Editor’s Choice: Statements of Agreement From the Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion Meeting Held in Pittsburgh, October 15-16, 2015

BACKGROUND

The Centers for Disease Control and Prevention (CDC) have labeled concussion a major public health issue because of the short-term and potential long-term effects associated with this injury. Sport- and recreation-related concussions (SRCs) in particular have increased in incidence, with ≈1.6 to 3.8 million SRCs occurring every year in the United States.1 Emergency department visits for SRC doubled between 1997 and 2007 for children 8 to 13 years of age and increased 200% for adolescents 14 to 19 years of age.2 Recent epidemiological studies document increases in the reported incidence rates for SRC at both the college and high school levels.3 Knowledge about concussion has increased significantly over the past decade with respect to the definition of signs and symptoms,4 assessment approaches,5 risk factors,6-10 and prognosis.11,12 However, the treatment and management of concussion have received little attention in the literature during this time period. This progression is a natural phenomenon in medicine, with the initial phase focusing largely on the definition of the condition and its identification/diagnosis, followed by a later focus on its treatment.13 The limited research related to treatment has focused on the effectiveness of prescribed cognitive and physical rest.14,15 Moreover, the approach to treating and managing concussion is largely a uniform approach based on a conceptual framework as a homogeneous injury.16 This is surprising, given that current consensus statements highlight the individualized nature of concussion.17 In short, many clinicians are treating patients with concussion much the same way today as they did a decade ago: using a rest-based approach.

The notion of treating a concussion more actively than prescribed rest is also not recognized by the public. In fact, in a recent Harris Poll, a majority (71%) of >2000 US adults surveyed did not recognize that concussions are treatable.18 In this same report, 1 in 3 adults reported that their child received no prescribed treatment after a concussion. Among those receiving treatment, the most commonly reported treatments were prescribed rest (51%), hydration (34%), and over-the-counter medicine (28%).18

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