Encyclopedia
Please note this is a comparison between Version 2 by Vivi Li and Version 1 by Neil Heron.
It is widely recognised in sports medicine that sports-related concussion (SRC) is one of the most difficult injuries to detect, with more needed to be done to recognise, remove and treat athletes with the condition
- SRC
- sports related concussion
- guidelines
- amateur sports
1. Introduction
It is widely recognised in sports medicine that sports-related concussion (SRC) is one of the most difficult injuries to detect, with more needed to be done to recognise, remove and treat athletes with the condition [1]. In July 2021, the Digital, Culture, Media and Sport Committee (DCIS) released a report on concussion in sport ordered by the House of Commons in the United Kingdom (UK) [2]. This report reignited the media’s interest in SRC due to the heavy criticism of the UK Government and sport’s governing bodies for their failure to reduce the risk of SRC, especially within the amateur athlete population.
An SRC is defined as a traumatic brain injury induced by biomechanical forces, either by a direct blow to the head, face, neck or elsewhere on the body with an impulsive force transmitted to the head [3]. Thus, athletes do not need to have a head injury to be concussed, which is a common misconception. The Concussion in Sports Group (CISG) is an organisation formed in 2001 following the first International Conference on Concussion in Sport, with the most recent meeting occurring in Berlin in 2016. Following this meeting, an updated consensus statement was released, building upon the principles outlined in previous statements [4,5,6,7][4][5][6][7]. The Berlin statement aims to guide those involved with athlete care by providing the latest scientific research on SRC and information on the recognition, diagnosis and management of SRC [8]. Although the statement is not designed to be a clinical practise guideline or legal standard of care, it acts as a framework for the development of sport- specific concussion guidelines published by the governing bodies of sport.
As outlined in the DCIS concussion in sport report, more attention needs to be payed to SRC in the amateur athlete population. Indeed, most sport, in terms of participation numbers, is played at the amateur level. Some aspects of amateur sport may serve to increase the risk of participants suffering from an SRC, such as the reduced access to appropriate protective equipment and the lack of healthcare professionals (HCP) at sporting events and the lack of SRC education for players and coaches. Additionally, some amateur athletes play a number of sports, and it is therefore important that the different SRC guidelines for amateur sports are consistent. This ensures that athletes are not competing in some sports when they are ‘banned’ from playing in other sports due to the different concussion guidelines.
2. Sporting Organisation Guidelines
In total, fifteen sporting organisations met the inclusion criteria, with the organisations investigated shown in Table 1. Concussion guidelines were found for all sporting organisations except British Cycling (BC) and British Equestrian (BE), and as a result were excluded from the report.Table 1. British sporting organisations under review.
| Sport | Sporting Organisation Concussion Guidelines | Sport(s) Played within Organisation |
|---|
Table 3. Summary of SRC guidelines published by UK sporting organisations continued.
| Sporting Organisation | |
|---|---|
| American Football | British American Football Associatio [15][9] |
3. Compliance with the Berlin Statement
All 13 of the sporting organisations based their concussion protocols on the Berlin statement to varying degrees. Following the convention adopted by the CISG, the findings will be presented using the 11 “R’s” enumerated in the Berlin statement. These include recognise, remove, re-evaluate, rest, refer, recover and return to sport. Rehabilitation, residual effects and risk reduction were not included in this review, as these are more relevant for the use of HCP. Table 2 and Table 3 summarise the contents of the sport-specific concussion guidelines.Table 2. Summary of SRC guidelines published by UK sporting organisations.
| Sporting Organisation | Assessment Tools | Initial Complete Rest (Hours) | GRTP Protocol | Prolonged Recovery | Return to Work/Education | Return to Play | Notes | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Record Concussion | Multiple Concussions | Medical Clearance | Child | Adult | Child | Adult | |||||||
| BAFA | SCAT3 PCRT | American Football | |||||||||||
| 48 | 24 | Yes | 23 | 19 | Athletes should not be left alone, consume alcohol or drive until all symptoms have gone | Basketball | British Basketball [16][10] | ||||||
| BB | Basketball and Wheelchair Basketball | ||||||||||||
| SCAT3 | PCRT |
NA | NA | Yes | NA23 | 19 | NA | NA | A second concussion within 12 months should be assessed and managed by HCPs | Yes | Boxing | England Boxing [17] | |
| EB | [11] | Boxing | |||||||||||
| NA | 24–48 | 24–48 | |||||||||||
| EB | Yes | 39 | 35 | If symptoms >four weeks post injury for children or >two weeks for adults contact your GP | When going back to school, you may need to go back gradually and have some changes to your schedule so that symptoms do not worsen. You should not return to sport until you have returned to full school/learning without symptoms | Yes | Two knockouts in 90 days = 90- day suspension Three knockouts in 12 months = 1-year suspension Loss of Consciousness (LOC):
Minimise use of mobile phones, TV, reading and all forms of training and exercise |
|
Cricket | England and Wales Cricket Board [18][12] | Cricket | ||
| Yes | ECB | SCAT5 PCRT |
NA | 24 | Yes | 23 | 7 | No alcohol, prescription or non- prescription drugs | |||||
| ECB | Urgent neurological or neurosurgical consultancy before continuing GRTP | Return-to-school guidelines, which include extra-time for assignments/exams, quiet study areas, increased breaks and rest |
Yes | Player needs a prolonged recovery period (i.e., three weeks) and/or onward referral. |
Yes | Cycling | British Cycling | Road, Off road (MTB), Track, Paracycling, Amateur BMX, Leisure/Sportive & Cyclo-cross |
|||||
| GAA | SCAT5 | ||||||||||||
| GAA | VOMS CRT5 |
Symptoms lasting > 10–14 days should be referred to an appropriate specialist48 | Male- 24–48 Female- 48 |
Yes | A graduated return to school/education strategy is necessary.15 | NAMale- 7 Female- 15 |
NAShould not be left alone for first 24 h. Minimise exposure to TV, PC, laptops, smartphones, tablets, video games etc |
Gaelic | Gaelic Athletic Association [19][13] | Gaelic, Hurling, Camogie and Handball | |||
| Yes | BG | SCAT5 PCRT |
NA | 48 | Yes | ||||||||
| BG | Individuals with symptoms >4 weeks for children and >2 weeks for adults may benefit from a supervised multidisciplinary approach | 28 | 14 | NA | NA | NA | NA | Gymnastics | British Gymnastics [20] | ||||
| Yes | GBH[14] | Acrobatic Gymnastics, Aerobic Gymnastics, Disability Gymnastics, Men’s Artistic Gymnastics, Rhythmic Gymnastics, TeamGym, Trampoline, Double Mini Tramp, Tumbling and Women’s Artistic Gymnastics | |||||||||||
| SCAT5 | PCRT |
NA | 24 | ||||||||||
| GBH | Should be assessed and managed by experienced HCP | Yes | 23 | 6 | Must be off all medications that modify symptoms of the concussion e.g., painkillers | Athletes should partake in a graduated return to school programme. | NA | Should be assessed and managed by an experienced HCP | Yes | Hockey | GB and England Hockey [21][15] | Field Hockey | |
| 24–48 | Yes | NA | 6 | NA | |||||||||
| BJ | NA | 7–10 days | 7–10 days | ||||||||||
| BAFA | NA | A player may need a day or two off work/study to rest and reasonable adjustments made to the player’s normal work/study | |||||||||||
| EIHA | |||||||||||||
| SCAT5 | |||||||||||||
| PCRT | |||||||||||||
| EIHA | NA | NA | NA | NA | Yes | Equestrian | British Eventing [22][16] | Dressage, show jumping and cross country | |||||
| Yes | 28 | ||||||||||||
| BJ | 14 | NA | NA | If unconsciousness results from shime waza (strangulation technique) the player may be allowed to return following three days of rest | Yes | NA | Yes | Ice Hockey | England Ice Hockey Association [23][17] | Ice Hockey | |||
| EN | SCAT5 PCRT |
NA | NA | Yes | 23 | ||||||||
| EN | Recovery >10 days need referred to an experienced HCP | Academic and non- academic work should cease until stage two of the GRTP and that workload is reduced until completion of GRTP | 6 | If no doctor present is suitably trained and experienced in the management of SRC a mandatory two week rest period must occur before commencing GRTP for all ages | NA | If second concussion within a 12-month period or history of multiple concussions (>3) referral to experienced HCP should take place | Yes | Judo | British Judo [24][18] | Judo | |||
| ERL | SCAT5 | ||||||||||||
| ERL | PCRT |
48 | NA24 | Yes | It is reasonable for a student to miss a day or two of studies but extended absence is uncommon and the young person’s academic teacher(s) or tutor should be consulted23 | 19 | Individuals should avoid initially then gradually reintroduce; reading, TV, computer games and driving | Yes | NA | Yes | Netball | England Netball [25][19] | Netball |
| ERU | SCAT5 | Yes | 23 | 19 | No driving, exercise, minimise screen time | No cognitive (brain) activities e.g., reading, television, computer, video games and smart phones. | |||||||
| NA | NA | No | |||||||||||
| BB | Concussion lasting longer than 10 days needs specialist assessmentPCRT | 24–48 | 24–48 | ||||||||||
| ERU | Athletes who fail to progress through GRTP should return to their GP for review | In some cases, it may be appropriate for the player to miss a day or two of work/study | NA | Anyone who sustains >2 concussions in a 12-month period should seek advice from their GP |
No | Rugby League | England Rugby League [26][20] | Rugby League | |||||
| FA | SCAT5 PCRT |
24–48 | 24–48 | Yes | 23 | 19 | Should not be left alone within the first 24 h, consume alcohol or drive a motor vehicle | Rugby Union | |||||
| FA | NA | Students may need to have allowances made for impaired cognition during recovery e.g., extra time | NA | Any player with a second concussion within 12 months should be assessed and managed by an experienced HCP | Yes | England Rugby Union [27][21] | Rugby Union, Sevens Rugby, Tag and Touch Rugby | ||||||
| Soccer | Football Association [28][22] | Soccer/Football | |||||||||||
Abbreviations: BAFA, British American Football Association; BB, British Basketball; EB, England Boxing; ECB, England Cricket Board; BC, British Cycling; GAA, Gaelic Athletic Association; BG, British Gymnastics; GBH, Great British Hockey; BE, British Eventing; EIHA, England Ice Hockey Association, BJ, British Judo; EN, England Netball; ERL, England Rugby League; ERU, England Rugby Union; FA, Football Association.
Abbreviations: SCAT—Sports Concussion Assessment Tool; PCRT—Pocket concussion recognition tool; VOMS—Vestibular Ocular Motor Screening; GRTP—Gradual return to play.
Abbreviations: HCP- Health care professional; GRTP- gradual return to play.
References
- Herring, S.; Kibler, W.B.; Putukian, M.; Solomon, G.S.; Boyajian-O’Neill, L.; Dec, E.L.; Franks, R.R.; Indelicato, P.A.; Labella, C.R.; Leddy, J.J.; et al. Selected issues in sport-related concussion (SRC|mild traumatic brain injury) for the team physician: A consensus statement. Br. J. Sports Med. 2021, 55, 1251–1261.
- Moreland, G.; Barkley, L.C. Concussion in Sport. Curr. Sports Med. Rep. 2021, 20, 181–182.
- McCrory, P.; Feddermann-Demont, N.; Dvoøák, J.; Cassidy, J.D.; Mclntosh, A.; Vos, P.E.; Echemendia, R.J.; Meeuwisse, W.; Tarnutzer, A.A. What is the definition of sports-related concussion: A systematic review. Br. J. Sports Med. 2017, 51, 877–887.
- McCrory, P.; Johnston, K.; Meeuwisse, W.; Aubry, M.; Cantu, R.; Dvorak, J.; Graf-Baumann, T.; Kelly, J.; Lovell, M.; Schamash, P. Summary and agreement statement of the 2nd International Conference on Concussion in Sport, Prague 2004. Br. J. Sports Med. 2005, 39, 196–204.
- McCrory, P.; Meeuwisse, W.; Johnston, K.; Dvorak, J.; Aubry, M.; Molloy, M.; Cantu, R. Consensus Statement on Concussion in Sport—The 3rd International Conference on Concussion in Sport Held in Zurich, November 2008. S. Afr. J. Sports Med. 2009, 1, 406–420.
- McCrory, P.; Meeuwisse, W.H.; Aubry, M.; Cantu, R.C.; Dvorak, J.; Echemendia, R.J.; Engebretsen, L.; Johnston, K.M.; Kutcher, J.S.; Raftery, M.; et al. Consensus Statement on Concussion in Sport—The 4th International Conference on Concussion in Sport Held in Zurich, November 2012. PM R 2013, 5, 255–279.
- Aubry, M.; Cantu, R.; Dvorak, J.; Graf-Baumann, T.; Johnston, K.; Kelly, J.; Lovell, M.; McCrory, P.; Meeuwisse, W.; Schamasch, P. Summary and agreement statement of the First International Conference on Concussion in Sport, Vienna 2001. Phys. Sportsmed. 2002, 30, 57–63.
- McCrory, P.; Meeuwisse, W.; Dvořák, J.; Aubry, M.; Bailes, J.; Broglio, S.; Cantu, R.C.; Cassidy, D.; Echemendia, R.J.; Castellani, R.J.; et al. Consensus statement on concussion in sport—The 5th international conference on concussion in sport held in Berlin, October 2016. Br. J. Sports Med. 2017, 51, 838–847.
- British American Football Association. British American Football Association Concussion Guidelines. 2017, Volume 1, pp. 1–10. Available online: https://rules.bafra.info/docs/2017/BAFA/Concussion%20Protocol%20FINAL.pdf (accessed on 10 July 2021).
- British Basketball. Concussion Guidelines for Basketball in Great Britain 2016-KEY POINTS SUMMARY. 2016, pp. 1–15. Available online: https://www.basketballengland.co.uk/media/12000/concussion-guidelines-2016.pdf (accessed on 11 July 2021).
- England Boxing. England Boxing Rule Book. 2020, p. 59. Available online: https://www.englandboxing.org/wp-content/uploads/2020/07/England-Boxing-Rule-Book-2020.pdf (accessed on 12 July 2021).
- England Cricket Board. New Some of the Key Developments Since the Last Ecb Concussion Guidelines. 2018, pp. 1–37. Available online: https://platform-static-files.s3.amazonaws.com/ecb/document/2018/03/20/1af72872-6efe-4cc9-8d47-9c9493bd46cd/ECB_Head_Injury_Concussion_Guidelines_2018.pdf (accessed on 10 July 2021).
- Gaelic Athletic Association. Concussion Management Guidelines for Gaelic Games. 2018, pp. 1–14. Available online: https://learning.gaa.ie/sites/default/files/ConcussionManagementGuidelinesforGaelicGamesNovember2018_0.pdf (accessed on 13 July 2021).
- Fédération Internationale de Gymnastique. Fig—Concussion Guidelines. 2020. Available online: https://a.storyblok.com/f/83342/x/bdad669133/medical_fig_concussion-overview.pdf (accessed on 27 July 2021).
- Moghal, M.; Rossiter, M. GB & England Hockey Concussion Policy Guideline Summary. 2018, pp. 1–12. Available online: https://www.cuhc.org.uk/wp-content/uploads/2020/10/CUHC-Concussion-Policy-2020-21.pdf (accessed on 11 July 2021).
- Eventing, B. British Eventing Rules & Member’s Handbook. 2021. Available online: https://www.britisheventing.com/news/2020-rules (accessed on 10 July 2021).
- International Ice Hockey Federation. International Ice Hockey Federation Concussion Protocol. 2017. Available online: https://blob.iihf.com/iihf-media/iihfmvc/media/downloads/medical/medical-care-guide/2021-iihf-concussion-protocol.pdf (accessed on 13 July 2021).
- British Judo. British Judo Association Minor Head Injury Policy. 2020, pp. 3–5. Available online: https://www.britishjudo.org.uk/wp-content/uploads/2020/02/Minor-Head-Injury-Policy-Valid-5th-February-2020-v1.1.pdf (accessed on 12 July 2021).
- England Netball. England Netball Concussion Policy. 2018. Available online: https://www.netballsouth.co.uk/userfiles/file/docs/competitions/EN-branded-concussion-policy.pdf (accessed on 12 July 2021).
- Rugby Football League. Concussion. Available online: https://www.rugby-league.com/governance/medical/concussion (accessed on 19 July 2021).
- England Rugby. HEADCASE- Extended Guidelines. Published Online First: 2021. Available online: https://www.englandrugby.com/dxdam/fc/fc36ddd4-fa06-413e-865a-3fb1d7c15926/HEADCASEEXTENDED.pdf (accessed on 14 July 2021).
- The Football Association. The FA’s Concussion Guidelines. 2019. Available online: https://www.thefa.com/get-involved/fa-concussion-guidelines-if-in-doubt-sit-them-outold (accessed on 10 July 2021).
More
