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The Concussion Recognition Tool 5th Edition (CRT5): Background and rationale
Abstract
The Concussion Recognition Tool 5 (CRT5) is the most recent revision of the Pocket Sport Concussion Assessment Tool 2 that was initially introduced by the Concussion in Sport Group in 2005. The CRT5 is designed to assist non-medically trained individuals to recognise the signs and symptoms of possible sport-related concussion and provides guidance for removing an athlete from play/sport and to seek medical attention. This paper presents the development of the CRT5 and highlights the differences between the CRT5 and prior versions of the instrument.
... This affects energy production in the mitochondria, resulting in little energy (glucose) to regulate normal information processing, as well as, signal transduction around the brain in the right way. As a result, a player can experience any or a range of disparate clinical signs and symptoms, including poor attention, headache, confusion, as well as, cognitive, vestibular and ocular motor impairments [6,8]. These clinical and cognitive symptoms evolve over a number of minutes or hours following injury and will almost always resolve spontaneously [9,10]. ...
... The SCAT questionnaire evaluates both cognitive and physical symptoms based on a scale of 0-6, where 0 indicates the absence of symptoms, while six indicates the highest severity [8]. Reported symptoms (i.e. ...
... Other components captured in the SCAT include cognitive screening (i.e., orientation, immediate memory and concentration) with high cognitive scores indicative of good cognitive performance, while high balance examination scores indicative of balance deficits. The revision of the SCAT3 gave birth to the SCAT5 which was released after the fifth Concussion In Sport Group consensus conference in 2016 [8,9]. The SCAT3 questionnaire was used to assess concussion pre-2017 while the SCAT5 questionnaire was used post-2017. ...
Background
Sports-related concussion (SRC) is a common injury mostly in contact sports. Specifically, it is a public health concern for collegiate rugby athletes because at least one concussion is reported in every two games and concussion has been reported to increase the risk of developing neuro-degenerative disorders later in life.AimTo clinically audit concussions to examine commonly reported signs/symptoms in the Sports Concussion Assessment Tool (SCAT).Materials and methodsRetrospective audit of a South African University health services medical electronic records database for all concussion International Classification of Diseases 10 (ICD10) diagnoses codes: S06.0, S06.00 and S06.01 in 367 rugby players (age 24.6 ± 4.3, height 1.8 ± 0.1 and weight; 90.7 ± 14.4) for the period 2013–2018.ResultsSCAT data was obtained for 70% of the 434 concussions. Headache (57%), “pressure in head” (56%), feeling slowed down (55%) and fatigue/low energy (54%) were the most frequently reported concussion symptoms on the SCAT. A significant reduction in the serial SCAT symptom (p < 0.001) and severity (p < 0.001) scores was observed in a sub-set of the rugby players. The concussion incidence proportion was 7%; this was obtained from an annual estimate of the University rugby club’s registered players and concussion count (n = 87) during the five-year period.Discussion and conclusionsThe initial SCAT sub-domain scores following a SRC in this collegiate cohort were consistent with other elite adult male sport cohorts in endorsing many symptoms and showing low-concentration scores. A unique feature of this study was the tracking of serial symptoms in a sub-set of this cohort. These players showed a clear reduction in symptom endorsement, but were still not symptom-free by their third SCAT. The collegiate student population should be educated regarding symptoms, including headache, which might be indicative of concussion following a head injury.
... Studies examining the impact of rest and activity post injury (9,10) have led to recommendations that cognitive and physical rest is appropriate for only a brief period (24 to 48 hours post injury), followed by graduated increases in activity in the context of symptom monitoring (11,12). Based on this information, the International Concussion in Sports Group (CISG) recently created guidelines (2) and tools (13)(14)(15) to assist with concussion recognition, and safe return to school and play (2). These guidelines have been adopted by major sporting codes (16,17) and incorporated into hospital guidelines (18). ...
... The app was developed as part of a collaboration between the Murdoch Children's Research Institute (MCRI), the Royal Children's Hospital (RCH) and the Australian Football League (AFL). The app's content is consistent with the 5 th CISG consensus guidelines (2), and incorporates validated tools such as the Sports Concussion Assessment Tool 5 th Edition (SCAT5 and Child SCAT5) (14,15), the Pocket Concussion Recognition Tool 5 th Edition (CRT5) (13), and the Post Concussion Symptom Inventory (PCSI) (24), in an accessible tool, delivered via smartphone. ...
... HeadCheck content is derived from the 5 th CISG consensus statement (2,6), validated tools (13)(14)(15)24), and current clinical best practice. The app reduces the barrier of paper or online resources (19) and facilitates easy access to information via smartphone. ...
Pediatric concussion is a growing health concern. Concussion is generally poorly understood within the community. Many parents are unaware of the signs and varying symptoms of concussion. Despite the existence of concussion management and return to play guidelines, few parents are aware of how to manage their child’s recovery and return to activities. Digital health technology can improve the way this information is communicated to the community. A multidisciplinary team of pediatric concussion researchers and clinicians translated evidence-based, gold-standard guidelines and tools into a smartphone application with recognition and recovery components. HeadCheck* is a community facing digital health application developed in Australia for management of concussion in children aged 5–18 years. The application consists of (I) a sideline concussion check and (II) symptom monitoring and symptom-targeted psychoeducation to assist the parent manage their child’s safe return to school, exercise and sport. The application was tested with target end users as part of the development process. HeadCheck provides an accessible platform for disseminating best practice evidence. It provides feedback to help recognize a concussion and symptoms of more serious injuries and assists parents guide their child’s recovery.
... 3 However, disagreements among concussion assessment measures and return to play (RTP) guidelines for athletes have resulted in a lack of a gold standard for concussion management, 4 and there remains relatively little research in examining the efficacy of tools in identifying concussion in sports. 5 What is known is that when assessing concussion for RTP decisions, a comprehensive approach is best. 6 However, most guidelines tend to focus on loss of consciousness (LOC) and post-traumatic amnesia (PTA) as hallmarks for identifying concussion, 7 and there has been argument in the literature regarding the onset of concussive symptoms (e.g. ...
... The pocket concussion recognition tool-fifth edition (CRT5) 23 was developed following a revision of the Pocket SCAT2 which comprised of concussion symptoms, and brief assessment of memory and balance. 5 The Pocket CRT5 expanded the SCAT2 to include more information about symptoms and signs of concussion. 5 The tool is relatively new and not yet widely disseminated, 5 and as such, there is limited evidence for validity and reliability. ...
... 5 The Pocket CRT5 expanded the SCAT2 to include more information about symptoms and signs of concussion. 5 The tool is relatively new and not yet widely disseminated, 5 and as such, there is limited evidence for validity and reliability. 24 A benefit of the tool, however, is that it does not rely on medically trained practitioners to deliver the assessment to inform management of concussion, 5 which allows for wider use and accessibility for sporting teams, thereby eliminating limitations outlined above for the SCAT5. ...
Currently, there is a lack of clear, “gold standard” guidelines for the identification and management of sports-related concussion. This is of concern considering the importance of preventing further injury during game-play. Moreover, a number of assessment measures and tools aim to detect concussion in athletes and help inform return to play decisions, including the assessment of posture and balance, eye-saccades, memory, attention, orientation and post-concussive symptomatology. However, they have often not been widely disseminated for validity studies, and their utility or sensitivity in detecting concussion is limited due to a number of factors. As such, this review will examine current guidelines and sideline assessments measures which aim to inform decisions about return to play following sports-related concussion.
... 2,12 Any obvious signs exhibited by an athlete may be very transient and not observed by medical personnel. 11,13 Several professional leagues now employ "spotters" whose sole responsibility is to watch a competition and its visual media coverage to alert appropriate medical staff if they visualize behavior suggestive of a concussion in any of the athletes competing. 14,15 Although this may help identify some athletes who may have suffered a concussion, physicians, therapists, and trainers are often dependent on athletes coming forward to volunteer their symptoms to make the diagnosis of a concussion. ...
... Although the diagnosis of a concussion should only be made after examination by a medical professional knowledgeable in sport-related concussions, very often the first step in this process is an athlete recognizing that they may have suffered a concussion and seeking assessment by team medical staff or other healthcare professionals. In this study, a minority of athletes who believed they had suffered at least one concussion during the previous season of football reported always seeking medical attention (17.9% in All athletes Age started playing sport 12 (8)(9)(10)(11)(12)(13)(14) 12 (9)(10)(11)(12)(13)(14) How many years played organized tackle football ...
... Although the diagnosis of a concussion should only be made after examination by a medical professional knowledgeable in sport-related concussions, very often the first step in this process is an athlete recognizing that they may have suffered a concussion and seeking assessment by team medical staff or other healthcare professionals. In this study, a minority of athletes who believed they had suffered at least one concussion during the previous season of football reported always seeking medical attention (17.9% in All athletes Age started playing sport 12 (8)(9)(10)(11)(12)(13)(14) 12 (9)(10)(11)(12)(13)(14) How many years played organized tackle football ...
Objective:
To determine why professional football players in Canada decided not to seek medical attention during a game or practice when they believed they had suffered a concussion.
Design:
Retrospective survey.
Setting:
Preseason Canadian Football League training camps.
Participants:
Four hundred fifty-four male professional football players.
Main outcome measures:
Reasons athletes did not seek medical attention for a presumed concussion during the previous season, how often this occurred and how important these reasons were in the decision process.
Results:
One hundred six of the 454 respondents (23.4%) believed they had suffered a concussion during their previous football season and 87 of the 106 (82.1%) did not seek medical attention for a concussion at least once during that season. The response "Did not feel the concussion was serious/severe and felt you could still continue to play with little danger to yourself" was the most commonly listed reason (49/106) for not seeking medical attention for a presumed concussion. Many players answered that they did not seek medical attention because they did not want to be removed from a game (42/106) and/or they did not want to risk missing future games (41/106) by being diagnosed with a concussion.
Conclusions:
Some professional football players who believed they had suffered a concussion chose not to seek medical attention at the time of injury. Players seemed educated about the concussion evaluation process and possible treatment guidelines, but this knowledge did not necessarily translate into safe and appropriate behavior at the time of injury.
... The CISG has developed a separate tool, the Concussion Recognition Tool 5 (CRT5), for use by non-medically trained individuals such as parents, coaches, players, officials, sports administrators and teachers. 23 The CRT5 is designed to assist in recognising suspected concussion in children, adolescents and adults and to provide information about initial management, including removal from the field of play. 23 In the absence of life-threatening trauma or red flags, any athlete who is suspected of having a concussion should not be left unsupervised and should be referred to a medical professional for further assessment. ...
... 23 The CRT5 is designed to assist in recognising suspected concussion in children, adolescents and adults and to provide information about initial management, including removal from the field of play. 23 In the absence of life-threatening trauma or red flags, any athlete who is suspected of having a concussion should not be left unsupervised and should be referred to a medical professional for further assessment. 20 If SRC is suspected by on-field healthcare staff or match officials and if there are no medical staff on-site to determine otherwise, the athlete cannot return to play that day. ...
Sport-related concussion is a common sporting injury induced by biomechanical forces. It results in transient impairment of neurological function that typically resolves spontaneously but can
be prolonged in some individuals. Differentiating concussion from structural head injuries and other serious pathologies is essential. Evidence-based strategies can guide decision-making when assessing and managing an athlete with possible sport-related concussion.
... The Concussion recognition Tool (CRT) provides information for the rescuer, medical or not, to carry out a practical and quick approach in the first care of the concussion victim. 8 Now the Sport Concussion assessment Tool (SCAT) is a more complete tool, used by the physician or qualified health professional in emergency care, commonly used in the locker room and in the evolutionary clinical follow-up of the athlete after the concussion. 8 In the case of suspected concussion, the athlete must be removed from the game, both due to the damage to his performance and the risk to his health, regardless of the technical or tactical conditions involved in the match. ...
... 8 Now the Sport Concussion assessment Tool (SCAT) is a more complete tool, used by the physician or qualified health professional in emergency care, commonly used in the locker room and in the evolutionary clinical follow-up of the athlete after the concussion. 8 In the case of suspected concussion, the athlete must be removed from the game, both due to the damage to his performance and the risk to his health, regardless of the technical or tactical conditions involved in the match. This is an important concept that should be widely disseminated to all those who work in the sport. ...
Soccer is one of the most popular sports around the world. The large number of practitioners, associated with technical and tactical characteristics, make it subject to a large number of injuries. Therefore, it is necessary the continuous training of health professionals who act as rescuers in soccer matches. In addition, due to a series of factors, there is currently an increase in the number of potentially more serious injuries, especially concussions. This has caused concern not only for health professionals, but also for the institutions that regulate the practice of sport. In professional soccer, there is a minimum requirement of material and human resources that guarantee greater safety for competitors, something not observed in amateur. The dissemination of basic first aid knowledge is extremely relevant and should cover the entire public involved in the sport.
... If the medical staff member knows the athlete well and is familiar with his/her normal behaviour, it may be easy to identify an aberrant level of functioning. The Concussion Recognition Tool 5 (CRT5) is the most recent revision of the Pocket Sport Concussion Assessment Tool introduced by the Concussion in Sport Group in 2005 that also may be used by the nonmedical "lay" person [14]. ...
... The simple adage "If in doubt, sit them out" was first suggested by the CISG in 2002 [17]. It is recommended that athletes with suspected/diagnosed SRC should not be left alone during the first 1-2 h, not use alcohol/recreational drugs, not be sent home alone and not drive in the acute postinjury period [14]. After this initial, acute phase, the graded return-to-play should then ensue. ...
Traumatic brain injury (TBI) is a major cause of acquired disability globally, and effective treatment methods are scarce. Lately, there has been increasing recognition of the devastating impact of TBI resulting from sports and other recreational activities, ranging from primarily sport‐related concussions (SRC) but also more severe brain injuries requiring hospitalization. There are currently no established treatments for the underlying pathophysiology in TBI and while neuro‐rehabilitation efforts are promising, there are currently is a lack of consensus regarding rehabilitation following TBI of any severity. In this narrative review, we highlight short‐ and long‐term consequences of SRCs, and how the sideline management of these patients should be performed. We also cover the basic concepts of neuro‐critical care management for more severely brain‐injured patients with a focus on brain edema and the necessity of improving intracranial conditions in terms of substrate delivery in order to facilitate recovery and improve outcome. Further, following the acute phase, promising new approaches to rehabilitation are covered for both patients with severe TBI and athletes suffering from SRC. These highlight the need for co‐ordinated interdisciplinary rehabilitation, with a special focus on cognition, in order to promote recovery after TBI.
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Abstract
symposium:Head Trauma in Sports and Risk for Dementia
... It is envisaged that this will: 1) improve safety and health outcomes for Taekwondo athletes who suffer concussive injuries; 2) assist athletes, coaches, parents, officials, administrators, and other relevant persons to recognize and manage concussion in Taekwondo athletes; and 3) assist Taekwondo governing bodies and clubs to align their policies and procedures to the current best evidence. This position statement is based on the most recent international consensus statement on concussion in sport and its supporting literature reviews and documents (5,6,7,9,12,13), which were developed in conjunction with the 5 th International Conference on Concussion in Sport, held in Berlin, Germany in October 2016; and a round-table discussion on concus-sion in Taekwondo, which was held during the 6 th International Symposium for Taekwondo Studies in Muju, Korea in June 2017. ...
... Recognizing concussion is vital for correct management and prevention of further injury (13). Recognizing concussion can be difficult because the signs and symptoms are variable, non-specific, sometimes subtle, and may evolve over time, especially during the first week after concussion occurs (5,13). Observers should suspect concussion when a blow to the head, neck, or body that transmits an impulsive force to the head. ...
The primary aim of this position statement is to encourage Taekwondo governing bodies to develop and implement evidence-informed, best practice concussion protocols and guidelines. It is envisaged that this will: 1) improve safety and health outcomes for athletes who suffer concussive injuries while participating in Taekwondo activities; 2) assist athletes, coaches, parents , officials, administrators, and other relevant persons to recognize and manage concussion in Taekwondo athletes; and 3) assist Taekwondo governing bodies and clubs to align their policy and procedures to the most up-to-date evidence. This position statement is predominantly based on the most recent international consensus statement on concussion in sport and its supporting literature reviews and documents, which were developed in conjunction with 5th International Conference on Concussion in Sport held in Berlin in October 2016.
... Participants were monitored for signs of concussion (adverse event [AE]) using Parts 1-3 of the CRT-5 [29], at Post, 2.5 hrs Post, 4-8 hrs Post and 24 hrs Post Task (Fig. 1). Parts 1 and 2 were used to identify 'red ag' and 'observable sign(s)' of concussion. ...
Background
Head impacts, particularly, non-concussive impacts, are common in sport. Yet, their effects on the brain are poorly understood. Here, we investigated the acute effects of non-concussive impacts on brain microstructure, chemistry, and function using magnetic resonance imaging (MRI) and other techniques.
Results
Fifteen healthy male soccer players completed this randomised, controlled, crossover trial. Participants completed a soccer heading task (‘Heading’; the Intervention) and an equivalent ‘Kicking’ task (the Control); followed by a series of MRI sequences between ~ 60–120 minutes post-tasks. Blood was also sampled, and cognitive function assessed, pre-, post-, 2.5 hours post-, and 24 hours post-tasks. Brain chemistry: Heading increased total N-acetylaspartate (p = 0.012) and total creatine (p = 0.010) levels in the primary motor cortex (but not the dorsolateral prefrontal cortex) as assessed via proton magnetic resonance spectroscopy. Glutamate-glutamine, myoinositol, and total choline levels were not altered in either region. Brain structure: Heading had no effect on diffusion weighted imaging metrics. However, two blood biomarkers expressed in brain microstructures, glial fibrillary acidic protein and neurofilament light, were elevated 24 hours (p = 0.014) and ~ 7-days (p = 0.046) post-Heading (vs. Kicking), respectively. Brain function: Heading decreased tissue conductivity in five brain regions (p’s < 0.001) as assessed via electrical properties tomography. However, no differences were identified in: (1) connectivity within major brain networks as assessed via resting-state functional MRI; (2) cerebral blood flow as assessed via pseudo continuous arterial spin labelling; (3) electroencephalography frequencies; or (4) cognitive (memory) function.
Conclusions
This study identified chemical, microstructural and functional brain alterations in response to an acute non-concussive soccer heading task. These alterations appear to be subtle, with some only detected in specific regions, and no corresponding functional deficits (e.g., cognitive, adverse symptoms) observed. Nevertheless, our findings emphasise the importance of exercising caution when performing repeated non-concussive head impacts in sport.
Trial registration
ACTRN12621001355864. Date of registration 7/10/2021. URL https//www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382590&isReview=true
... Research methodologies are not able to standardise or control factors that may influence a recovery trajectory, such as the mechanism of injury interacting with individual characteristics and physiology (Cancelliere et al., 2016;Davidson et al., 2015;Duhaime & Rindler, 2015;Isokuortti et al., 2016), individuals suffering a variety of impairments (Ellis et al., 2016;Schneider, 2019) and varying behaviour, social and academic demands and compliance to post-SRC advice varying between individuals (Bigler et al., 2015;McCauley et al., 2013;Rosenbaum & Lipton, 2012). Whilst there are studies assessing how long recovery of symptom burden (Asken et al., 2018;Chorney et al., 2017;Collins et al., 1999;Covassin et al., 2012b;Echemendia et al., 2017;Elbin et al., 2011;Guskiewicz et al., 2003;Howell et al., 2018;Macciocchi et al., 1996;McCauley et al., 2013;McCrea et al., 2020;Wang et al., 2018;Zhu et al., 2015) and neurocognitive impairment takes (Covassin et al., 2012b;Elbin et al., 2011;Field et al., 2003;Guskiewicz et al., 2003;Hoffman et al., 2017;Kerr et al., 2016;Patricios et al., 2018;Zhu et al., 2015), only a handful have reassessed at specific time points (Broglio, Macciocchi, & Ferrara, 2007a, 2007bGallagher et al., 2018;Hoffman et al., 2017;McCrea et al., 2003;Resch et al., 2015;Zuckerman et al., 2012). In the aforementioned studies, individuals have reassessed individuals on different days and reported as a singular reassessment time point. ...
Background
Time to recovery for symptom burden and neurocognition following a Sports-Related Concussion (SRC) has previously been determined by consolidating varying re-assessment time points into a singular point, and has not been established for Vestibular-Ocular-Motor (VOM) function or academic ability.
Objectives
Establish when recovery of symptom burden, neurocognition, VOM function, and academic ability occurs in university-aged student-athletes.
Methods
Student-athletes completed an assessment battery (Post-Concussion Symptom Scale (PCSS), Immediate Post-Concussion Assessment and Cognitive Test (ImPACT), Vestibular Ocular-Motor Screening (VOMS), Perceived Academic Impairment Tool (PAIT)) during pre-season (n = 140), within 48 hours, 4, 8 and 14 days post-SRC and prior to Return To Play (RTP) and were managed according to the rugby Football Union’ community pathway (n = 42). Student-athletes were deemed recovered or impaired according to Reliable Change Index’ (RCI) or compared to their individual baseline.
Results
Symptom burden recovers by four days post-SRC on RCI and to baseline by eight days. VOM function and academic ability recovers by 8 days. Some student-athletes demonstrated worse performance at RTP on all tests by RCI and to baseline, except for on VOMS score and near point convergence by RCI change.
Conclusions
Variation in individual university-aged student-athletes requires a multi-faceted approach to establish what dysfunctions post-SRC exist and when recovery occurs.
... In 2017 the Concussion Recognition Tool, CRT 5,209,210 was introduced to be used by non-healthcare professionals but, to date, there are no published validation data for this tool. ...
The European Resuscitation Council has produced these first aid guidelines, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics include the first aid management of emergency medicine and trauma. For medical emergencies the following content is covered: recovery position, optimal positioning for shock, bronchodilator administration for asthma, recognition of stroke, early aspirin for chest pain, second dose of adrenaline for anaphylaxis, management of hypoglycaemia, oral rehydration solutions for treating exertion-related dehydration, management of heat stroke by cooling, supplemental oxygen in acute stroke, and presyncope. For trauma related emergencies the following topics are covered: control of life-threatening bleeding, management of open chest wounds, cervical spine motion restriction and stabilisation, recognition of concussion, cooling of thermal burns, dental avulsion, compression wrap for closed extremity joint injuries, straightening an angulated fracture, and eye injury from chemical exposure.
... Additionally, it has been demonstrated to be unreliable and subject to individual bias. 16,17 Although the AFL also recommends the community-based Concussion Recognition Tool 5th (CRT5), 18 which can similarly be used to help identify players with suspected concussion on the basis of concussion signs and/or reported symptoms, the CRT5 does not include the sign ''no protective action in fall to ground,'' and includes non-specific signs of concussion (e.g., slow to get up, facial injury) which may increase the likelihood of a type I error. 2,6,19 At the professional level in rugby, Gardner and coworkers examined the relationship between observable signs of concussion in video footage and clinical outcomes of concussion using the SCAT3. ...
Video surveillance and detection of players with observable signs of concussion by experienced medical staff facilitates rapid on-field screening of suspected concussion in professional sports. This method, however has not been validated in community sports where video footage is unavailable. This study aimed to explore the utility of observable signs of concussion to identify players with decrements in performance on concussion screening measures. In this observational prospective cohort study, personnel with basic training observed live matches across a season (60 matches) of community male and female Australian football for signs of concussion outlined in the community-based Head Injury Assessment form (HIAf). Players identified to have positive signs of concussion (CoSign+) following an impact were compared to players without signs (CoSign-). Outcome measures, the Sport Concussion Assessment Tool (SCAT3) and Cogstate, were administered at baseline and post-match. CoSign+ (n = 22) and CoSign- (n = 61) groups were similar with respect to age, sex, education, baseline mood, and medical history. CoSign+ players exhibited worse orientation, concentration, recall, and slower reaction time in attention and working memory tasks. Comparing individual change from baseline to post-match assessment revealed 100% (95% CI: 84%- 100%) of CoSign+ players demonstrated clinically-significant deficits on SCAT3 or Cogstate tasks, compared to 59% (95% CI: 46% to 71%) of CoSign- players. All CoSign+ players observed to have a blank/vacant look demonstrated clinically-significant decline on the Standardized Assessment of Concussion (SAC). Detection of observable signs of concussion represents a rapid, real-time method to screen players suspected of concussion in community sports where video technology and medical personnel are rarely present. Consistent with community guidelines, it is recommended that all CoSign+ players are immediately removed from play for further concussion screening.
... Coaches' in NZ who reported the safest response (27%, strongly agree) were also much lower than American university coaches (40%). 51 As per the Concussion Recognition Tool (CRT5), 70 and the Sport Concussion Assessment Tool (SCAT5), 71 the loss of consciousness is a "red flag" that requires the player to be referred to immediate care. 10 Future coach education initiatives should attempt to address this lack of knowledge regarding "red flag" identification and the need for immediate care referral. ...
The aim of this study was to evaluate New Zealand high school rugby union players’ and community coaches’ concussion knowledge (CK), concussion attitude (CA) and concussion reporting intentions (CRI) and to explore the impact gender, age, ethnicity, socio-economic status, experience, and concussion history had on these outcome measures. This cross-sectional study utilised the Rosenbaum Concussion Knowledge and Attitudes survey to evaluate CK, CA and CRI. The survey and demographic information were completed by 533 high school players (61.5% male, M = 16.2 yrs) and 733 community rugby coaches (93.0% male, M = 42.2 yrs). Coaches displayed greater awareness, safer attitudes, and stronger reporting intentions towards concussion than players. Among players, differences in CK, CA and CRI were observed by gender, ethnicity, and socio-economic status. Among coaches, differences in CRI were found by age and coaching experience. No differences were observed for age or concussion history in players. Gender, ethnicity, and grade coached were not significant for coaches. Players who identified as Māori or Pasifika and those from schools in low socio-economic areas displayed poorer CK and CA. Years of experience for both players and coaches played a critical role in improving CA and is a factor that should be considered when welcoming new participants to either role. Concussion non-disclosure is a systemic issue and is common across gender, ethnicity and socio-economic status and appears to worsen as the playing season progresses. More work is needed to develop educational strategies that are both culturally responsive, sustainable, and address reporting behaviours.
... If no physician is present, the principles of "recognize and remove" and "if in doubt, sit them out" should be applied. 38 During this initial examination, it is essential to focus on red and orange flags. The elements of the initial (on-pitch) inspection and examination ( Figure 4) are based on the latest version of the Sport Concussion Assessment Tool (eg, SCAT5™) 39 and the NICE criteria. ...
Head injuries can result in substantially different outcomes, ranging from no detectable effect to transient functional impairments to life‐threatening structural lesions. In high‐level international football (soccer) tournaments, on average, one head injury occurs in every third match. Making the diagnosis and determining the severity of a head injury immediately on‐pitch or off‐field is a major challenge for team physicians, especially because clinical signs of a brain injury can develop over several minutes, hours or even days after the injury. A standardised approach is useful to support team physicians in their decision whether the player should be allowed to continue to play or should be removed from play after head injury.
A systematic, football‐specific procedure for examination and management during the first 72 hours after head injuries and a graduated Return‐to‐Football programme for high‐level players has been developed by an international group of experts based on current national and international guidelines for the management of acute head injuries. The procedure includes seven stages from the initial on‐pitch examination to the graduated Return‐to‐Football programme. Details of the assessments and the consequences of different outcomes are described for each stage. Criteria for emergency management (red flags), removal from play (orange flags), and referral to specialists for further diagnosis and treatment (persistent orange flags) are provided. The guidelines for Return‐to‐Sport after concussion‐type head injury are specified for football. Thus, the present paper presents a comprehensive procedure for team physicians after a head injury in high‐level football.
... The consensus statement does provide the opportunity for non-medically trained personnel to recognise the signs of concussion for which there are two well-known instruments. The Concussion Recognition Tool (version 5) is a pocket-sized card that lists the 'red-flags' of concussion that require an ambulance; then if no 'red-flags' are apparent, simple steps to observe signs and symptoms in the individual ( Echemendia et al., 2017). A second assessment that is gaining popularity is the King-Devick (KD) Galetta et al., 2016;Nguyen, King, & Pearce, in press;Rist, Cohen, & Pearce, 2017). ...
This article updates coaches and tennis sports scientists on recent changes to the consensus statement for sports-related concussion. Specifically, the article provides new information that can be applied to tennis. While concussion in tennis is rare, head injuries in tennis do occur. It is important that in-lieu of medical staff available at training or tournaments, coaches and sports science practitioners are concussion aware.
... For example, facilities appropriately set-up to provide room for medical assessment and alternative rest of the field for all injured athletes. These facilities should be staffed with properly trained professionals that understand the assessment processes that are guided by Sports Concussion Assessment Tool 5 (SCAT5) and Concussion Recognition Tool 5 (CRT5) [44]. ...
Head injuries in sports often go unnoticed and untreated with a risk of increasing the severity of neurological difficulties for affected athletes. While there is much research on athletes in developed countries, the data on athletes from developing countries is lacking. Using a descriptive case study approach, this report focuses on concussions from four main sports (football, athletics, basketball and rugby). Emphasis was placed on those athletes who had been identified with a sport-related concussion (SRC). The phases of emergency, intermediate, rehabilitative, and return to sports participation were considered in this study. Three SRC cases from both male and female athletes were observed and interviewed for post-injury management from the emergency phase to return to sports participation. There was evidence of lack of specific pre-season screening of athletes for concussion history and standard care for concussed athletes in all the three cases observed using the best medical practice framework. Our study shows barriers such as knowledge among the sports resource providers; a law and policies to mandate care, and the absence of specific facilities for managing athletes with concussions. Implementation of sports health care policies is necessary to mandate care for athletes. Strategies for prevention and management of concussions are necessary, especially through increasing the awareness and knowledge using the Concussion Awareness Training Tool (CATT). Further studies with larger samples are encouraged to ascertain the magnitude of existing barriers.
... In lower levels of competition where trained medical staff are not available, off-field concussion screening tests are not recommended, and a 'recognise and remove' strategy is more appropriate, with immediate withdrawal from play when there is any degree of suspicion of concussion. [22] Previously administered as test cards, the KD test is now currently available only as a proprietary tablet application. Preceding studies have suggested differential baseline performance between these formats, and although unlikely, it is possible that diagnostic accuracy could also vary across these configurations. ...
Background
The King-Devick (KD) test is an objective clinical test of eye movements that has been used to screen for concussion. We characterised the accuracy of the KD test and the World Rugby Head Injury Assessment (HIA-1) screening tools as methods of off-field evaluation for concussion after a suspicious head impact event.
Methods
A prospective cohort study was performed in elite English rugby union competitions between September 2016 and May 2017. The study population comprised consecutive players identified with a head impact event with the potential to result in concussion. The KD test was administered off-field, alongside the World Rugby HIA-1 screening tool, and the results were compared with the preseason baseline. Accuracy was measured against a reference standard of confirmed concussion, based on the clinical judgement of the team doctor after serial assessments.
Results
145 head injury events requiring off-field medical room screening assessments were included in the primary analysis. The KD test demonstrated a sensitivity of 60% (95% CI 49.0 to 70) and a specificity of 39% (95% CI 26 to 54) in identifying players subsequently diagnosed with concussion. Area under the receiver operating characteristic curve for prolonged KD test times was 0.51 (95% CI 0.41 to 0.61). The World Rugby HIA-1 off-field screening tool sensitivity did not differ significantly from the KD test (sensitivity 75%, 95% CI 66 to 83, P=0.08), but specificity was significantly higher (91%, 95% CI 82 to 97, P<0.001). Although combining the KD test and the World Rugby HIA-1 multimodal screening assessment achieved a significantly higher sensitivity of 93% (95% CI 86% to 97%), there was a significantly lower specificity of 33% (95% CI 21% to 48%), compared with the HIA-1 test alone.
Conclusions
The KD test demonstrated limited accuracy as a stand-alone remove-from-play sideline screening test for concussion. As expected with the addition of any parallel test, combination of the KD test with the HIA-1 off-field screening tool provided improved sensitivity in identifying concussion, but at the expense of markedly lower specificity. These results suggest that it is unlikely that the KD test will be incorporated into multimodal off-field screening assessments for concussion at the present time.
Traumatic brain injury (TBI) in sports, encompassing sport-related concussions (SRCs) and more severe injuries, poses a significant challenge globally. This review explores the challenges of TBI in sports, focusing on mild TBIs and SRC. Over 70% of TBIs are mild, presenting diverse challenges with a lack of consensus on rehabilitation. Diagnosis is challenging, and prognosis varies. Assessment tools like Sports Concussion Assessment Tool-5 th Edition aid in sideline evaluation, and management involves rest and personalised rehabilitation. Prevention involves rule enforcement, education, ongoing research exploring neuroimaging techniques and the use of novel assessment tools. Collaborative, individualised approaches are crucial for TBI rehabilitation in sports. Further research is needed to refine strategies and enhance preventive measures.
Objective
To provide athletic trainers and team physicians with updated recommendations to the 2014 National Athletic Trainers’ Association (NATA) concussion position statement regarding concussion management, specifically in the areas of education, assessment, prognostic factors, mental health, return to academics, physical activity, rest, treatment, and return to sport.
Background
Athletic trainers have benefited from the 2 previous NATA position statements on concussion management, and although the most recent NATA position statement is a decade old, knowledge gains in the medical literature warrant updating several (but not all) recommendations. Furthermore, in various areas of the body of literature, current evidence now exists to address items not adequately addressed in the 2014 statement, necessitating the new recommendations. This document therefore serves as a bridge from the 2014 position statement to the current state of concussion evidence, recommendations from other organizations, and discrepancies between policy and practice.
Recommendations
These recommendations are intended to update the state of the evidence concerning the management of patients with sport-related concussion, specifically in the areas of education; assessment advances; prognostic recovery indicators; mental health considerations; academic considerations; and exercise, activity, and rehabilitation management strategies.
Introduction
Sport-related concussions (SRC) have been a concern in all sports, including soccer. The long-term effects of soccer-related head injuries are a public health concern. The Concussion in Sport Group (CISG) released a consensus statement in 2017 and several soccer governing associations have published their own SRC guidelines while referring to it but it is unclear whether this has been universally adopted.
Research question
We aimed to investigate whether guidelines published by soccer associations have any discrepancies; and the extent to which they follow the CISG recommendations.
Materials and methods
A scoping review of available soccer-specific SRC guidelines was performed via databases PubMed, Google Scholar, and official soccer association websites via web browser Google. The inclusion criteria were soccer-specific SRC guidelines. Comparisons between guidelines were made concerning the following index items: initial (on-site) assessment, removal from play, re-evaluation with neuroimaging, return-to-sport protocol, special populations, and education.
Results
Nine soccer associations with available guidelines were included in this review. Guidelines obtained were from official associations in the United Kingdom, United States of America, Canada, Australia, and New Zealand. When compared to each other and the CISG recommendations, discrepancies were found within guidelines regarding the index items. Additionally, major soccer associations in some countries famous for soccer were found to have not published any publicly available guidelines.
Discussion and conclusion
SRC guidelines from different soccer associations contain discrepancies which may be detrimental to athletes, both short and long-term. We recommend that all major soccer governing associations publish guidelines that are standardised and accessible to all athletes.
Objectives:
Equestrians have a high risk of concussions per hospital records. However, most concussions occur in private settings where concussions are not tracked. We determined concussion incidence by self-report, expressed per 1000 h of exposure, and determined helmet usage and concussion knowledge.
Design:
Descriptive epidemiological study.
Methods:
Equestrians were recruited using a snowball method of sampling in which enrolled participants recruited more equestrians. Participants completed a survey of equestrian experience and history of concussion, symptoms and provided estimates of hours spent in various equestrian activities. From these data, incidences of concussions were calculated. In addition, they answered questions regarding helmet usage and willingness to take risks when concussed.
Results:
210 participants (203 women) reported 27 ± 14 years of equine experience and 728 concussions, 3.47 ± 5.34 per person (0-55). Incidence while riding was 0.19/1000 h which was greater than the incidence while driving (0.02/1000 h) or handling horses (0.03/1000 h). Riders were helmeted at the time of injury 85% of the time. While concussion knowledge was high, most reported willingness to risk permanent injury by continuing to work with horses while injured.
Conclusions:
To our knowledge this is the first study to document incidence of concussions in equestrians: incidence is higher while riding than during football or rugby training. Helmets were far more commonly worn at the time of concussion than reported in hospital data, suggesting that helmets effectively reduce concussions severe enough to warrant urgent medical care.
Sports-related concussions (SRC) are frequent injuries occurring in most contact and collision sports across all ages and all levels of play. Once thought of as a “ding” or simply “part of the game,” it is now understood that concussions are brain injuries that can have significant neurocognitive consequences if not evaluated and managed appropriately. This chapter reviews the definition of concussion, mechanism of injury, the pathophysiology underlying the injury, epidemiology, and the clinical management of players who have sustained a concussion. The focus then turns to prevention of the injury and, more importantly, the prevention of deleterious consequences from improper management. Various prevention strategies are discussed ranging from education to legislative reform.KeywordsSports concussionNeuropsychological assessmentConcussion pathophysiologyConcussion advocacyConcussion prevention
Previous literature has determined the physiological effects of concussions; however, limited research has examined the impact of concussion education on the reporting tendencies of athletes and its effect on proper diagnosis and treatment. The purpose of this study was to determine the effectiveness of preseason concussion education on the self-reported likelihood and confidence in concussion reporting for collegiate, recreational-level athletes. We hypothesized that participants receiving the concussion education would show improved scores in reporting intentions, but that the return to sport would affect these outcomes. Thirty-eight participants received a presentation discussing signs, symptoms, and proper treatment of concussions. Self-reported measures of athlete perceptions were obtained by survey, presented before the educational session (Pre), immediately after the presentation (Post 1), and two weeks following the presentation (Post 2). Ninety-eight athletes did not receive the education session and were used as a control group. Results revealed a significant effect of concussion education. Specifically, survey scores between Pre and Post 1 and Pre and Post 2 surveys significantly differed, while no differences in survey scores were revealed among teams or concussion history. The results suggest that the effects of concussion education were maintained after beginning competition season. Regardless of the type of sport played or athletes’ concussion history, preseason concussion education effectively increase athletes’ ability to recognize and report possible concussions. Future studies should consider alternative education designs and the long-term effects of education to improve future educational opportunities for athletes and provide proper treatment of sports-related concussions.
Track cycling is a fast, exciting sport and requires a specific sports-related concussion (SRC) assessment protocol. This paper proposes the first SRC assessment protocol for use in track cycling and proposes that this should occur in three stages. Stage 1 will occur at the trackside, whilst stage 2 occurs in the changing room immediately after the event and stage 3 the day following the suspected SRC. This SRC protocol is in its first iteration and we hope it stimulates debate to allow further refinement.
Background
It can be a challenge for clinicians to evaluate trauma that could represent cervical spine injury, concussion, or both. These conditions share common mechanisms of injury and symptom profiles, yet distinct aetiology and management. In the clinical evaluation of concussion, a range of standardised tools are available but the extent to which such tools include cervical spine evaluation is unclear.
Objective
To identify a variety of standardised clinical concussion evaluation tools, examine if these tools include cervical spine evaluation, and describe the characteristics of cervical spine evaluation included. To have an informed discussion about how cervical spine evaluation might best be approached after a concussion event.
Design
Scoping review.
Method
A structured literature search was performed in eight databases to identify standardised clinical concussion evaluation tools. Each tool was then reviewed for cervical spine evaluation, and the characteristics of tools including cervical spine evaluation were described.
Results
The structured search identified 82 standardised clinical concussion evaluation tools. Eleven tools included cervical spine assessment related primarily to the evaluation of red flags and symptoms, just three included physical examination.
Conclusion
Few standardised clinical concussion evaluation tools include cervical spine evaluation, and even fewer include physical examination. Cervical spine evaluation in concussion may benefit from closer alignment with established approaches to screening for clinically significant cervical spine injuries. In concussion, we advocate for an approach to cervical spine evaluation that includes screening for dangerous mechanisms of injury, neurological deficit, distracting injury and neck pain; and physical examination of neck range of motion and neck tenderness.
Objectives
To examine the decision-making processes employed by schools' Rugby coaches in the management of injured players and to explore the factors that influenced those decisions. A secondary objective was to gauge interest in an education focused toolkit for schools' Rugby coaches.
Design
A qualitative study using one-to-one online interviews.
Setting
Schools who compete in the Ulster Schools' Cup Rugby competition.
Participants
Eleven Rugby union coaches from four post primary schools.
Outcome measures
A thematic analysis approach was used to examine the factors that influence schools' Rugby coaches' decision-making processes in the management of injured players.
Results
Findings suggest coaches are influenced in their decision making by four primary factors: their experience and learning, their relationships with other stakeholders, their knowledge and understanding of the roles and responsibilities of medical staff, healthcare and health fitness professionals, and resources available to them.
Conclusions
Schools' Rugby coaches play a significant role in the supervision of injured adolescent Rugby players, often drawing from their playing and coaching experiences. Schools retain, or recommend the services, of healthcare professionals (HCPs) and health and fitness professionals (HFPs). The role of these healthcare and health and fitness professionals, along with their qualifications and experience is not fully understood by coaches. Coaches acknowledge that there is a need for further training and would welcome education initiatives aimed at increasing awareness of musculoskeletal injury in schoolboy Rugby players.
Traumatic brain injury (TBI) is a common cause of death and disability. Primary prevention is focused on injury prevention programs, education, and policies. Prehospital care is focused on rapid identification and prevention of secondary brain injury through appropriate volume resuscitation and maintaining adequate oxygenation and ventilation. Evidence does not support prehospital intubation for pediatric patients with TBI. Prehospital intubation by ground transport services in adult patients with severe TBI is also not supported, but may be of benefit in some systems with resources to ensure appropriate training and monitoring. Available evidence does not support the use of hyperosmolar agents in the prehospital setting. Concussions are a form of mild TBI and EMS personnel are often the first on scene for sports-related concussions. A structured approach to evaluating these patients is encouraged. Transportation and destination protocols for trauma and TBI patients should be implemented to support decision making. Adult patients with moderate and severe TBI should be transported to a Level I or Level II trauma center, and pediatric patients should be transported to a pediatric trauma center when available.
The European Resuscitation Council has produced these first aid guidelines, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics include the first aid management of emergency medicine and trauma. For medical emergencies the following content is covered: recovery position, optimal positioning for shock, bronchodilator administration for asthma, recognition of stroke, early aspirin for chest pain, second dose of adrenaline for anaphylaxis, management of hypoglycaemia, oral rehydration solutions for treating exertion-related dehydration, management of heat stroke by cooling, supplemental oxygen in acute stroke, and presyncope. For trauma-related emergencies the following topics are covered: control of life-threatening bleeding, management of open chest wounds, cervical spine motion restriction and stabilisation, recognition of concussion, cooling of thermal burns, dental avulsion, compression wrap for closed extremity joint injuries, straightening an angulated fracture, and eye injury from chemical exposure.
Objective:
The aim of this review is to provide a summary of the epidemiology, clinical presentation, pathophysiology, and treatment of traumatic brain injury in collision athletes, particularly those participating in American football.
Data sources:
A literature search was conducted using the PubMed/MEDLINE and Google Scholar databases for publications between 1990 and 2019. The following search phrases were used: "concussion," "professional athletes," "collision athletes," "mild traumatic brain injury," "severe traumatic brain injury," "management of concussion," "management of severe traumatic brain injury," and "chronic traumatic encephalopathy." Publications that did not present epidemiology, clinical presentation, pathophysiology, radiological evaluation, or management were omitted. Classic articles as per senior author recommendations were retrieved through reference review.
Results:
The results of the literature review yielded 147 references: 21 articles discussing epidemiology, 16 discussing clinical presentation, 34 discussing etiology and pathophysiology, 10 discussing radiological evaluation, 34 articles for on-field management, and 32 articles for medical and surgical management.
Conclusion:
Traumatic brain injuries are frequent in professional collision athletes, and more severe injuries can have devastating and lasting consequences. Although sport-related concussions are well studied in professional American football, there is limited literature on the epidemiology and management of severe traumatic brain injuries. This article reviews the epidemiology, as well as the current practices in sideline evaluation, acute management, and surgical treatment of concussions and severe traumatic brain injury in professional collision athletes. Return-to-play decisions should be based on individual patient symptoms and recovery.
Participation in sports exposes athletes to the potential for eye injuries. This chapter presents the epidemiology and risks for sport-related eye injuries with discussion of sport-related ocular trauma management. For each type of injury, both sideline and clinical management considerations are presented. An overview of sport-related concussion is also presented with an emphasis on the management of visual symptoms.
Objectives: Explore sport-related concussion (SRC) awareness, behaviours and attitudes of medical team staff working in elite football in the United Kingdom. Including usage and awareness of the FA guidelines, concussion education rates of players and coaching staff, and collection of baseline concussion assessments. Additionally, pitch-side confidence in SRC recognition, associated perceived influence of players, coaching staff, referees and other officials on decisions, and attitude towards a “concussion” substitute were explored.
Methods: Cross-sectional questionnaire study distributed online by organisations including or representing medical staff working in elite football in the United Kingdom.
Results: 120 responses were gathered. High awareness rates of the FA guidelines were found (97%) with variable rates of player and coaching staff concussion education. Baseline concussion assessments were collected by 78%. Of those, 99% collected SCAT5 with low rates of other neuro-psychometric testing (17%). Confidence of pitch-side SRC recognition was high (93% feeling very confident or confident). A small number of respondents thought players never under-reported symptoms to avoid removal (6.6% selecting it rarely or never occurred). There is a perception of coaching staff trying to influence removal decisions with 40% often or sometimes feeling influence. Introduction of a “concussion” substitute was seen as strongly positive for player welfare (85% strongly agreeing or agreeing).
Conclusions: High awareness rates of the FA concussion guidelines are not consistent with adherence to recommendations around baseline concussion assessment and concussion education. Confidence in SRC recognition was high but removal decisions could be subject to attempted influence by players and coaching staff.
Objectives
Concern regarding identification and management of sports-related concussion (SRC) in the community sports of Gaelic games exists. This study aimed to examine Gaelic games coaches’ and referees’ previous SRC experiences, knowledge of and attitudes on SRC and views on SRC education.
Design
Cross-sectional study;
Setting
Online survey instrument.
Participants
Irish male and female Gaelic games coaches (n=144) and referees (n=110).
Main outcome measures
Demographics, SRC previous experience, SRC knowledge, attitudes towards SRC reporting and previous and future interest in SRC education.
Results
Most coaches (70.1%) and referees (74.5%) previously dealt with a suspected SRC event. In the most recent SRC event, coaches predominantly removed the player from play (97.0%) and referees frequently informed medical staff (97.1%) or coaches present (96.3%). Coaches and referees were predominantly (>90%) able to identify common SRC signs and symptoms such as dizziness, nausea, confusion, poor balance and headache. Coaches and referees displayed positive attitudes towards removing players from play regardless of game importance.
Conclusions
Good knowledge of common SRC symptoms were displayed, however their ability to recognise false signs and symptoms was limited. Widespread promotion of Gaelic games SRC education across all stakeholders is warranted and should target the misconceptions highlighted in this study.
Basketball has become a more physical sport with a corresponding increase in the number of injuries. Fortunately, while the majority of injuries can be handled off the court, a number of injuries may require on-court evaluation. Concussions and sudden cardiac events have received increased attention more recently, especially among the basketball community, given the potential for catastrophic outcomes. Facial injuries occasionally require prompt treatment and removal from athletic activity. Some upper extremity injuries also require prompt evaluation including shoulder dislocations as well as unstable dislocations of the hand and wrist. Although rare, knee dislocations can be limb-threatening and necessitate a thorough initial evaluation, while isolated knee ligament injuries should be immediately recognized and managed accordingly. Acute or stress-related injuries to the midfoot and forefoot similarly mandate careful evaluation, and Achilles tendon ruptures are often quite evident and rarely missed. It is important for the medical provider to be aware of the injuries requiring on-court evaluation and the proper algorithms when encountered.
Although concussion has been a subject of interest for centuries, this condition remains poorly understood. The mechanistic underpinnings and accepted definition of concussion remain elusive. To make sense of these issues, this article presents a brief history of concussion studies, detailing the evolution of motivations and experimental conclusions over time. Interest in concussion as a subject of scientific inquiry has increased with growing concern about the long-term consequences of mild traumatic brain injury (TBI). Although concussion is often associated with mild TBI, these conditions-the former a neurological syndrome, the latter a neurological event-are distinct, both mechanistically and pathobiologically. Modern research primarily focuses on the study of the biomechanics, pathophysiology, potential biomarkers and neuroimaging to distinguish concussion from mild TBI. In addition, mild TBI and concussion outcomes are influenced by age, sex, and genetic differences in people. With converging experimental objectives and methodologies, future concussion research has the potential to improve clinical assessment, treatment, and preventative measures.
Sports-related concussion (SRC) is a traumatic brain injury induced by a biomechanical force. Concussions often result in rapid onset of short-term impairment of neurological function, though symptoms may evolve over minutes to hours. It is rarely associated with structural changes, and providers should use caution when ordering and interpreting advanced imaging. Importantly, SRC may take place with or without loss of consciousness, and most athletes remain conscious through the inciting event. Education surrounding SRC should be implemented in preseason training by licensed health-care professionals. There is limited evidence as to which clinical measurement tool is best; providers should develop a protocol for their team with baseline and on-field assessments appropriate to their athlete population. SRC management should focus on a supervised progression of activity and absence of symptom recurrence. Exact return to sport timelines should be individually based, depending on symptoms and progression through a structured rehab program.
The importance of training coordination for the development of young players is a well-established area of research. However, rhythm, despite having a crucial importance in tennis, is one of the coordinative capacities less studied and therefore, there is a lack of information that could allow coaches to design coaching sessions that focus on these capacities. This article highlights the importance of rhythm in tennis, and also presents a series of general exercises (without the use of a specific tennis equipment), special exercises (with the use of specific tennis equipment) and specific exercises (whilst rallying or playing) aimed at the training of these coordinative capacities
The number of studies related to notational analysis of the serve has grown in recent years, and this latest research has suggested that: players win more points with the return of serve at younger age groups; with males, there is more variation in the direction and more points are won on the forehand than the backhand return; and, women return closer to the net with a flatter trajectory than their male counterparts. Despite advances in research there is still little known on female tennis, especially on clay courts. 795 points of female matches at the BBVA Open Valencia 2017 ITF event were analysed. On the first serve, on the advantage side, players use mainly backhands and hit crosscourt, whereas on the deuce side, there were no significant differences in forehands and backhands hit, and there was more variation in direction. On the second serve, on the advantage side of the court, players still mainly used backhands but hit more shots down the line; whereas on the deuce side, players hit mainly inside-out forehands and there are no differences in the direction hit
Objectives: The recognition and management of concussion has become a major health concern across all sports. Despite recent attention, concussion assessment and return-to-play protocols appear to be highly variable between leading professional sporting bodies across Australia. Without readily available guidelines, players at all levels may be at risk of suboptimal management following in-game trauma. The purpose of this study was to explore the publicly available concussion guidelines of the major Australian sporting codes with an aim to identify potential opportunities to develop a national sporting consensus.
Methods: Internet sites of the major sporting organizations within Australia were accessed between June 2018 to July 2018. Sites were reviewed for information pertaining to an available concussion protocol or guidelines including; concussion definition, player education documentation, requirement of baseline testing, standard concussion diagnostic measures, use of sideline testing and removal from play guidelines, return-to-play, minimum return-to-play intervals and the implementation of external evaluation of potential concussion cases.
Results: Twelve sites were visited. There was consensus between many of the sporting organizations in terms of concussion definition, removal of play and sideline testing protocols. A step-wise return-to-play protocol was prevalent across most sports. A number of sporting sites however did not have readily available information.
Conclusions: There is notable room for the development of concussion guidelines in Australian sport. Researchers and sporting organizations need to continuously amend current protocols to ensure this reflects best evidence-based practice.
Keywords: concussion, sport, sporting organization, mild traumatic brain injury, concussion protocols
Introduction:
Concussion is among the most commonly occurring sport and recreation injuries in today's society. An understanding of the heterogenous nature of concussion will assist in directing a multifaceted and comprehensive interdisciplinary assessment following injury.
Purpose:
The purpose of this masterclass article is to summarize the current state of the evidence in the area of concussion, describe typical symptom presentations and assessment techniques that may assist in directing appropriate management following concussion.
Implications:
A comprehensive assessment including a thoughtful differential diagnosis will assist the clinician to direct care appropriately and efficiently in individuals who have suffered a concussion.
Objective:
To assess concussion experiences, knowledge, and attitudes of motorsport medical personnel and drivers and to determine priority areas regarding concussion within the sport.
Design:
Sequential mixed-method design. Part 1: stakeholder interviews; part 2: cross-sectional online survey.
Setting:
United Kingdom.
Participants:
Part 1: key motorsport stakeholders (N = 8); part 2: motorsport medical personnel and drivers (N = 209) representing amateur and/or professional 4-wheeled motorsport.
Main outcome measures:
Concussion experience, knowledge, attitudes, and perceived priority areas.
Results:
Thirty-one percent of surveyed drivers (age = 37.91 ± 13.49 years: 89% male) reported suffering from concussion in motorsport. Eighty-seven percent of surveyed medical personnel (age = 48.60 ± 10.68 years: 74% male) reported experience with concussed drivers, and 34% reported feeling pressured to clear a driver with concussion. Gaps in knowledge and misperceptions about concussion were reported in both groups, and disparity between concussion attitudes emerged between drivers and medical personnel. Application of assessment and management procedures varied between medical personnel and there was evidence motorsport policy and concussion guidelines may not be directly followed. According to both medical personnel (77%) and drivers (85%), "education and training" is the top priority area for the sport.
Conclusions:
There is clear evidence of concussions in motorsport, but accurate knowledge about this injury is missing. Concussion education and training for all drivers and medical personnel is required. Additional investigations into concussion attitudes are advised to complement and advance simple educational initiatives. Further investigation is also required to determine how to best support motorsport medical personnel, and general practitioners, who hold significant responsibility in guiding drivers from diagnosis to return to racing, and to support the effective implementation of policy.
The 2017 Berlin Concussion in Sport Group Consensus Statement provides a global summary of best practice in concussion prevention, diagnosis and management, underpinned by systematic reviews and expert consensus. Due to their different settings and rules, individual sports need to adapt concussion guidelines according to their specific regulatory environment. At the same time, consistent application of the Berlin Consensus Statement’s themes across sporting codes is likely to facilitate superior and uniform diagnosis and management, improve concussion education and highlight collaborative research opportunities. This document summarises the approaches discussed by medical representatives from the governing bodies of 10 different contact and collision sports in Dublin, Ireland in July 2017. Those sports are: American football, Australian football, basketball, cricket, equestrian sports, football/soccer, ice hockey, rugby league, rugby union and skiing. This document had been endorsed by 11 sport governing bodies/national federations at the time of being published.
Background:
Elite athletes can experience a diverse range of symptoms following post-concussive injury. The impact of sport-related concussion on specific mental health outcomes is unclear in this population.
Objective:
The aim was to appraise the evidence base regarding the association between sport-related concussion and mental health outcomes in athletes competing at elite and professional levels.
Methods:
A systematic search of PubMed, EMBASE, SPORTDiscus, PsycINFO, Cochrane, and Cinahl databases was conducted.
Results:
A total of 27 studies met inclusion criteria for review. Most of the included studies (67%, n = 18) were published in 2014 or later. Study methodology and reporting varied markedly. The extant research has been conducted predominantly in North America (USA, n = 23 studies; Canada, n = 3), often in male only (44.4%, n = 12) and college (70.4%, n = 19) samples. Depression is the most commonly studied mental health outcome (70.4%, n = 19 studies). Cross-sectional retrospective studies and studies including a control comparison tend to support an association between concussion exposure and depression symptoms, although several studies report that these symptoms resolved in the medium term (i.e. 1 month) post-concussion. Evidence for anxiety is mixed. There are insufficient studies to draw conclusions for other mental health domains.
Conclusion:
Consistent with current recommendations to assess mood disturbance in post-concussive examinations, current evidence suggests a link between sports-related concussion and depression symptoms in elite athletes. Causation cannot be determined at this stage of enquiry because of the lack of well-designed, prospective studies. More research is required that considers a range of mental health outcomes in diverse samples of elite athletes/sports.
Background:
All states have enacted legislation addressing the management of sports-related concussions (SRCs) in adolescent athletes. The effect of these laws on health care utilization is uncertain. Hypothesis/Purpose: The purpose was to evaluate the effects of New York's 2011 Concussion Management and Awareness Act ("Lystedt Law") on emergency department (ED) concussion health care visits (EDCHVs) and brain imaging utilization. It was hypothesized that New York concussion legislation would have a significant temporal effect on EDCHVs.
Study design:
Descriptive epidemiology study.
Methods:
Using the New York State Department of Health Statewide Planning and Research Cooperative System (SPARCS) database, trends in EDCHVs from 2005 to 2015 were identified among 12- to 18-year-old patients, comprising 5,740,403 total ED visits.
Results:
Overall, 208,024 EDCHVs, including 54,669 for an SRC, occurred during the study period. EDCHVs increased from 13,664 (2.74% of all ED visits) in 2005 to a peak of 21,374 (4.26%) in 2013, with greatest relative increases from 2008 to 2013. SRCs followed a similar trend: 3213 (0.64%) in 2005 to a peak of 6197 (1.24%) in 2013. Brain imaging utilization decreased by 5.3% for EDCHVs and 15.4% for SRCs (all comparisons year-by-year and for trends; P < .001).
Conclusion:
The period of greatest increases in EDCHVs and decreases in brain imaging utilization for SRCs preceded New York concussion legislation by several years, suggesting a minimal direct effect on emergency care-seeking behavior for concussions. Instead, increased public awareness of SRCs and imaging guidelines may have driven EDCHV trends and imaging practices.
Sports medicine has played a role in athlete safety, strengthening physical ability, improving sports performance, and players’ life extension. Recently, sports medicine is adding some roles to provide lifetime healthcare for athletes including children in the development stage, active players and retired players. Concussion in sport, the effects of exercising in childhood on bone and joint health, and female athlete triad are described in this review paper. Some proposals for protection of the athletes’ lifetime healthcare are also discussed.
This paper presents the Sport Concussion Assessment Tool 5th Edition (SCAT5), which is the most recent revision of a sport concussion evaluation tool for use by healthcare professionals in the acute evaluation of suspected concussion. The revision of the SCAT3 (first published in 2013) culminated in the SCAT5. The revision was based on a systematic review and synthesis of current research, public input and expert panel review as part of the 5th International Consensus Conference on Concussion in Sport held in Berlin in 2016. The SCAT5 is intended for use in those who are 13 years of age or older. The Child SCAT5 is a tool for those aged 5-12 years, which is discussed elsewhere.
This article presents the Child Sport Concussion Assessment Tool 5th Edition (Child SCAT5). The Sport Concussion Assessment Tool was introduced in 2004, following the 2nd International Conference on Concussion in Sport in Prague, Czech Republic. Following the 4th International Consensus Conference, held in Zurich, Switzerland, in 2012, the SCAT 3rd edition (Child SCAT3) was developed for children aged between 5 and12 years. Research to date was reviewed and synthesised for the 5th International Consensus Conference on Concussion in Sport in Berlin, Germany, leading to the current revision of the test, the Child SCAT5. This article describes the development of the Child SCAT5.
This paper presents the Sport Concussion Assessment Tool 5th Edition (SCAT5), which is the most recent revision of a sport concussion evaluation tool for use by healthcare professionals in the acute evaluation of suspected concussion. The revision of the SCAT3 (first published in 2013) culminated in the SCAT5. The revision was based on a systematic review and synthesis of current research, public input and expert panel review as part of the 5th International Consensus Conference on Concussion in Sport held in Berlin in 2016. The SCAT5 is intended for use in those who are 13 years of age or older. The Child SCAT5 is a tool for those aged 5-12 years, which is discussed elsewhere.
In November 2001, the First International Symposium on Concussion in Sport was held in Vienna, Austria. This meeting was organized by the International Ice Hockey Federation (IIHF) in partnership with the Federation Internationale de Football (FIFA) and the International Olympic Committee (IOC) Medical Commission. As part of the resulting mandate for the future, the need for leadership and updates was identified. To meet that mandate, the Second International Symposium on Concussion in Sport was organized by the same group and held in Prague, Czech Republic, in November 2004.
This paper is a revision and update of the recommendations developed following the 1st (Vienna) and 2nd (Prague) International Symposia on Concussion in Sport. The Zurich Consensus statement is designed to build on the principles outlined in the original Vienna and Prague documents and to develop further conceptual understanding of this problem using a formal consensus-based approach. A detailed description of the consensus process is outlined at the end of this document under the "background" section (see Section 11). This document is developed for use by physicians, therapists, certified athletic trainers, health professionals, coaches and other people involved in the care of injured athletes, whether at the recreational, elite, or professional level. While agreement exists pertaining to principal messages conveyed within this document, the authors acknowledge that the science of concussion is evolving, and therefore management and return-to-play (RTP) decisions remain in the realm of clinical judgment on an individualized basis. Readers are encouraged to copy and distribute freely the Zurich Consensus document and/or the Sports Concussion Assessment Tool (SCAT2) card, and neither is subject to any copyright restriction. The authors request, however, that the document and/or the SCAT2 card be distributed in their full and complete format.
Consensus statement on concussion in sport-the 4th international conference on concussion in sport held in Zurich
- P Mccrory
- W Meeuwisse
- M Aubry
McCrory P, Meeuwisse W, Aubry M, et al. Consensus statement on concussion in
sport-the 4th international conference on concussion in sport held in Zurich,
November 2012. Phys Ther Sport 2013;14:e1-e13.