Grades of Concussion and
Recommendations for Management

Grade 1: Transient confusion; no loss of consciousness; resolution of mental-status abnormalities in less than 15 minutes.

Recommended management:

1. Remove the person from contest.
2. Immediate and 5-minute-interval examinations of mental-status abnormalities or post-concussion symptoms, both at rest and with exertion.
3. The person may return to contest if clear of symptoms.

Grade 2: Transient confusion; no loss of consciousness; concussion symptoms or mental-status abnormalities with amnesia for longer than 15 minutes.

Recommended management:

1. Remove the person from contest and disallow return to contest that day.
2. Frequent on-site examinations for signs of evolving intracranial abnormality.
3. Evaluation by a trained person the following day.
4. A physician should perform a neurologic examination to clear the person for return to play after a full week of no symptoms, both at rest and with exertion.

Grade 3: Any loss of consciousness.

1. Brief (seconds)
2. Prolonged (minutes)

Recommended management:

1. Transport to the nearest ER by ambulance if the person is still unconscious or worrisome signs are detected.
2. An immediate neurologic examination should be done, including the appropriate neuro-imaging procedures, when indicated.
3. Hospital admission is indicated if any signs of pathology are detected or if the person's mental status remains abnormal.

Headaches are common after grade 1 and 2 injuries.

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