Concussion has not had wide-spread attention historically, despite being one of the most common sports-related injuries with potential long-term consequences. Fortunately, this has changed in recent years and there is now a push for more education on prevention and treatment. The fourth and latest International Consensus Conference on Concussion in Sport that I attended in December 2012 furthered this effort by revealing new findings about this serious medical condition.
Since the last consensus conference four years ago, the recommendation for treating concussion has been rest. This practice was re-addressed at the 2012 conference and it was determined that perhaps relative rest—not bed rest—along with some low level activity and therapy before symptoms have completely disappeared, would be a better solution. It was also suggested that patients take part in more low level activities, physiotherapy and have a neuropsychological consult one month after the trauma.
The Sport Concussion Assessment Tool (SCAT2), which outlines the standardized method for evaluating athletes 10 years and older for concussions, was also discussed at the conference. It will be refined this year and updated with the SCAT3. Among other changes, the new SCAT would exclude neck injuries from the assessment. What won’t change are the present guidelines for youth athletes that ban heading in soccer, tackling in football and body checking in ice hockey until the athlete is 14 years old.
There needs to be continued research, however, on the types and magnitudes of head forces for specific ages and sports to better understand the threshold of concussion. The consensus found no evidence that helmets or mouth guards protect against concussions as they are caused by the acceleration/deceleration of the head, though helmets do have their place in protecting people from other types of brain injuries.
Along with the SCAT, the consensus also releases an official consensus statement that provides concussion treatment guidelines. The new official consensus statement won’t be published until later this month or the next, but here are some of the other key points the conference panel agreed upon:
- No return to play on the same day;
- A potential revision of the pocket SCAT for non-health care personnel;
- Creation of a Child SCAT for children under 10;
- Removal of baseline testing from the post-concussion evaluation of patients; and
- Computerized neuropsychological testing only for athletes whose concussions persist.
- Have zero tolerance for head checking and maximize rule enforcement for other unsafe behaviors that put players at risk for the head injuries;
- Teach proper techniques and fundamentals for their respective sports;
- Learn how to recognize concussions and provide an appropriate response; and
- Reduce unnecessary contact in youth sports.
The conference also highlighted the need to implement a multi-faceted approach to tackling concussions and the need for various experts to come together and find the best way to manage and prevent sports concussions. What we do next can and will affect the lives of all athletes so this dialogue must be continued for the betterment and safety of sports.
—Barry Jordan, M.D., M.P.H.
Assistant Medical Director