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It is hard to miss the attention the media has given regarding concussions in the last 2 years. Just recently the NFL made a settlement for $765 million dollars due to a lawsuit with more than 4,500 former NFL players or their representatives. Millions have been pledged for research, education and prevention.

Not everyone understands just what a concussion is. Concussions can cause problems with thinking, remembering, physical and emotional symptoms or sleep disturbance. Last year I was the medical director of a sports concussion center that had seen 880 visits last school year. The previous year it was 500 visits, the year before 200. Why the increase? A perfect storm of media attention, state legislation and education efforts lead to an increased public awareness.

International Concussion Guidelines have been in place since a meeting in 2001 by the world experts in the field; they have been updated three times with the last being in 2012, and published this year. So, why still the confusion? We are facing a cultural shift in sports. We are educating players, referees, coaches, parents, kids and health care providers. Not everyone has embraced the changes. In NC, state law now requires clearance from a physician for high school athletes before they can return to play. Community and church leagues don't have the same mandates. In fact concussion diagnosis is often missed due to a lack of qualified individuals on the sidelines to help identify concussions.

As a provider I have received criticism from visiting teams' coaches, home teams' coaches and parents for making the diagnosis on the sideline. I've had kids try to hide their concussion and hide their symptoms to stay in the game. A study from Wisconsin in high school football athletes described over 40% of players failed to report a concussion during a season for a variety of reasons such as, not wanting to let the team or coach down, or not wanting to be pulled out of a game.

Obviously, we have a ways to go with education at all levels. An excellent resource is with free information for athletes to physicians. There are even free on-line training modules on the website. The quick take home is, if your child has any symptoms and you suspect a concussion they are out of any sporting activities or driving until cleared by a physician with training in concussion management.