American doctors urge medical evaluations for all concussed athletes.

wants Americans to take the risk of sports concussions more seriously and is recommending that organizers of sports programs for children, teens and adults take stronger action to limit potential harm to athletes. A new position statement from the American Academy of Neurology recommends that any athlete who is suspected of having suffered a concussion be removed from participation until evaluated by a physician trained in the management of sports concussions (www .aan.com/globals/axon/assets/7913.pdf). The academy is also recommending that no athlete be allowed to participate in sports while still experiencing concussion symptoms and that any athlete who suffers a concussion consult a neurologist or physician with proper training before returning to play. Another recommendation from the academy is sure to prove more difficult to implement: The neurologists recommend that a certified athletic trainer be present at all sporting events — including practices — where athletes are at risk for concussions. Even Dr. Jeff Kutcher, lead author of the academy’s position statement and chair of its sports neurology section, acknowledges that’s not always feasible, due to the costs and limited availability of certified trainers. But he says the recommendation makes a statement about “what we think our priorities should be.” “If a school does not have access to a certified athletic trainer, they need to think long and hard about the safety of their kids and whether they should have contact sports,” he says. Kutcher says the most significant point in the neurologists’ position statement may be its shift away from a past practice parameter document that established a return-to-play protocol based on a graded scale of symptoms. The new emphasis on treating athletes as individuals, he says, should result in more athletes “going back to play when it is safe to do so and not too early and not too late.” The National Athletic Trainers’ Association says only about 40% of United States high schools have access to certified trainers for student athletes. Tamara McLeod, an associate professor in the athletic training program at A.T. Still University in Mesa, Arizona, says that in cases when a certified athletic trainer isn’t available, better education of parents and coaches about the importance of not returning athletes to play too soon is critical. In News CMAJ