Neurologists: More caution needed

Any athlete who is even suspected of sustaining a concussion should be taken out of competition and evaluated by a doctor specializing in the diagnosis and treatment of brain injuries, according to new recommendations issued by the American Academy of Neurologists.

In addition, after concussions, specialists should be consulted before clearing athletes for return to play, according to the group, which is the largest professional association of neurologists (doctors who treat the brain and nervous system) in the U.S.

These guidelines are part of a position statement on sports concussions that the Academy published on Monday. The statement urges athletes, parents and coaches to exercise caution when it comes to dealing with potential brain trauma. "No athlete should be allowed to participate in sports if he or she is still experiencing symptoms from a concussion," the statement said.

The statement, the first update to the Academy's concussion guidelines since 1997, puts the neurologists firmly on one side of a pitched battle over who needs to be on hand when young athletes could suffer brain injuries.

Under rules put in place earlier this year by the National Federation of State High School Associations, schools are supposed to remove any athlete from play who shows signs of a concussion, and not return them to the field until "cleared by an appropriate health-care professional." The neurologists are more specific: "A certified athletic trainer should be present at all sporting events, including practices, where athletes are at risk for concussion."

Concussions can be difficult to diagnose and typically don't show up on tests such as CT scans and MRIs.

Currently, however, just 42 percent of high schools have access to a certified athletic trainer, according to the National Athletic Trainers Association -- and those athletic trainers often are not present during all contact sport practices as well as games. Many local school officials have complained they don't have the resources to hire a fuller complement of athletic trainers. And only seven states mandate that high school players be evaluated or cleared for return to play by medical professionals trained to manage concussions.

The Centers for Disease Control has estimated that more than 400,000 athletes high-school age or younger suffer concussions every year, and sports now rank second (behind car accidents) as the leading cause of serious brain injury in the U.S.

Recent research indicates the problem of concussions in youth sports may be even more serious than athletes, parents or coaches generally realize. A new study by Canadian researchers who directly examined youth hockey players, rather than relying on athletes or team doctors to report injuries, found concussions occurring 3.3 times as often as the highest previous estimates.

In September, the Center for Injury Research and Policy issued a report looking at emergency room visits by basketball players aged 5 to 19 from 1997 through 2007. Its conclusion: while overall injuries dropped 22 percent over that period, the number of brain injuries jumped 70 percent.

Despite the explosion of popular interest in the subject, Lara McKenzie, co-author of that study, said, "Many athletes do not recognize the symptoms of concussions or do not report them."

Peter Keating is a Senior Writer for ESPN The Magazine and ESPN Insider.