Published: March 18, 2013

The American Academy of Neurology said Monday that it had revised its guidelines for handling concussions to emphasize treating athletes case by case rather than according to a predetermined scale.

The move brings the group more in line with best practices followed by the N.F.L. and other leagues and associations, and it essentially acknowledges that concussions are too idiosyncratic to be categorized neatly.

“We’ve moved away from the concussion grading systems we first established in 1997 and are now recommending concussion and return to play be assessed in each athlete individually,” said Christopher C. Giza, a doctor at the David Geffen School of Medicine and Mattel Children’s Hospital at U.C.L.A. and one of the lead authors of the new guidelines. “There is no set timeline for safe return to play.”

Concussions, Giza and other authors of the report said, are clinical diagnoses. “Symptom checklists, the Standardized Assessment of Concussion (SAC), neuropsychological testing (paper-and-pencil and computerized) and the Balance Error Scoring System may be helpful tools in diagnosing and managing concussions but should not be used alone for making a diagnosis.”

The revised recommendations were announced at the academy’s annual meeting in San Diego on Monday, and they have been published in Neurology, the medical journal of the academy, which includes more than 25,000 neurologists and neuroscience professionals.

In noting that more than a million American athletes experienced concussions each year, the authors of the study noted that the risk of concussion was greatest in football and rugby, followed by hockey and soccer, and that the risk of concussion for young women and girls was greatest in soccer and basketball.

Critically, the authors found “no clear evidence that one type of football helmet can better protect against concussion over another kind of helmet.”

Signs and symptoms of a concussion include headaches; sensitivity to light and sound; changes in reaction time, balance and coordination; changes in memory, judgment, speech and sleep; and loss of consciousness or blackouts. The guidelines recommend that athletes suspected of having a concussion should be immediately removed from play.

“If in doubt, sit it out,” said Jeffrey S. Kutcher, a doctor at the University of Michigan Medical School in Ann Arbor and a member of the academy. “You only get one brain; treat it well.”

Source : The New York Timess