Case Synopsis: A high school football player died after returning to play, too quickly, following a concussion which occurred in September 2008. He previously sustained a concussion in September 2007 as well. This is significant because an athlete who has sustained a concussion is significantly more likely to have subsequent concussions; some experts suggest an athlete is 4 times more likely.

Following his concussion, the athlete was appropriately evaluated and held out of competition. He was later cleared to return to activity; however, he was not evaluated on a consistent daily basis by the athletic trainer. Furthermore, the athlete did not participate in a standard return to play program and was allowed to play before he was fully recovered. Sadly, he died after a relatively mild collision while attempting to make a tackle.

Expert Analysis: The brain, much like other tissues of the human body, requires rest in order to heal. Returning an athlete to activity too soon can have devastating consequences. An athlete whose symptoms have not fully resolved, and has not healed completely, may die as a result of “second impact syndrome” if they are permitted to play. The subsequent injury, resulting in death, is oftentimes of a mild nature. Recommendations provided by the International Consensus Conferences on Concussion in Sport have dramatically changed the way we identify and manage concussions. It is standard practice to have an athlete participate in a return to play program in order to monitor progress and provide adjustments to the scheduled date of return, if indicated. This program, at best, was provided inconsistently. There was no established concussion plan in place delineating responsibilities and establishing procedures for a safe return to play. As a result, the athletic trainer thought the coach was aware that the athlete was not cleared to play and the coach thought the athlete was permitted to participate.

This case serves to emphasize the important need to provide consistent ongoing evaluation of athletes returning to play following a concussion, the importance of a gradual return to play procedure and, additionally, this case serves as a glaring example of the essential need for Thorough and timely communication among all professionals involved with the student’s/athlete’s concussion care. The physician, parent, school nurse, athletic trainer, athletic director, coach, teacher and counselor all play an important role in insuring a full and successful recovery for the student/athlete.

Case Result: Case settled.