The Concussion in Sport Group has conducted its sixth International Conference. The conference builds upon previous meetings and involved systematic reviews by author groups over three and a half years. Jason Tee summarizes their findings and recommendations on concussions in sports, providing the most up-to-date information on what is currently considered best practice for preventing and managing athletes who
suffer concussions.
New Zealand v South Africa - World Cup warm-up - South Africa’s Kwagga Smith in action with New Zealand’s Anton Lienert-Brown Action Images via Reuters/Matthew Childs
In recent years, concussion has gained greater attention due to the impact on athlete health. Numerous accounts of retired athletes suffering from neurological conditions such as dementia, depression, anxiety, and other mental health challenges have populated the news media, creating a heightened awareness of the potential long-term concussion effects. The increased popular concern regarding sport-related concussion is illustrated by the success of the 2015 film Concussion, starring Will Smith, which earned over $50 Million worldwide. Typically, Hollywood doesn’t like to let the facts get in the way of a good story, and there are some noted inaccuracies in the Concussion film.
On the other hand, a committed group of international medical professionals and concussion experts known as the Concussion in Sport Group has been meeting for over 20 years to discuss and refine concussion detection, diagnosis, and treatment. They recently published their sixth consensus statement on concussion in sports. It represents the most up-to-date, evidence-informed understanding of concussion in sports and clarifies the current best practice management(1).
A concussion is a multifaceted neurological condition that can manifest differently depending on individual characteristics and the mechanism and severity of the injury. As a result, two athletes with concussions may present with very different signs and symptoms. One of the clear challenges in managing concussions is that many are either misdiagnosed or not diagnosed at all because of this variable presentation. The Concussion in Sport Group reached a majority agreement on the definition of sport-related concussion.
Updated Concussion Definition
Sport-related concussion is a traumatic brain injury caused by a direct blow to the head, neck, or body resulting in an impulsive force being transmitted to the brain that occurs in sports and exercise-related activities. This initiates a neurotransmitter and metabolic cascade, with possible axonal injury, blood flow change, and inflammation affecting the brain. Symptoms and signs may present immediately or evolve over minutes or hours and commonly resolve within days but may be prolonged. Sport-related concussion results in a range of clinical symptoms and signs that may or may not involve loss of consciousness*
*definition abridged from Br J Sports Med. 2023 Jun;57(11):695-711.
It is difficult to estimate the incidence of concussions in sports because of the inherent difficulties in diagnosing and reporting the condition. In 2013 the American Medical Society for Sports Medicine estimated that 3.8 million sports-related concussions occur in the USA each year, but half of these go unreported(2). Since this initial estimate, several research studies have indicated that concussion incidence is increasing year-on-year(3,4). The increase in concussion incidence in recent years may result from increased awareness and reporting. Ultimately, the higher concussion rates are a positive outcome because they reflect increased diagnosis and treatment(5).
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