Cerebral concussions occur frequently in contact sports; more than 250 000 concussions occur annually in football alone. Definitions and classifications of severity of concussions vary, which makes evaluation of data extremely difficult. By combining elements of various definitions, the author has developed a practical, on-the-field grading scheme for identifying concussions in contact sports (grade 1: mild, with no loss of consciousness; grade 2: moderate, with less than five minutes of unconsciousness or more than 30 minutes of post-traumatic amnesia; grade 3: severe, with five or more minutes of unconsciousness or 24 or more hours of post-traumatic amnesia.) Also discussed are management of concussions and guidelines for determining when an athlete may safely return to play.
Boxing has been criticized as a brutal sport, and many have called for its abolition. The author reviewed the literature on the health hazards of boxing and found that it has a lower fatality rate than several other sports, including horseracing and parachuting. The most serious health effect of boxing is chronic encephalopathy that affects the pyramidal, extrapyramidal, and cerebellar systems. Often called punchdrunk syndrome, it appears to be directly related to skill level and frequency of participation. Symptoms usually do not appear until after the boxer has retired. The boxing council and a medical surveillance program are necessary to enforce uniform licensing and medical standards and to generate data for research.