However, athletes often deny symptoms and a concussion diagnosis may depend on others noticing that a player is “off,” Dr Harmon added.

Symptoms: Why Do Patients Lie?

Conflicts of interest between players, coaches, and stakeholders can represent barriers to an honest athlete-doctor relationship.

“Enforcement of no same-day return-to-play rules may result in conflicts of interest with the team goals which may be affected by loss of a key member,” Dr Giza said. “There are many distinct ethical factors in sports-related concussion, including conflicting interests between the player, the doctor, and the team.”

Though potentially immune to the impact of competing interests, independent sideline consultants are costly and their level of care may be hampered by lack of access to an athlete’s past medical history. Issues regarding patient confidentiality and concussion reporting are common, particularly for high-profile athletes.

“For a diagnosis of concussion to happen, players need to be honest [about their condition], doctors need to make the right decision for the player, and coaches should not have hiring/firing responsibility for medical personnel. Until all 3 of these things happen or an objective test is developed that does not depend on the player telling the truth, the diagnosis and management of concussion will continue to be difficult,” Dr Harmon emphasized.

AAN Guidelines Encourage a Multimodal Approach

As part of the guideline development subcommittee of the AAN, Giza and colleagues delivered an evidence-based guideline update on the evaluation and management of concussion in sports.2

“In the AAN guidelines, we provide an objective review of all existing studies (up to 2012) using transparent criteria to identify what management practices are supported by science and where the gaps are in relation to our understanding of sports-related concussion,” Dr Giza said.

The 2013 AAN guidelines include data specifying the relative risk for concussion associated with different sports, and indicate that women are at higher risk for injury than men. No particular helmets, mouth guards, or headbands were proven more effective than others for reducing concussion rates in clinical studies.3

This article originally appeared on Clinical Pain Advisor