Management of the Complicated Sports Concussion Patient

CONTEXT: Whereas the majority of sports concussions are isolated self-limited events, some patients have more complicated presentations and management needs. This review presents a framework for the management of these complicated concussion patients. EVIDENCE ACQUISITION: A MEDLINE search for the years 1990 to 2009 was performed using the search terms concussion and athletic injuries. Secondary search terms included symptom, incidence, treatment, and risk factor. The Strength of Recommendation Taxonomy grading system was used for all clinical recommendations. RESULTS: Patterns of complicated sports concussion presentations were identified from literature review, anecdote, and personal experience of the author and colleagues. All clinical recommendations carry a grade of C, unless otherwise noted. CONCLUSION: The sports medicine provider should be aware of certain patterns of complicated sports concussion presentations in order to use a patient-focused approach to management.