Current International Consensus on Concussion
Every 4 or so years, a panel of medical experts meets to update and form a consensus on the best management of concussion. In late 2012 this was the 4th such gathering termed the Zurich 2012 Consensus Statement of Concussion in Sport. The results of this update have been published in the last week, bringing in a number of changes for doctors, trainers, players, and in the case of children, their parents. Some of the information is outlined below:
What is concussion?
Concussion can be defined as a clinical syndrome of neurological impairment that results from traumatic biomechanical forces transmitted to the brain (either directly or indirectly). The clinical features typically come on rapidly after injury and resolve spontaneously over a sequential course. Concussion reflects a functional rather than structural injury. This means that unlike higher grades of traumatic brain injury, there is no structural or anatomical damage evident in the brain.
How is it diagnosed?
Concussion is thought in be an evolving process, with symptoms and signs potentially deteriorating with time. For this reason a period of relative rest of 10 minutes is recommended before concussion assessment is made. Concussion can result in a number of signs and symptoms which the player may develop, including affected balance, loss of consciousness, convulsions, headache, blurred vision, and post traumatic amnesia, to name a few. Any or all of these symptoms make a diagnosis of concussion likely.
Should a player return to sport on the same day as a concussion?
No! There is overwhelming consensus that a concussed player cannot safely recover from their injury on the same day. Most football codes in Australia have mandatory rules that a concussed player is not to return to play, form the elite level, all the way down to grass roots games.
Is a loss of consciousness or convulsion mean a concussion is worse than simply developing a headache?
While both of these outcomes look impressive, and are frightening to see, they are simply different outcomes of a concussive injury. An immediate loss of consciousness does not mean that the concussion is any worse or has a poorer prognosis than a concussion resulting in visual disturbance or headache. Likewise immediate post concussive convulsions are common, typically transient, and often follow a blow to the face. The development of delayed loss of consciousness or convulsions is significant, and mandates hospital admission.
How can I know when it is safe to return to sport?
All concussed players should receive a medical clearance before being allowed to return to sport. A Sports and Exercise Medicine Physician is specially trained to assess resolution of symptoms, and guide a safe graded return to exercise. A number of tools are available including the updated SCAT3 assessment, a possibly computer based tests to determine balance and cognitive recovery. In rare cases symptoms will persist for >10 days, and specialist treatment is recommended.
What is CTE?
CTE stands for Chronic Traumatic Encephalopathy. It has received a lot of media attention recently, and is promoted heavily in the USA, where there is the suggestion that concussion injuries will inevitably lead to chronic and irreversible brain damage. The Zurich 2012 consensus suggests that as of now there is no confirmed causal relationship between concussion and exposure to contact sports and CTE.
Where can I get more information?
There are a number of online resources that can provide more information about concussion. Printable versions of SCAT3 and CRT are available at: http://links.lww.com/JSM/A30. Also both homepages for the AFL and IRB provide sport specific information about concussion.