Domain 5: Sport Concussion Considerations



Refer a child/adolescent with multiple concussions or baseline conditions associated with concussion-like symptoms to an interdisciplinary concussion team to help with return to full-contact sports or high-risk activities or retirement decisions from full-contact sports or high-risk activities.

Level of Evidence:  

Return to full-contact sport or high-risk activity decisions can be complicated for children/adolescents with more complex medical histories. The following factors should be taken into consideration in the discussion and decisions made about return-to-sport or retirement: 

  • Concussion history.
  • Co-morbidities (e.g., learning and communication deficits, ADHD, physical disabilities, psychiatric disorders).
  • Absolute contraindications for return-to-sport and high-risk activities.
  • Early recurrence or greater frequency of symptoms.
  • Lower injury threshold.
  • Increasing recovery time.
  • Potential short- and long-term sequelae.

Some patients may benefit from neuropsychological assessment to determine resolution of cognitive problems. If a post-injury cognitive or neuropsychological assessment is deemed clinically necessary, it is recommended that this assessment be interpreted by a pediatric neuropsychologist.


Baseline testing on children/adolescents using concussion assessment tools or tests (or any combination of tests/tools) is not recommended or required for concussion diagnosis or management following an injury. 

Level of Evidence:   

See the Parachute Statement on Baseline Testing for more information (Parachute Canada). 

“Baseline testing refers to the practice of having an athlete complete certain concussion assessment tools/tests prior to sports participation to provide baseline measurements that can be compared to post-injury values in the event of a suspected concussion. Current evidence does not support a significant added benefit of baseline testing athletes. This includes the Child SCAT5 and the SCAT5 tools, as well as neuropsychological and neurocognitive tests, both computerized or not.” (Parachute Statement on Baseline Testing)

See Recommendation 5.3: Special considerations regarding baseline testing.


Special considerations regarding baseline testing.

Level of Evidence:   

Please consult the Parachute Statement on Baseline Testing for more information (Parachute Canada).

“There may be unique athlete populations and sports environments where baseline testing may be considered. These situations should be considered the exception and not the rule.” 

  • “Clinical neuropsychologists may consider baseline cognitive or neuropsychological testing in select youth athletes (greater than 12 years old) who have pre-existing conditions, such as a history of previous concussion, ADHD, or learning disorders, that may impact the interpretation of post-injury test results.”
  • “Certain teams and sporting federations have well-established physician-supervised concussion protocols with dedicated experienced healthcare professionals working directly and continuously with youth athletes (i.e., that are present at training and competition events). In these sport environments, baseline testing may be considered as an optional assessment within the comprehensive concussion protocol as long as the medical teams caring for these athletes include experienced healthcare professionals who have competency-based training and clinical experience to allow them to administer and interpret these tests.” 

(Reproduced with permission from Parachute Canada: Parachute Statement on Baseline Testing).



Recommendation 2.3d: Refer select patients (e.g., highly active or competitive athletes, those who are not tolerating a graduated return to physical activity, or those who are slow to recover) to a medically supervised interdisciplinary team with the ability to individually assess sub-symptom threshold aerobic exercise tolerance and to prescribe aerobic exercise treatment.

Level of Evidence: