New consensus published on preventing and treating sport-related concussions

There is no question that concussion is among the more concerning injuries in sport today. The question is how to best detect, assess, treat and prevent it.

Researchers at the University of Calgary's Faculty of Kinesiology have played an integral role in shaping an international consensus on recognizing and treating concussion in sport. The document, International Consensus Statement on Concussion in Sport, was published on April 26 in two special editions of the prestigious British Journal of Sports Medicine.

"This consensus was built on the latest scientific evidence and will have a profound impact diagnosing and treating sport-related concussions," says Dr. Willem Meeuwisse, MD, a sport medicine physician and epidemiologist who co-chaired the consensus conference. "While most people recover in the initial 10-14 day time period following injury, in some cases individuals may have symptoms that may persist."

This consensus statement builds on the previous 4th conference in Zurich, updates the assessment tools in light of the new evidence.

"Recognize and Remove" is essential

The document was written to assist doctors and health professionals in the care of athletes of all levels, including adults and children, that may have suffered a concussion. It also includes a tool with specific information for the general public and a specific tool for use in children under the age of 12.

"The new tools created from this consensus are designed to assist parents, coaches, officials and players to identify athletes with a potential concussion and remove the athlete from further risk of injury," says Dr. Carolyn Emery, PhD, physiotherapist and professor in the Faculty of Kinesiology.

"The overriding theme presented in this document is: 'recognize and remove.' In other words, when concussion is suspected, the athlete should be removed from the sporting environment and a comprehensive assessment should be conducted in a standardized way. If a concussion is diagnosed, they should not return to sport the same day," adds Meeuwisse.

International collaboration

Recognizing the impact of this potentially serious injury, the world's biggest sport bodies have helped support the consensus process and the statement created by scientists studying the current literature. These organizations include: the International Ice Hockey Federation (IIHF), the International Olympic Committee (IOC), FIFA, World Rugby, and the International Federation for Equestrian Sports (FEI).

More than 400 academics from 24 countries participated in the 5th International Consensus Conference in Berlin in October 2016. Over the past two years, a scientific committee and expert panel consisting of 33 individuals from around the globe with expertise in sport concussion, contributed through defining the key questions, completing literature reviews and met to come to a consensus on the research presented at the conference. The consensus statement is the summary of a list of specific topics that was agreed upon by the expert panel.

"One of the amazing things about this document is that it is a collaborative achievement by many people across the globe with different areas of expertise in sport-related concussion who have collaborated to come up with a unified answer to key questions in concussion," says Dr. Kathryn Schneider, PhD, physiotherapist and assistant professor in the Faculty of Kinesiology.

Sport Injury Prevention Research Centre plays key role

Three faculty members from the Sport Injury Prevention Research Centre in the Faculty of Kinesiology at the University of Calgary were involved in the process. The Sport Injury Prevention Research Centre is one of ten IOC Centres of Excellence in Injury and Illness Prevention in Sport in the world.

Dr. Willem Meeuwisse, a sport medicine physician and epidemiologist, co-chaired the consensus conference, known as the 5th International Consensus Conference on Concussion in Sport. Dr. Kathryn Schneider and Dr. Carolyn Emery (both physiotherapists and epidemiologists) played key roles, each leading one of the 12 key topic areas and systematic reviews addressed at the meeting on treatment and prevention, respectively.

A systematic review collects and critically analyzes multiple research studies or papers. These 12 papers were the basis upon which the consensus statement was written.

Previous consensus statements have been among the most highly cited papers in the area of sport related concussion, with the 4th international consensus statement being cited over 1500 times and a pdf version of the Sport Concussion Assessment Tool (SCAT3) being downloaded over 100,000 times.

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BACKGROUNDER: Summary of key points in consensus statement

(Source: Dr. Willem Meeuwisse, Dr. Kathryn Schneider and Dr. Carolyn Emery, Sport Injury Prevention Centre.)

'Recognize and Remove' for best management of concussion

Key points that are new in the 5th International Consensus statement on concussion in sport:

• If a concussion is suspected, the athlete should be removed from the sporting environment and a comprehensive assessment should be conducted in a standardized way by a qualified health care provider.

• A brief period of rest (24-48 hours) after injury is appropriate. After this time, patients should be encouraged to become gradually and progressively more active while staying below their physical and cognitive thresholds.

• Most individuals recover in the initial 10-14 days. Treatments including psychological, cervical and vestibular rehabilitation are now recognized as important components of recovery in some people. Submaximal and sub-symptom threshold exercise may also be of benefit.

• Advanced neuroimaging, fluid biomarkers and genetic testing are important research tools but require further research before they can be used in clinical decision making.

• The expected symptom duration in children is up to four weeks.

• Children should not return to sport until they have successfully returned to school. However, early introduction of symptom-limited physical activity is appropriate.

• The literature on long-term consequences of exposure to head trauma is inconsistent. Thus, further research in this area is needed to answer these important questions.

• Helmets in skiing/snowboarding have been shown to reduce the risk of traumatic brain injury (including concussion). In addition, policy disallowing body checking in youth ice hockey reduces the risk of concussion in 11-12 year old ice hockey players.

Key points related to concussion for the general public:

• A concussion should be suspected if any symptoms (such as headache, dizziness, blurred vision, etc) and/or visible signs of a concussion (lying motionless, slow to get up, disorientation, balance disturbances, etc) occur following a blow to the head.

• Athletes should be removed from play and not allowed to return to play until medically assessed and cleared by a physician to return to sport.

• Initially, a period of rest (24-48 hours) is recommended. After this time individuals are encouraged to become gradually more active and remain below their symptom threshold.

• Most adults recover in 10-14 days and most children recover in the initial 30 days. Treatment should be directed based on individualized comprehensive assessments and could include treatments such as psychological, cervical and vestibular rehabilitation. Submaximal exercise may be of benefit.

• Children should return to school prior to returning to sport.

• A gradual return to sport protocol should be completed prior to medical clearance to return to sport.

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