American Medical Society for Sports Medicine
View all recommendations from this societyReleased April 5, 2014
Avoid ordering a brain CT or brain MRI to evaluate an acute concussion unless thereare progressive neurological symptoms, focal neurological findings on exam or there is concern for a skull fracture.
Concussion is a clinical diagnosis. Concussion is not associated with clinically relevant abnormalities on standard neuroimaging with CT or MRI. These studies should be ordered if more severe brain injury is suspected. CT is best utilized for skull fracture and intracranial bleeding, whereas MRI may be ordered for prolonged symptoms, worsening symptoms or other suspected structural pathology.
These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.
How The List Was Created
The American Medical Society for Sports Medicine (AMSSM) has identified this list of clinical recommendations for the Choosing Wisely® campaign. The goal was to identify common topics in the practice of sports medicine that, supported by a review of the literature, would lead to significant health benefits and a reduction of common procedures that can be unnecessary or cause harm. For each item, evidence was reviewed from peer-reviewed literature and several sports medicine consensus statements. The list was initially generated and drafted by AMSSM’s Quality Measures Subcommittee. It was then edited and approved by AMSSM’s Practice and Policy Committee and the Board of Directors.
The American Medical Society for Sports Medicine’s disclosure and conflict of interest policy can be found at www.amssm.org.
Sources
Harmon KG, Drezner JA, Gammons M, Guskiewicz KM, Halstead M, Herring SA, Kutcher JS, Pana A, Putukian M, Roberts WO. American Medical Society for Sports Medicine position statement: concussion in sport. Br J Sports Med. 2013 Jan;47(1):15–26.
McCrory P, Meeuwisse WH, Aubry M, Cantu B, Dvořák J, Echemendia RJ, Engebretsen L, Johnston K, Kutcher JS, Raftery M, Sills A, Benson BW, Davis GA, Ellenbogen RG, Guskiewicz K, Herring SA, Iverson GL, Jordan BD, Kissick J, McCrea M, McIntosh AS, Maddocks D, Makdissi M, Purcell L, Putukian M, Schneider K, Tator CH, Turner M. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport, Zurich, November 2012. Br J Sports Med. 2013 Apr;47(5): 250–8.
McCrory P, Meeuwisse W, Johnston K, Dvorak J, Aubry M, Molloy M, Cantu R. Consensus statement on concussion in sport—the third international conference on concussion in sport held in Zurich, November 2008. Phys Sportsmed. 2009 Jun;37(2):141–59.
