Docs ethically bound to guard against concussion

Physicians have an “ethical obligation” to educate athletes about concussion and protect them against it, the American Academy of Neurology (AAN) asserts in a new position statement. That responsibility includes clearing athletes to play only when they’re medically ready, regardless of pressure from players, parents, or coaches.

The position statement, released ahead of the first AAN Sports Concussion Conference, held July 11 to 13, urges doctors who care for athletes with concussions to make their primary responsibility safeguarding “the present and future mental and physical health of their patients,” especially with regard to decisions about returning to play after a concussion.

Doctors also must educate patients and their families about the dangers of concussion in relevant sports: especially football and other contact sports such as soccer, lacrosse, hockey, rugby, and basketball. “Physicians have a duty to provide athletes and their parents with information about concussion risk factors, symptoms, and the risk of postconcussion neurologic impairments,” the AAN concludes.

The statement notes that as many as 3.8 million sports-related concussions occur each year, according to the Centers for Disease Control and Prevention, and they can have “devastating” short- and long-term effects, including cognitive impairment, behavior problems, premature dementia, and chronic traumatic encephalopathy. Physicians who take care of athletes during and after a sports-related concussion are ethically required to have adequate training and experience in recognizing and evaluating potential brain injury, the AAN states.

They also have a responsibility to restrict athletes from returning to play prematurely after a concussion or resuming play after multiple concussions, which “is grounded in the physician’s commitment to beneficence and protecting athletes from potential harm,” the statement emphasizes, adding that preserving patient autonomy “does not outweigh all other ethical imperatives.”

The statement also recommends wider use of baseline cognitive testing; adding training in concussion evaluation and management to neurology residency programs; and developing a national concussion registry with mandatory reporting to help track the incidence and recurrence of concussion at all levels of play. (Available clinical concussion guidelines are based primarily on data from high school and college athletes; pediatric data are limited.)

The AAN based its statement, which corresponds with its sports concussion guidelines, on analysis of available research and ethical issues related to concussion. The latest version of the Academy’s Concussion Quick Check App can be downloaded from its Sports Concussion Toolkit. 

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