 states have adopted youth sports concussion laws that address questions related to education, removal from play, and return to play. Statutes differ, however, about which individuals are authorized to clear an athlete to return to the field. Some statutes specify that a physician must make this determination, while others allow athletic trainers, nurse practitioners, and physician assistants to do so. “States do not uniformly require that individuals providing clearance be trained in the evaluation and management of concussion,” said the authors.

Physicians responsible for the care of athletes, either on or off the sidelines, should ensure that they have appropriate training and experience in recognizing, evaluating, and managing concussion and potential brain injury, the authors of the report advised. State-based youth sports concussion laws generally have a low removal-from-play threshold to protect young athletes from harm, which may encourage coaches, parents, and athletes to take the risks of concussion seriously.

A Concussion Registry Could Aid Understanding
Discussion of sports-related concussion is timely, said Ellen Deibert, MD, a neurologist at Wellspan Neurology in York, Pennsylvania, in an accompanying editorial. The Centers for Disease Control and Prevention recently estimated that from 1.6 to 3.8 million sports and recreation-related concussions occur each year. The previous annual estimate was 300,000 such concussions per year.

“Overall, the article is a refreshing reminder of the issues surrounding the treatment of sports-related concussion and the need for continued education and research on this topic,” said Dr. Deibert.

The position paper’s authors call for the establishment of a concussion registry to improve understanding of concussion. Such a registry “would need to be interdisciplinary and in collaboration with other subspecialists already involved in concussion management,” said Dr. Deibert. “The role the neurologist plays will eventually be defined during that process. However, in 2014, there remains an immediate need for providers to treat concussion patients. The only question you need to answer is what your role will be in supporting this effort.”

—Bianca Nogrady

Privacy laws can present a challenge to physicians managing athletes with concussion, particularly if those athletes want to return to play against the physician’s advice, according to a position paper on sports-related concussion published online ahead of print July 9 in Neurology. Waivers may help physicians avoid this challenge, however.

“Evaluating and managing sports-related concussion raises a variety of distinctive ethical and legal issues for physicians, especially relating to return-to-play decisions,” said Matthew P. Kirschen, MD, PhD, a neurologist at the Children’s Hospital of Philadelphia, and his colleagues. The official position paper was written by the Ethics, Law, and Humanities Committee, a joint committee of the American Academy of Neurology, the American Neurological Association, and the Child Neurology Society.

Lack of appropriate physician training is also a major concern in sports-related concussion. A survey by the American Academy of Neurology found that although most neurologists see patients with sports-related concussion, few have had formal or informal training on managing concussion.

Potential Role for Waivers
One of the most challenging aspects of managing sports-related concussion is the decision about when the athlete can return to play, which can be problematic if he or she wants to return to play prematurely. Athletes may ignore their physician’s advice or seek a physician who will approve their return to play, which may bring the original physician into conflict with privacy laws that restrict the sharing of personal health information without the patient’s consent.

“The evaluating physician could find himself or herself in the difficult position of being legally restricted from sharing a concussion evaluation with the athlete’s coaches and school personnel, even though making such a disclosure might be in the best interest of the athlete’s health,” said the authors.

In response to this problem, some institutions now require athletes to sign waivers that allow personal health information to be shared between the physician affiliated with the school department and the coaches and other team or school staff.

Youth Sports Concussion Laws Vary by State
All 50 states have adopted youth sports concussion laws that address questions related to education, removal from play, and return to play. Statutes differ, however, about which individuals are authorized to clear an athlete to return to the field. Some statutes specify that a physician must make this determination, while others allow athletic trainers, nurse practitioners, and physician assistants to do so. “States do not uniformly require that individuals providing clearance be trained in the evaluation and management of concussion,” said the authors.

Physicians responsible for the care of athletes, either on or off the sidelines, should ensure that they have appropriate training and experience in recognizing, evaluating, and managing concussion and potential brain injury, the authors of the report advised. State-based youth sports concussion laws generally have a low removal-from-play threshold to protect young athletes from harm, which may encourage coaches, parents, and athletes to take the risks of concussion seriously.

A Concussion Registry Could Aid Understanding
Discussion of sports-related concussion is timely, said Ellen Deibert, MD, a neurologist at Wellspan Neurology in York, Pennsylvania, in an accompanying editorial. The Centers for Disease Control and Prevention recently estimated that from 1.6 to 3.8 million sports and recreation-related concussions occur each year. The previous annual estimate was 300,000 such concussions per year.

“Overall, the article is a refreshing reminder of the issues surrounding the treatment of sports-related concussion and the need for continued education and research on this topic,” said Dr. Deibert.

The position paper’s authors call for the establishment of a concussion registry to improve understanding of concussion. Such a registry “would need to be interdisciplinary and in collaboration with other subspecialists already involved in concussion management,” said Dr. Deibert. “The role the neurologist plays will eventually be defined during that process. However, in 2014, there remains an immediate need for providers to treat concussion patients. The only question you need to answer is what your role will be in supporting this effort.”

—Bianca Nogrady