In Reply Casper raises the question of why we excluded discussion of second impact syndrome in our consensus statement.1 Second impact syndrome is an important topic with differing opinions regarding its pathophysiology and risk factors.2 More research is needed to accurately estimate the risk of second impact syndrome and to learn best prevention strategies. For these reasons, our panel elected not to include second impact syndrome as one of the questions to address. In addition, current understanding is that this syndrome appears to occur when a person who is already symptomatic from a current brain injury sustains a second impact to the brain. Laws in all 50 states and the District of Columbia currently specifically say that symptomatic players are not to return to play until provided medical clearance.
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Rivara FP, Giza CC, Gioia GA. Including Second Impact Syndrome in Sports-Related Concussions Evidence Review—Reply. JAMA Pediatr. Published online April 13, 2020. doi:10.1001/jamapediatrics.2020.0540
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