Abstract Concussion symptoms are nonspecific and may be related to other causes. Symptom scores and timeline of return to activity at many institutions are based on having no symptoms at baseline with the current measurement tools. This assumption in the diagnosis and treatment of concussions may lead to prolonged return to activity, compounded concussion symptoms, and unintended psychological and social sequelae. More baseline data is needed, especially in military academies, according to the CARE Consortium Study. During the high-stress initial training period at one mid-Atlantic military college a no-symptom baseline is unlikely for first-year students. The potential overlap of concussion and typical baseline symptoms make diagnosis and release to activity a challenge for providers. A baseline survey of first-year, non-concussed students using a standard concussion scoring tool showed that 95 % of participants were symptomatic at baseline. Stakeholders were presented the results and a policy analysis using Bardach’s Eight-fold Path was performed comparing three other policy options. The policy analysis found that a narrower or less descriptive baseline description could have unintended negative impacts on clinical outcomes and provider liability. It also found that preseason baseline testing should be included for all students at the mid-Atlantic military college. Colleges, especially those in high-stress settings, should consider reevaluating baseline descriptions and testing recommendations in concussion policy to accommodate normal variations in symptomatology and provide freedom in clinical judgement
