Quick Concussion Questions: What Athletic Trainers Should Ask Right Away

The Initial Clinical Objective

Athletic trainers must quickly determine:

• Whether a concussion is suspected.
• If immediate removal from play is warranted (spoiler: it almost always is when a concussion is suspected).
• What symptoms are present, and how they evolve in real time.

The initial conversation should collect specific, symptom-oriented, and context-sensitive data. These questions should not be generalized but targeted to the nature of the injury, witnessed behavior, and athlete’s subjective report.

Key Questions Every Athletic Trainer Should Ask

When a concussion is suspected, the first few minutes matter—but not all questions need to be asked at once. Some questions are meant for immediate sideline assessment, while others can be explored later during a more stable evaluation window (e.g., halftime, post-game, or in the training room).

Sideline Priorities: Maddocks Questions and Acute Assessment

These are rapid-response questions designed to assess orientation, memory, and cognitive function in the first moments following a potential concussion. They are commonly used on the field or court, often within seconds of contact, and are supported by the 6th International Consensus Statement on Concussion in Sport (Amsterdam, 2022).

1. “What venue are we at?”
   
   
2. “Which half is it now?”
   
   
3. “Who scored last in this game?”
   
   
4. “What team did you play last week?”
   
   
5. “Did your team win the last game?”
   
   

These questions, known as the Maddocks questions, help determine orientation and memory in real time. They are useful not only for diagnosis but also for deciding on immediate removal from play—any incorrect answer should raise concern for possible concussion and prompt removal for further evaluation.

Follow-Up Clinical Questions: Asked When Safe and Appropriate

After the athlete is safely removed from play—or if immediate danger has been ruled out—additional questions should explore symptom severity, neurologic function, and concussion history. These questions provide deeper clinical insights for guiding the next steps in care.

1. “What do you remember about what just happened?”
   Checks for anterograde and retrograde amnesia. Difficulty recalling events before or after the injury suggests cortical involvement, often affecting the medial temporal lobe and hippocampus.
   Research Note: Athletes with memory dysfunction immediately after injury are more likely to have longer recovery times (McCrea et al., 2003).
   
   
2. “Do you feel dizzy, foggy, or out of it?”
   Descriptions of fogginess or imbalance correlate with vestibular and cognitive disruption. These symptoms, especially in younger athletes, are associated with longer recoveries (Lau et al., 2011).
   
   
3. “Do you have a headache now?”
   Headache is the most common symptom in the minutes following a concussion. This question establishes a baseline for tracking changes over the first 24–48 hours.
   
   
4. “Did you feel dazed, or did you black out?”
   Helps detect loss of consciousness or altered awareness—both are red flags. Even the sensation of being "dazed" may reflect functional brain changes that require close monitoring.
   
   
5. “Have you felt like this before after a hit?”
   Previous concussion history significantly impacts risk for prolonged recovery and complicates baseline comparisons (Giza et al., 2013). This question is essential for context.
   
   
6. “Are you nauseated or sensitive to light or sound?”
   These symptoms suggest involvement of deeper brain structures and may point toward a migraine or vestibular profile. Their persistence into Day 2–3 is often linked to prolonged recovery (Meehan et al., 2013).
   
   

This two-tiered approach—starting with sideline Maddocks questions and following up with symptom-based assessment—helps athletic trainers triage efficiently, document thoroughly, and make informed recommendations for further care.

Applying the Questions in Clinical Context

Consider a high school soccer player who collides mid-air with another athlete and lands awkwardly, briefly staggering before walking off the field.

When approached, she reports feeling “a little off” but insists she’s “fine to keep playing.” Here’s how the above questions can guide a more clinically sound decision:

• Memory check: She can’t recall who took the last corner kick.
• Foggy feeling: She says her head feels “full” and “like it’s hard to think.”
• Headache: She reports pressure across her forehead.
• LOC: No blackout, but says things “went silent” for a second.
• History: This is her second concussion in 18 months.
• Light sensitivity: She squints even in late afternoon sun.

This constellation of symptoms warrants immediate removal from play and formal evaluation—aligning with consensus guidelines that emphasize an abundance of caution when in doubt.

What Not to Overlook

It’s tempting under pressure—especially in championship settings—to minimize symptoms or trust an athlete’s insistence that they're “okay.” But subtle signs often emerge only when systematically questioned.

Additionally, trainers must avoid the trap of equating normal sideline balance or orientation tests with clearance. The absence of dramatic signs doesn’t rule out a concussion. Many symptoms develop or worsen hours later, making the initial assessment vital not just for diagnosis but for tracking clinical trajectory.

Where to Go After the Questions

The information gathered should be meticulously documented and communicated to supervising physicians, neurologists, or concussion specialists as part of the broader management plan. The Consensus Statement (Amsterdam, 2022) reinforces a multi-domain approach—including symptom checklists, cognitive screening, and vestibular-ocular evaluations—which begins with the foundational data collected during the first few minutes post-injury.

This also underscores the role of athletic trainers not merely as first responders but as essential contributors to ongoing clinical decision-making.

Concussion assessment begins with questions—but the right ones. For athletic trainers, these early inquiries aren't routine—they’re critical clinical instruments that capture neurologic integrity when the brain is most vulnerable.

Incorporating these questions into sideline protocols, with follow-up over 24–48 hours, supports safer outcomes, earlier referrals, and athlete-centered care. And when time and judgment matter most, asking well is part of treating well.

References

• McCrea M, Guskiewicz KM, Marshall SW, et al. Acute effects and recovery time following concussion in collegiate football players: the NCAA Concussion Study. JAMA. 2003;290(19):2556–2563.
  
• Giza CC, Kutcher JS, Ashwal S, et al. Summary of evidence-based guideline update: Evaluation and management of concussion in sports. Neurology. 2013;80(24):2250–2257.
  
• Lau BC, Kontos AP, Collins MW, Mucha A, Lovell MR. Which on-field signs/symptoms predict protracted recovery from sport-related concussion among high school football players? Am J Sports Med. 2011;39(11):2311–2318.
  
• Meehan WP, Mannix RC, Monuteaux MC, et al. Early symptom burden predicts recovery after sport-related concussion. Pediatrics. 2013;133(6):999–1006.
• McCrory P, Meeuwisse W, Dvorak J, et al. Consensus Statement on Concussion in Sport—The 6th International Conference on Concussion in Sport. Br J Sports Med. 2023;57(11):695–711.