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Top 10 Facts You Need to Know: Sport-Related Concussion BRIAN J. TOLLEFSON, MD, CAQ-SPORTS MEDICINE; RICHARD L. GRANTIER, MD; PATRICK O’BRIEN It is estimated that there are as many as 3.8 million sport-related concussions (SRC) annually in the United States.1 This number may actually be much higher as many SRC go undiagnosed or unreported. It is important for all primary care providers to become familiar with the current literature, management guidelines, and state laws pertaining to SRC. Sports-related concussion is a potentially serious injury that requires prompt identification and proper management to ensure a safe return to play.
1
The Consensus Statement on Concussion in Sport is a peerreviewed publication considered by many to be the gold standard for the diagnosis and management of sport-related concussion. The Consensus Statement on Concussion in Sport is the product of an international group of clinicians and researchers considered to be experts in the field of SRC. This Concussion in Sport Group (CISG) meets every four years to collaborate on a review of current literature and expert opinion related to SRC. The most recent meeting was held in Berlin in October 2016. The CISG consensus statement from that meeting was published in April 2017. The CISG consensus statement builds on the previously published Consensus statements.2-5 The CISG consensus statement is not intended to be a legal standard of care. It is intended to be a guide consistent with the “reasonable practice of a healthcare professional”.6
2
The definition of sport-related concussion is complex. The 2017 CISG consensus statement defines SRC as a traumatic brain injury induced by biomechanics forces with the following common features: • Caused by a direct blow to the head or an impulsive force transmitted to the head from elsewhere on the body. • Typically results in rapid onset and resolution of impaired neurological function. • E xhibits clinical signs and symptoms due to functional disturbance rather than structural injury—no abnormality seen on standard neuroimaging. • Results in a range of clinical signs and symptoms that often do not include loss of consciousness.
Although it is often done in practice and seen in literature, the CISG consensus statement guards against using the terms ‘sport-related concussion’ and ‘mild traumatic brain injury’ interchangeably.6,7
3
Medical providers caring for athletes must be up-to-date on the diagnosis and management of Sport-Related Concussion. The diagnosis of SRC is not always straightforward, and the misdiagnosis or mismanagement of SRC can have devastating consequences for the injured athlete. The clinical signs and symptoms are often subtle and may even be delayed for hours or days after the initial injury.8 It is important to be familiar with the signs and symptoms of SRC and maintain a strong index of suspicion for this often under recognized condition. Medical providers can gain valuable up-to-date SRC training by reviewing the 2017 Consensus Statement on Concussion in Sports referenced above6 and by completing the CDC HEADS UP to Health Care Providers online training modules.9
4
Sport-Related Concussion should be suspected in an athlete that displays any of the following signs and symptoms after a direct or indirect impact to the head:
• O bservable Signs—loss of consciousness, slowness to get up after a play, disorientation, blank stare, balance or coordination difficulties, head or facial injury, vomiting, emotional lability. • R eported Symptoms—headache, dizziness, blurred vision, sensitivity to noise or light, irritability, anxiousness, drowsiness, feeling slowed down or “in a fog”.
276 VOL. 59 • NO. 6/7 • 2018
